Family Life and Human Sexuality (FLHS) and Disease Prevention and Control (DPC) Annual Report -- Elementary School
MCPS Form 345-30AG
June 2019

Instructions:  Maryland State Board of Education Regulation (COMAR 13A. 04.18) requires that all public schools provide instruction to students on Family Life and Human Sexuality and HIV/AIDS Prevention Education. This worksheet is to be used to complete the annual report required by state mandate. For more information, please see MCPS Regulation IGP-RA.
This google form should be filled out upon completion of the Family Life and Human Sexuality and Disease Prevention and Control Units.  One form per school should be submitted.  If any questions, contact Teresa Shatzer: Teresa_Shatzer@mcpsmd.org.
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Elementary School: *
Today's Date *
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School Year *
Respondent's name and title *
Part I: Instruction Information for Family Life and Human Sexuality
Dates when FLHS unit instruction was taught *
Total classroom hours for FLHS instruction *
Number of students who received FLHS  instruction *
Number of students who were excused (opt-out) from FLHS instruction *
Describe type of alternative instruction for students who were excused (opt-out) from FLHS *
Parents/Guardians were informed of their right to have their student excused from the FLHS unit  by (Check all that apply) *
Required
The FLHS unit was taught in a coeducational setting *
Instruction about menstruation to the students who did not participate in FLHS unit was provide by *
Part II: Instruction Information for Disease Prevention and Control
Dates when DPC unit instruction was taught *
Total classroom hours for DPC instruction *
Number of students who received DPC instruction *
Number of students who were excused (opt-out) of DPC instruction *
Describe type of alternative instruction for students who were excused (opt-out) from DPC *
Parents/Guardians were informed of their right to have their student excused from the DPC unit  by (Check all that apply) *
Required
Part III: Meetings, Materials, and Teacher Training
Date(s) of the Parent Information Meeting and review of FLHS/DPC instructional materials *
Parents were notified about the Parent Information Meeting to review FLHS/DPC instructional materials by *
Community Involvement: Each school is required to have a local school-community planning group.  An administrator, parent(s)/guardian(s), and teacher(s) must be included in each school's planning group.  Please list names of the members of your local school-community planning group for FLHS and DPC.  Indicate whether each person is a parent/guardian, teacher, or administrator.  
Date of Community Planning Meeting *
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The planning group reviewed and evaluated the program by (survey, informal observation, student or parent feedback, etc.). Explain *
All teachers in your school that delivered FLHS and DPC lessons have successfully completed the initial Face to Face FLHS/DPC training or Annual Online FLHS/DPC update prior to instruction *
Part IV: Non-Diploma Bound Students
Instruction on Health Education topics, including FLHS and DPC were made available to non-diploma bound students (for example, LFI, SCB, ALO) *
If response to previous question is "yes," explain what resources were used
Please list additional supports needed to assist you in the implementation of the Family Life and Human Sexuality and/or Disease Prevention and Control units in your school.
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