Family Life and Human Sexuality (FLHS) and Disease Prevention and Control (DPC) Annual Report -- High School
MCPS Form 345-30CG
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.
School Name *
Today's Date *
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School Year *
Respondent's name and title *
Part I: Instruction Information for Family Life and Human Sexuality
Average Instruction Time in Hours during Semester 1 For Grade 10 FLHS (Total classroom hours for FLHS instruction) *
Number of students who received FLHS instruction (Opt-In) in Grade 10 during semester 1 *
Number of students who were excused (Not Opt-In) from FLHS instruction in Grade 10 during semester 1 *
Average instruction time in hours during Semester 2 for Grade 10 FLHS (Total classroom hours for FLHS instruction) *
Number of students who received FLHS instruction (Opt-In) in Grade 10 during semester 2 *
Number of students who were excused (Not Opt-In) from FLHS instruction in Grade 10 during semester 2 *
Grade 10 Alternative Unit A was provided for students assigned to NOT Opt-In FLHS unit: *
Specify location where alternative unit was provided for those students assigned to Not Opt-In for FLHS Unit *
Is instruction on Family Life and Human Sexuality included as part of any other course in this school? *
If yes to the previous question, please list course(s):
Parents/Guardians were informed of their right to have their student excused (Not Opt-In) from the FLHS unit by (Check all that apply) *
Required
Part II: Instruction Information for Disease Prevention and Control
Average Instruction Time in Hours during Semester 1 For Grade 10 DPC (Total classroom hours for DPC instruction) *
Number of students who received DPC instruction (Opt-In) in Grade 10 during semester 1 *
Number of students who were excused (Not Opt-In) from DPC instruction in Grade 10 during semester 2 *
Grade 10 Alternative Unit B was provided for students assigned to NOT Opt-In DPC unit: *
Specify location where alternative unit was provided for those students assigned to Not Opt-In for DPC Unit *
Is instruction on HIV/AIDS Prevention included as part of any other course in this school? *
If yes to the previous question, please list course(s):
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 who taught FLHS and DPC have successfully completed the initial Face to Face FLHS/DPC training or Annual Online FLHS/DPC update prior to instruction *
Number of teachers in your school who are trained to teach Grade 10 Health Education Family Life and Human Sexuality and Disease prevention and Control Units *
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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