DIOCESAN CHARTER COMPLIANCE - SAFE ENVIRONMENT OFFICE MAY REPORT
In order to comply with the implementation of the Charter for the Protection of Children and Young People, programs and events
must be recorded by Catechetical Leaders and Catholic School Principals in the following manner:
Name/Location of Parish:(*)
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Please select an option from the drop down menu:(*)
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PROGRAM/EVENT DATE(s) LOCATION GRADE(s) # Students # Parents
CURRICULUM (mandated NYS)          
*NYS Child Health Safety Program (please fill in grade(s) and number of students at the end of this line) 9/1/16 – 6/30/17 NA
CURRICULUM (additional curriculum, if used)          
OTHER SAFE ENVIRONMENT ACTIVITIES (list below)          
Family Internet Safety Pact, Distributed ** **Applies to Parish Religious Education Programs ONLY.
*This program is mandatory in all Public and Catholic Schools. The children from our Catholic Schools are using this curriculum as part of their Safe Environment Education, and children attending our Parish Religious Education Classes are trained in this Safe Environment program as well.
• Catholic Schools, please list above the grade levels and number of students from your school.
• Public Schools, please list above the grade levels and number of students from your Parish Religious Education (Faith Formation) Program.
Number of parents who refused to participate, if any:
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(AUDIT PURPOSES ONLY)

Affirmation(*)
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Date(*)
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Your Name:(*)
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Your Email:(*)
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Please print this page for your records before you click on the Submit button. After you have printed the page please click on submit to send the information.
Verification
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