Diocese of Evansville Safe Environment Curriculum Verification Form
2009-2010 Academic Year

Parish:                                                                      City:    

Director/Coordinator of Religious Education:         Date:

The information below indicates the number of students who received safe environment instruction during the academic year and the number of students who were opted out of the lesson.

GRADE                                            NUMBER INSTRUCTED                        NUMBER OPTED OUT

Pre-Kindergarten:                                                            
Kindergarten:                                                                   
Grade 1:                                                                            
Grade 2:                                                                            
Grade 3:                                                                            
Grade 4:                                                                            
Grade 5:                                                                            
Grade 6:                                                                            
Grade 7:                                                                            
Grade 8:                                                                            
Grade 9:                                                                            
Grade 10:                                                                          
Grade 11:                                                                          
Grade 12:                                                                          

TOTAL:                                                                            
 

Please complete and submit this form by December 31, 2009.