Domestic Violence Progress Report Form

1. Parties & case details

Basic report information, agency details, client identity, and court references.

Easy-fill version

To From Sending agency Program agency Client name Date of birth Source PDF shows 04/08/1972. Phone Email Docket / case number Court # / Department Date of report Report type

2. Program status

Program timeline, meeting schedule, and supervision status.

Group day / time Starting date Approximate completion date

Status

Formal Probation Court Probation CFS / Family Court

Amount per session Fee status

3. Attendance & fees

High-level attendance summary. These summary numbers also update from the session log below.

Sessions attended Sessions missed Excused missed Unexcused missed Make-up sessions attended Amount past due Attendance notes

4. Compliance questions

Structured yes / no answers for the main progress-report findings.

1. Compliance with all conditions of the program contract

Yes No

2. Client is benefiting from this program

Yes No

3. Client is currently at risk of termination

Yes No

4. Client is currently at risk for extension

Yes No

5. Beliefs & behavior assessment

Instead of hard-to-read marks in a PDF, each item uses a clear 1–5 rating scale.

Scale: 1 = Poor, 2 = Marginal, 3 = Adequate, 4 = Good, 5 = Excellent

Assessment item	1	2	3	4	5

6. Comments & signature

Plain-language summary plus date and signature area.

Comments

Facilitator / signatory name Signature date Signature box

Type a signer’s name above, or print this form and sign physically.

7. Session log

A repeatable table for attendance entries. Add or remove rows as needed. Summary stats can be recalculated from this table.

Date	Class #	Class fee	Fee paid	Status	Facilitator	Note	Remove