TX HHS Form 5102. Participant Information

Form 5102 is used to document participant attendance and basic demographic information for youth enrolled in a Youth Prevention Program. The form captures session participation, age, race, ethnicity, and gender data to support program accountability, reporting requirements, and evaluation of prevention services delivered in school or community settings.

Purpose of Form 5102

The primary purpose of Form 5102 is to create an official record of who participated in a Youth Prevention Program curriculum and whether participants attended scheduled sessions. The form helps prevention providers demonstrate that services were delivered as planned and that participation aligns with program funding, oversight, and evaluation requirements.

This form is commonly used to support internal monitoring, grant compliance, and outcome reporting for youth prevention initiatives.

When This Form Must Be Used

Form 5102 should be completed whenever a Youth Prevention Program session cycle is conducted. Typical situations include:

• Delivery of a school-based prevention curriculum
• Community-based youth prevention group sessions
• Grant-funded prevention activities requiring attendance tracking
• Program cycles that include multiple instructional sessions

The form is generally not required for informal outreach activities or events that are not part of a structured prevention curriculum.

Who Is Authorized to Complete the Form

Form 5102 is completed by the Prevention Specialist or program staff responsible for delivering the prevention curriculum. Youth participants do not complete the form themselves.

The Prevention Specialist signs and dates the form to confirm the accuracy of the recorded information.

Explanation of Key Sections

Program and Curriculum Information

This section identifies the curriculum name, session dates, group cycle information, and location where services were delivered. Accurate completion links participant data to a specific prevention program cycle.

Session Timing and Location

Start time, end time, and school or community site details document when and where the prevention services occurred. This information is often reviewed during audits or program evaluations.

Participant Demographics

For each participant, the form records age, race, ethnicity, and gender using standardized codes. These data points support demographic reporting and help programs assess reach and equity.

Attendance Tracking

Attendance is marked as P (Present) or A (Absent) for each session. Accurate attendance records are critical for verifying participation and program completion.

Prevention Specialist Certification

The Prevention Specialist’s name and date at the bottom of the form confirm that the information is complete and accurate.

Practical Tips for Completing Form 5102

• Complete attendance entries immediately after each session.
• Use the correct demographic codes as listed on the form.
• Ensure participant names are legible and consistent.
• Verify session dates match the actual delivery dates.
• Sign and date the form once all information is finalized.

Common Mistakes to Avoid

• Leaving attendance fields blank
• Using incorrect race or ethnicity codes
• Failing to document both session dates
• Submitting the form without a Prevention Specialist signature
• Recording participants who did not attend any session

Legal and Programmatic Context

Form 5102 supports compliance with state and grant-related requirements for youth prevention programs. Accurate participant and attendance documentation helps demonstrate that funded prevention services were delivered as approved and can be required during monitoring reviews, audits, or performance evaluations.

Incomplete or inaccurate records may affect program credibility, reporting accuracy, or future funding decisions.

Real-Life Examples of Use

• A school-based prevention program tracks attendance for a two-session curriculum.
• A community youth center documents participant participation for grant reporting.
• A prevention provider prepares records for a program compliance review.

Documents Commonly Used with This Form

• Youth Prevention Program curriculum materials
• Session sign-in sheets
• Grant or contract reporting forms
• Program schedules and lesson plans

Frequently Asked Questions

Is Form 5102 required for every prevention session?

It is required for structured program cycles that require attendance documentation.

Who completes and signs the form?

The Prevention Specialist delivering the program.

Can attendance be updated later?

Yes, but entries should reflect actual session participation.

Are demographic fields mandatory?

They are typically required for reporting and evaluation purposes.

What if a participant attends only one session?

Attendance should be recorded accurately for each session.

How long should the form be retained?

Retention depends on program or funding requirements.

Related Forms

• Youth Prevention Program Outcome Reports
• Participant Consent or Enrollment Forms
• Program Session Logs
• Grant Performance Documentation

Form Details

• Form Name: Youth Prevention Program Participant Information
• Form Number: 5102
• Program Area: Youth Prevention Services
• Region: Texas
• Revision Date: August 2019