Evaluation Plan Template printable pdf download

Evaluation Plan Template

I. BACKGROUND

Provide a brief overview of your program that includes the following:

Program Description

What do you plan to do?

Need

Why is the program needed?

Target Population

Who is the target population of this program?

Objectives

What are the program’s objectives (SMART objectives)?

Stage of Program Development

In what stage of development is the program? (i.e., planning, implementation)

II. LOGIC MODEL

A logic model is a graphic depiction of the program and shows the logical relationships among the resources that

are invested, the activities that are implemented, and the benefits or changes that result from the activities. A logic

model includes the following components:

Inputs

What resources are available to the program in terms of staff, money, space, time, partnerships,

etc.?

Examples of resources: Diabetes self-management curriculum, trained health educators,

informational materials

Activities

What activities are being undertaken (or planned) to achieve the outcomes?

Examples of Activities: Provide preventive dental services to children; conduct diabetes

screenings at health fairs; implement the CATCH program in elementary schools

Strategy.

Capacity.

Sustainability.

Evaluation Plan Template