Health & Medical
In 2 paragraphs, describe the strategies you will use to achieve these goals and objectives. Please also include any behavior change theory(ies) or planning models you used, and how you used it to select your intervention strategies.
Implementation Plan
Describe how the program will be implemented. Include a description of each strategy used (which of the
7 CDC strategies); must use 3 different strategies. Identify level of prevention and level of influence. For example,
The proposed program will utilize the following intervention strategies:
Strategy 1: Develop and deliver a health education program to …
Strategy 2: Organize and begin a walking group to …
Strategy 3: Advocate for policy change in the environment to …..
This section should indicate when each step will be conducted over the course of your 3‐year program.
Evaluation Concerns
In 2‐4 paragraphs, include a description of formative and summative evaluation ideas for this program, and how data will be collected. For example, there are 15 elements in formative evaluation (p. 367), describe two process evaluation items (p. 370‐372). Also, discuss your evaluation design as it relates to summative evaluation; either experimental, quasi‐experimental, or non‐experimental design (p. 378) and describe two impact evaluation items, including baseline data you will collect, in this section. Describe two outcome evaluation items, including baseline data you will collect . Who will conduct the evaluation, and who will collect the data and results ?
Lastly,discuss three practical and ethical considerations with evaluations and how you plan to mitigate .
Marketing/Outreach Plan
In 2‐3 paragraphs, describe how you plan to advertise your program, reach/recruit your priority population into your program, and to share your final results back with the community. Often, this is a community meeting, town hall, presentation, or published report that community members and other stakeholders can access during and after the program ends.
Budget
Expenses Cost Donations* Grant Request
Staff salaries and wages
Rental Space
Equipment
Supplies and materials
Printing and copying
Meetings
Marketing and advertising
Staff and volunteer training
Contract services
Miscellaneous
Travel
Incentives
Classroom/Workshop supplies
Total $0 $0 $0
*In‐kind contributions are donations of goods, services or time instead of cash. Think about areas you may be able to
get donations. For example, Office Max may be willing to donate $50 in supplies or a local church may donate the use
of one of their classrooms once a week for your 12 week session (worth $1200).
Budget Narrative
Explain expenses, revenue, or grant requests. Keep it short and to the point. Include a brief statement
on how you determined costs (e.g. “We based salaries off of most recent Bureau of Labor and
Statistics available data.”)
