"Evaluation Plan Template"

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Evaluation Plan Template
Use this template for writing your evaluation plan. Following this
template are detailed instructions to guide you in developing your plan. If
you need additional assistance, please contact tbewg@cdc.gov.
{State Program Name}
Evaluation Plan for {Years covered}
Prepared by:
{Names}
{Affiliation}
{Date}
2
Evaluation Plan Template
Use this template for writing your evaluation plan. Following this
template are detailed instructions to guide you in developing your plan. If
you need additional assistance, please contact tbewg@cdc.gov.
{State Program Name}
Evaluation Plan for {Years covered}
Prepared by:
{Names}
{Affiliation}
{Date}
2
INTRODUCTION
Evaluation Goal
What does this evaluation strive to achieve?
What is the purpose and use of this evaluation?
Evaluation Team
Lead Evaluator
Team Members
Evaluation Advisory Group (optional)
Table 1. Roles and Responsibilities of the Evaluation Team Members
Individual
Title or Role
Responsibilities
I. STAKEHOLDER ASSESSMENT
Who are the stakeholders for the TB program?
What role do they have in the evaluation?
How do you plan to engage the stakeholders (i.e., conduit for coalition, advisory board,
project teams)?
Table 2. Stakeholder Assessment and Engagement Plan
Stakeholder
Interest or
Role in the
How and When to Engage
Category
Perspective
Evaluation
II. BACKGROUND AND DESCRIPTION OF THE TB PROGRAM AND PROGRAM
LOGIC MODEL
Need
Why is the program needed (i.e., magnitude, cause(s) and trends of the TB
problem)?
Context
What context is the program operating under (i.e., environmental factors that may
affect the initiative)?
3
Target Population
Who is the target population of this TB program?
Objectives
What are the program’s objectives (SMART objectives)?
Stage of Program Development
What stage of development is the TB program currently in (i.e., planning,
implementation, mature phase of the program)?
Resources/Inputs
What resources are available to the program in terms of staff, money, space, time,
partnerships, etc.?
Activities
What activities are being undertaken (or planned) to achieve the outcomes?
Outputs
What products (i.e., materials, units of services delivered) are produced by your
staff from the activities?
Outcomes
What are the program’s intended outcomes (intended outcomes are short-term,
mid-term, or long-term)?
Table 3. Program Description
Resources
Activities
Outputs
Outcomes
Initial
Subsequent
Short-/Mid-term
Long-term
Logic Model
Provide a logic model of your program.
III. FOCUS OF THE EVALUATION
Stakeholder Needs
Who will use the evaluation findings?
How will the findings be used?
What do they need to learn from the evaluation?
Evaluation Questions
What are your evaluation questions (include process driven or outcome driven
evaluation questions)?
What do you want to learn from the evaluation?
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Evaluation Design
Longitudinal data, points of comparison, multiple data sources, mixed methods
Resource Considerations
What resources are available to conduct the evaluation?
What data are you already collecting?
Evaluation Standards
How will you address the standards for effective evaluation -
utility, feasibility, propriety, and accuracy?
IV. GATHERING CREDIBLE EVIDENCE: DATA COLLECTION
Indicators
How will you measure success?
What are some of the measurable or observable elements that can tell you about
your program and its effects?
Table 4. Indicators and Program Benchmark for Evaluation Questions
Evaluation
Process and Outcome
Program Benchmark
Indicators
Question
1.
2.
Data Collection
What methods will you use to collect the data?
Where is the data?
How often will it be collected?
Who is responsible for collecting the data?
How will you manage and store the data?
Table 5. Data Collection Plan
Indicator
Data Sources
Collection
Who
When
How
5
Plan Timeline
When will evaluation activities occur?
Table 6. Illustrative Timeline for Evaluation Activities
Evaluation
Timing of Activities for {Year}
Activities
1
Qtr
2
Qtr
3
Qtr
4
Qtr
st
nd
rd
th
V. JUSTIFYING CONCLUSIONS: ANALYSIS AND INTERPRETATION
Analysis
What method will you use to analyze your data (quantitative or qualitative
techniques)?
Table 7. Analysis Plan
Data Analysis Technique
Responsible Person
Interpretation
Who will you involve in drawing, interpreting and justifying conclusions?
What are you plans to involve them in this process?
VI. ENSURING USE AND SHARING LESSONS LEARNED: REPORT &
DISSEMINATION
Dissemination
Who is your audience?
What medium do you plan to use to disseminate the evaluation findings to your
audience?
Table 8. Dissemination Plan
Yes 
Dissemination Medium
Responsible Person
Use
What are your plans for using evaluation findings?
How, where, and when will the findings be used?
Who will implement these findings?
How will you monitor your implementation plan?
APPENDICES
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