Prevention Program Development and Evaluation Questionnaire Form
Share information to support prevention program planning and evaluation.
Program Context
Program Name
*
Prevention Need or Problem Addressed
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Intended Population and Program Setting
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Program Approach or Key Activities
Readiness and Intended Outcomes
Program Development Stage
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Exploring
Planning
In Development
Implementing
Revising
Available Capacity, Resources, or Partnerships
Intended Changes or Outcomes
*
Evaluation Plan
What key evaluation questions should the program answer?
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What indicators or measures could be used, and how could relevant information be collected without gathering sensitive personal or medical details?
What is the proposed evaluation timeline, including important milestones and anticipated barriers?
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