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Outcomes Logic Model
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Organization Name:
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Project Name:
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Date Created
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Date Reviewed
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Program
Influencers (Key entities that help define the program
or to whom the program will report results) |
List program influencers |
Organizational Mission |
Organization's mission statement or key
action words |
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Program Purpose
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We do what?
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Summary of key proposed services
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For whom?
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Target population(s)
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For what outcome(s)?
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Benefits/changes in skill, knowledge, attitude or life condition
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Program Activities
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Program Services
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List key activities needed to provide or manage services
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List services to be delivered directly to participants
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Target Population
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List specific characteristics of primary intended participants
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Intended Outcomes (Changes in skill, knowledge, attitude,
behavior, life condition or status)
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Indicators (Measures) (Concrete evidence, occurrence,
or characteristic that will show the desired change occurred)
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Immediate:
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Intermediate:
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Long-term:
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Outcome #1 _______List outcome____________
| Indicator(s)
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Data Source (Where
data will be found) |
To Whom
(Segment
of population to which this indicator is applied) |
Data Intervals
(Points
at which information is collected) |
Target
(the
number , percent, variation or other measure of change) |
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Outcome #2 ___________________
| Indicator(s)
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Data Source (Where
data will be found) |
To Whom
(Segment
of population to which this indicator is applied) |
Data Intervals
(Points
at which information is collected) |
Target
(the
number , percent, variation or other measure of change) |
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Outcome #3 ___________________
| Indicator(s)
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Data Source (Where
data will be found) |
To Whom
(Segment
of population to which this indicator is applied) |
Data Intervals
(Points
at which information is collected) |
Target
(the
number , percent, variation or other measure of change) |
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