Application for Building Evaluation Capacity Initiative

Lead by The Consultation Center at

Yale School of Medicine

July 2016 – June 2018

Please remember applications should be no more than five pages in total: one (1) page of information about the organization and populations served, two (2) pages of program content narrative that includes responses to the five questions, a one (1) page cover letter by the organization director or senior leadership that indicates the organization’s commitment to full participation in the initiative, and a one (1) page brief evaluation survey.

Organization’s Information

The organizational information is collected to track what organizations and populations are benefiting from this program. Please answer each question below starting in the gray box using single-spaced, 11-point font. The boxes will increase in size as you begin to type/paste text.

Organization’s name:

Name of program that will be evaluated:

Organization’s primary focus (select one):

Please email completed applications by 5:00pm on Friday, August 12, 2016 to Alyson Ferguson at: .

Applicants will be notified of the award decision by September 13, 2016.

Application for Building Evaluation Capacity Initiative

Lead by The Consultation Center at

Yale School of Medicine

Arts and Culture

Behavioral Health

Education

Health and Wellness

Human Services

Other

Please email completed applications by 5:00pm on Friday, August 12, 2016 to Alyson Ferguson at: .

Applicants will be notified of the award decision by September 13, 2016.

Application for Building Evaluation Capacity Initiative

Lead by The Consultation Center at

Yale School of Medicine

Organization’s annual budget:

Number of people served by the organization:

Population of Interest (select all that apply):

Please email completed applications by 5:00pm on Friday, August 12, 2016 to Alyson Ferguson at: .

Applicants will be notified of the award decision by September 13, 2016.

Application for Building Evaluation Capacity Initiative

Lead by The Consultation Center at

Yale School of Medicine

Youth

Elderly

Women

Men

LGBTQ

New Americans/Immigrants

Other

Please email completed applications by 5:00pm on Friday, August 12, 2016 to Alyson Ferguson at: .

Applicants will be notified of the award decision by September 13, 2016.

Application for Building Evaluation Capacity Initiative

Lead by The Consultation Center at

Yale School of Medicine

Geographic area served (i.e. county/counties, specific zip codes, etc.):

The next question is to help determine if this project is benefitting minority-led organizations.

Senior leadership of organization (Executive Director/ CEO) identifies as:

Please email completed applications by 5:00pm on Friday, August 12, 2016 to Alyson Ferguson at: .

Applicants will be notified of the award decision by September 13, 2016.

Application for Building Evaluation Capacity Initiative

Lead by The Consultation Center at

Yale School of Medicine

African American White Latino

Asian American or Pacific Islander Native American Two or more races

Other

Please email completed applications by 5:00pm on Friday, August 12, 2016 to Alyson Ferguson at: .

Applicants will be notified of the award decision by September 13, 2016.

Application for Building Evaluation Capacity Initiative

Lead by The Consultation Center at

Yale School of Medicine

Is your organization currently a grantee of one of the following funders?

The Barra Foundation The Scattergood Foundation

The Philadelphia Foundation United Way of Greater Philadelphia and Southern New Jersey

Organization’s Mission Statement:

Program Content

Please answer each question below starting in the gray box using single-spaced, 11-point font. The boxes will increase in size as you begin to type/paste text. Program content should be no more than two (2) pages. Also, please complete the Evaluation Capacity Survey on the next page, which will NOT be counted as part of the 2-page limit.

1) Describe the program that will be the focus of this evaluation training and consultation.

2) Describe your organization’s current use of data for monitoring, quality assurance, or evaluation purposes. Note any data-related reports that are generated.

3) (a) Identify units, departments, or persons (roles within the organization and not names are fine) who are responsible for data collection and analysis, data-related report preparation, and data-related presentations. (b) Indicate whether these individuals or others will participate in this initiative.

4) (a) Describe how data is currently used for planning and decision making, report preparation, and presentations within the organization. (b) Provide a candid assessment of the quality of data used. (This information will be kept confidential and will not prejudice your application.)

5) Describe how participating in this initiative will build organizational capacity so that your organization can better meet its objectives.

Evaluation Capacity Survey

As part of your application, we ask that you take a few minutes to complete this brief survey regarding your organization’s capacity for evaluation. The survey will help our team assist your organization to build and sustain evaluation capacity. We recognize that not all staff and programs in your organization will have the same level of evaluation capacity, so please complete the survey for the staff and program that is the focus of this application. Please be as honest as possible to ensure that we help build capacities most in need of support.

Please indicate your agreement by marking the appropriate choice -- Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree – for each of the following statements.

1) My organization is able to carry out a successful program evaluation, including:

a) Implementing reliable data collection procedures.