Investment Committee Evaluation Form

United Way of MPM

Investment Committee Evaluation Form

Program: ______Agency: ______

Application Review Date: ______

Total Score: ______(Maximum score of 100 points; 90 points for new programs/existing partner; 82 points new program/ new partner)

Instructions: Thoroughly review the application. Indicate your rating based on the application and investment meeting. Add notes as needed. For each section, select an overall rating using the following scale:

Program Description

Ø  The program has clearly identified which client outcome their program addresses. (2 pts)

Ø  The program has chosen one of the following:

Ø  Totally new program or replication of a best practices model. (5 pts)

Ø  Expansion of an existing program within the applicant organization. (3 pts)

Ø  Extension of an existing program to a new setting. (3 pts)

Ø  Existing program with no changes. (1 pt)

Ø  The agency has explained the need for the program by explaining conditions that affect clients’ lives and the magnitude and implications of these problems. (5 pts)

Ø  There is evidence that program practices are based on a logical rationale that demonstrates effectiveness in achieving the desired outcome. The program shows it is effective and meeting the clients’ needs. (5 pts)

Program Description Score______(out of 17 pts)

Program Results

Ø  There is clear linkage of inputs, activities, and indicators to achievement of client outcome. (5 pts)

Ø  Program has identified

Ø  Number of unique (unduplicated) people/clients served by program was provided. (1 pt)

Ø  Number of unique people/clients served through United Way funds was provided. (1 pt)

Ø  Number of units of service for total program was provided and calculation explained. (1 pt)

Ø  Number of units of service provided through United Way funds was provided. (1 pt)

Ø  Cost per unique person/client was provided. (1 pt)

Ø  The cost to continue community impact services is in line with what is being provided. (5 pts)

Ø  The program proposes goals which advance the client outcome. (4 pts)

Ø  The program can provide outcome data in the funding period to support its identified impact in this area. (4 pts)

Program Results Score______(out of 23 pts)

Outcome Measurement

Ø  Each indicator has a valid instrument used to measure achievement of goals and client outcome. (5 pts)

Ø  Agency has an effective data collection and reporting system to track reported goals and client outcome. (5 pts)

Outcome Measurement Score______(out of 10 pts)

Program Improvement/Status Report for Previous Investment

Ø  The program provides evidence that its services produce intended client outcome. (4 pts)

Ø  Information is accurately reported and corresponds to the original application (including revised goals). (4 pts)

Ø  The program met its proposed targets for the last investment cycle or provided reasonable explanation for variance. (2 pts)

Program Improvement Score______(out of 10 pts)

Partnership Compliance

Ø  Agency actively promotes partnership with United Way including compliance with partner funding agreement addressed in application.

Ø  Member agency did not actively solicit designated dollars. (1 pt)

Ø  Attended the United Way campaign kick-off. (1pt) *

Ø  Conducted a United Way campaign (packet completed by October 31 for agency partners). (1 pt) *

Ø  Did not conduct any direct solicitation fund raising campaigns between Sept 1 and Oct 31. (1 pt)

Ø  Promoted United Way partnership in media opportunities (radio and television). (1 pt)

Ø  United Way’s investment is credited in agency’s marketing materials and an example is attached. (2 pts)

Ø  The United Way logo is on agency’s website. (1 pt)

Ø  The United Way partnership is listed in agency press releases and an example is attached. (2 pts)

*New partners are eligible for these points.

Partnership Compliance Score______(out of 10/2 pts)

Budgets, Fees, and Grants

Ø  The program provides an accurate budget with realistic costs for providing services (including narrative). (6 pts)

Ø  United Way investment dollars are/will be used to leverage other resources, and these resources were specifically identified in the budget narrative. (2 pts)

Ø  The cost per unit of service is included and correctly calculated. (4 pts)

Ø  The program lists individual expense line items and shows how expenses were calculated and how program costs are reasonable. (8 pts)

Budget, Fees, and Grants Score______(out of 20 pts)

Program Sustainability

Ø  There is evidence that this program has an effective plan to meet its budgetary needs. Program states other sources of funding they are pursuing. (2 pts)

Ø  The program does not unnecessarily duplicate another service offered in the proposed service area. Program shows how it is different or collaborating with other similar programs. (4 pts)

Ø  There is evidence of collaborative partnerships with other community entities. (4 pts)

Program Sustainability ______(out of 10 pts)

TOTAL SCORE for currently funded program:______/100

TOTAL SCORE for new program of an existing partner:______/90

TOTAL SCORE for new program of a new partner:______/82