Please e-mail completed form to Jan Connal, firstname.lastname@example.org
What issue or concern is the intervention designed to address?
What were the desired outcomes you expected from this intervention?
What data was collected to identify the issue or concern on your campus?
Summarize the research used to determine that this intervention should have been piloted:
Describe the Intervention:
What if any data have you collected to measure the effectiveness of the intervention?
Summary of findings based on data:
How will you scale your program up to include a larger population?
How can this program be sustained if outside funding is no longer available?
What have you learned about the effectiveness of this program?
What improvements can you think of to strengthen the program?