Montana Tobacco-Use Prevention Resource Center
University of Montana Technical Assistance and Training Center – Missoula
Missoula, MT 59812-1728
Program Evaluation Plan - Worksheet [SAMPLE]
Key Components
A. Planning & Implementation Issues
1)
2)
Were formal meetings or
discussions held with School
Board and principals?
How were School Board
members and principals kept
informed of the progress of the
curriculum training endeavor?
B. Assessing Attainment of Objectives
1)
What school curriculum was
selected for implementation?
2)
Is the content of the selected
curriculum consistent with
CDC recommended guidelines?
3)
Was at least one training in the
selected curriculum provided?
4)
When was training provided?
C. Program Impact on Participants
1)
Which school districts/schools
were involved in the training?
2)
How many teachers attended
the curriculum training.
D. Program Impact on Community
1)
What might be the potential
number of students in the
school district(s) impacted
through the delivery of the
curriculum?
Increased level of support
among School Board
members and District
principals for the provision of
training and implementation
support of a preferred
tobacco-use prevention
curriculum

# meetings/discussions
held

# of communications
distributed to key
individuals

Reported change in #
of key supporters
Promote availability of
school-based tobacco-use
prevention curricula

# of training events
provided in selected
curricula
X

# of teachers attending
the training

% of schools in district
represented
X
Increased numbers of students
exposed to a preferred
tobacco-use prevention
curriculum

# of estimated students
impacted by
curriculum
X
X
Instructions: Complete one worksheet for each program objective established for your program.
Description of
Evaluation
Activities
(Indicate data source if applicable)
Will prepare a written
summary of each meeting
held with key school district
leadership and OPI
representatives
X
Increased numbers of school
teachers trained in a preferred
tobacco-use prevention
curriculum
Physiologic
Measurements
Direct Observations
Community Forums
Record-keeping or
Tracking System
Focus Group
Indicators
Structured Interview
Process &
Outcome
Measures
Written Survey
Evaluation Questions
Review of Existing
Data
Evaluation Methods
X
Will develop a brief pre-post
survey to use with key
leadership
Will prepare a written
summary describing the
purpose and intent of the
training as well as:

How training was
promoted to teachers

Who attended the
training

Summed evaluation
results

Individual teacher
implementation plans
Will provide a participant
sign–in sheet at the training
event(s) to capture this
information as well as other
pertinent contact information
Will develop a post-training
survey and distribute to all
participants to gather
necessary data to facilitate
design of follow-up support.
How Will
Findings Be
Reported and
to Whom?
In quarterly and final
year-end reports
presented to program
leadership and funders.
In quarterly and final
year-end reports
presented to program
leadership and funders.
In quarterly and final
year-end reports
presented to program
leadership and funders.
In quarterly and final
year-end reports
presented to program
leadership and funders.