Project title |
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The personnel involved in implementing the project |
Principal project managers (Please specify the names of all project managers, their workplace and contact number) |
Principal project colleagues (Please specify the names of all project managers, their workplace and contact number) |
Other individuals involved in project implementation (Please specify the names of all project managers, their workplace and contact number) |
Title of the stakeholding organization (Please specify the name of the volunteer in the organization, address and contact number) |
Goals and objectives |
Primary project goal |
Secondary objectives |
Interventions |
Title of intervention |
1. Project manager |
2. Project colleagues |
3. Other individuals involved in project implementation |
4. Organizations cooperating with the project |
5. Goals pursued by intervention |
6. Target community |
7. Type of intervention |
8. Venues of intervention (Please specify all intervention venues, names of volunteers, addresses and contact numbers) |
9. Date of starting interventions |
10. Date of ending interventions (if applicable) |
11. Amount of spent budget (direct and indirect budgets), Source of budget |
12. a) Method of education (class, face-to-face, educational materials, gatherings, education via media, etc.) |
12. b) Please specify in detail the type and method of implementing your non-educational interventions (if applicable) |
13. Challenges confronting the implementation of interventions |
14. How do you rate the success of intervention? |
15. Given the explanations, has the intervention been modified or totally discontinued? |
16. State your degree of satisfaction with this intervention. |
17. Do you think this intervention must be continued, modified, or discontinued? State your reasons. |
18. Have the goals of your respective intervention been stabilized in the system? |
19. How do you assess the future continuity of habits encouraged by your respective intervention? |
20. Do you think this intervention can be nationalized? Please state your reasons. |