Using the Logic Model provided, fill in the components for a public health program on one of the following health issues: nutrition, Diabetes, Opioid Abuse, Cigarette Smoking Cessation or reproductive health.

Inputs are what will be necessary to run the program, staff, evidence, venue, material, budget.

Outputs; are the design of the program, number of sessions and the content and how implemented. (Lecture, PowerPoint, video combination).

Outcomes should have measurable objectives for the program itself, the immediate learning, and the long-term outcome. Make sure to include formative, summative, process impact and outcome evaluation designs in your program.

The assumptions and external factors include the culture of the community and any factors that help or hinder the program.

1. Program:

2. Situation Statement:

3. Inputs - What we will invest

4. Outputs Outcomes -

a. Impact Activities - What we will do

b. Participation Who we will reach

5. Outcomes -

a. Short Term Results - Learning

b. Medium Term Results -Behavioral Action

c. Long Term Results - Ultimate Impact

6. Assumptions 7. External Factors

8. Evaluation

Program: Situation Statement: External Factors Evaluation