Program Outcome Results

2004Data Report

Agency Name:______

Program Name: ______

OUTCOME #1: ______

______

Time period measured: ______

Total number served: ______

Total number reported:______

If the total reported is not the same as the number served, please describe why (i.e., conscious sampling, incomplete data response rates, etc.): ______

______

How was the target determined? ______

______

Indicator(s) / Previous Year Actual / This Year Target / This Year Actual
#
Reported / #
Achieved / %
Achieved / %
Achieved / #
Reported / #
Achieved / %
Achieved
Indicator: / TOTAL / Influencing factor:
List category / List category
# / %
(of total) / # / % / # / %
Achieved
Not achieved
GRAND TOTAL / 100% / 100% / 100%

(Outcome #1, continued)

Interpretation of Results:

Highlight areas with the greatest difference between the target & actual results.

Identify key issues that have impacted the data

Predict the future effect

Action Taken:

Identify if any changes were made in the following areas in response to the results – program, data collection system, management system.

OUTCOME #2 ______

______

Time period measured: ______

Total number served: ______

Total number reported:______

If the total reported is not the same as the number served, please describe why (i.e., conscious sampling, incomplete data response rates, etc.): ______

______

How was the target determined? ______

______

Indicator(s) / Previous Year Actual / This Year Target / This Year Actual
#
Reported / #
Achieved / %
Achieved / %
Achieved / #
Reported / #
Achieved / %
Achieved

Please use additional space as necessary to answer the following:

Interpretation of Results:

Action Taken:

OUTCOME #3______

______

Time period measured: ______

Total number served: ______

Total number reported:______

If the total reported is not the same as the number served, please describe why (i.e., conscious sampling, incomplete data response rates, etc.): ______

______

How was the target determined? ______

______

Indicator(s) / Previous Year Actual / This Year Target / This Year Actual
#
Reported / #
Achieved / %
Achieved / %
Achieved / #
Reported / #
Achieved / %
Achieved

Please use additional space as necessary to answer the following:

Interpretation of Results:

Action Taken:

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09/29/18