CONTRACT EVALUATION FORM by w0g9Ia

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									                                      EVALUATION REPORT: SHORT FORM
                                         HIV PREVENTION CONTRACTS


Contractor :

Agency Staff Submitting this Report:

Address:

Funding Source:                                            Amount of Contract:

Term of Contract:

Overall Rating:

                Commendable               Acceptable               Needs Improvement                Unacceptable


Please address the following sections as it relates to the goals and objectives of your contract:

1. Completion of process objectives: Please discuss each of your process objectives and outline your accomplishments
during this contract period.



2. Completion of outcome objectives. Please discuss your outcome objectives and outline your accomplishments
during this contract period.



3. Client Satisfaction: Please summarize the results of your client satisfaction surveys and attach a final analysis
report.




4. Overall experience delivering the services: Please discuss your overall experience working with the target
population in delivering the intervention. Include the challenges you encountered and how you dealt with the
challenges. Also include the successes and/or unexpected impact that can be attributed in your provision of the
services.




5. Future Plans for the Program: Please outline your plan to continue or discontinue providing services without the
funding assistance of the SFDPH. Include your plan to transition clients to other services.




C:\Docstoc\Working\pdf\8c046802-43e1-4360-9d11-5d6ddb8e4abb.doc                                             7/4/2012
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Overall Rating:
                                                                                                                            Formatted: Font: Bold

:               Commendable               Acceptable               Needs Improvement                Unacceptable            Formatted: Pattern: 12.5%
                                                                                                                            Formatted: Font: Bold


Please address the following sections as it relates to the goals and objectives of your contract:

1. Completion of process objectives: Please discuss each of your process objectives and outline your accomplishments
during this contract periode year.




2. Completion of outcome objectives. Please discuss your outcome objectives and outline your accomplishments
during this contract periode year.




3. Client Satisfaction: Please summarize the results of your client satisfaction surveys for the previous contract period
and attach a final analysis completed reportreport.




4. Overall experience delivering the services: Please discuss your overall experience working with the target
population in delivering the intervention. Include the challenges you encountered and how you dealt with the
challenges. Also include the successes and/or unexpected impact that can be attributed in your provision of the
C:\Docstoc\Working\pdf\8c046802-43e1-4360-9d11-5d6ddb8e4abb.docC:\Documents and
Settings\JamesN\Desktop\finalcloseout.DOC                            7/4/20124/13/20062/1/2005
services.




5. Future Plans for the Program: Please outline your plan to continue or discontinue providing services without the
funding assistance of the SFDPH. Include your plan to transition clients to other services.




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                                                                                                                      12 pt




C:\Docstoc\Working\pdf\8c046802-43e1-4360-9d11-5d6ddb8e4abb.docC:\Documents and
Settings\JamesN\Desktop\finalcloseout.DOC                            7/4/20124/13/20062/1/2005

								
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