Form C—Project Description Page

Please note: Online form is for viewing purposes only. The online form CANNOT be submitted or saved.

Applicant Agency Name:

Please limit your response to this form to 5 pages.

1. Describe how your agency has used past (Healthy People 1990 and 2000) and is using the current (2010) Healthy People initiative.  Please include the successes and challenges your agency has faced.  If your agency has not used Healthy People before, please describe a similar strategic planning activity that your agency has engaged in.

2. Using the Healthy People 2020 framework and supporting concepts for improving population health, please address the following in a narrative description:

   • Identify each framework component, population health improvement concept, existing Healthy People 2010 focus area topic(s), or topics that address the determinants of health (social and physical environment, biology and genetics, health services, or individual behavior) that your project will address. Explain why you have chosen each component, concept, and/or topic.

   • Describe the activities you will implement under each (or multiple) framework component, concept or topic you have selected. Please support your choice of activities from the public health and/or science literature, planning tools, or based on past success with implementing this activity for strategic planning purposes.

   • If not directly tied to your activity (s), describe how you will involve multi-sectoral and interdisciplinary perspectives and contributions to your project.

   • What products (e.g. meeting summaries, organization strategic plan, timeline, logic model, webpage, community assessment results, agency policies/proposed legislation) will you provide as a deliverable (s) for each of your proposed activities?

   • Describe how this evaluation project will complement your agencies Healthy People 2020 state, territory or tribe(s) planning activities in progress or under consideration, or the use of the national Healthy People 2020 objectives (expected release in 2010)

AGREEMENT TO COMPLETE EVALUATION (REQUIRED)

I agree to participate in an evaluation of this project and complete a report of how funds were spent by June 15, 2010.

Name of Responsible Party

Date

E-mail Address of Responsible Party: 

Phone number of Responsible Party: 

Form A  |  Form B  |  Form C  |  Form D  |  Form E  |  Form F  |  Form G

---

This page last updated on: March 12, 2009

Content for this site is maintained by the Office of Disease Prevention & Health Promotion, U.S. Department of Health and Human Services.