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Title Subtitle School name Location
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About Your School Details to include: General relevant info location
system (e.g. government) age range of students (e.g. Prep – 12) No. staff No. students
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About your Team Who was on your team How was the team assembled?
How often did you meet? What enabled your team to work collaboratively and effectively with each other?
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Diagnosis Phase
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Identifying Opportunities for Growth
Text Block
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Data Collected Text Block
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Needs Statement The needs statement – as already completed
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Intervention Phase
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The Intervention Please briefly describe the intervention you chose to run
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Intervention Steps Please briefly describe how the intervention was implemented
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Intervention Insights
Please briefly describe challenges, solutions and noteworthy events or interactions which occurred as the result of the intervention.
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Evaluation Phase
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Evaluation Methodology
Please describe how you implemented the evaluation
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Data Collected Please describe the data that you collected
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The Impact Please describe the impact of the program, as evaluated using the collected data.
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Where to Next?
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Next Steps Please describe where you are heading.
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Thank you
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