1. Title Team Members

2. Program Components What is the program trying to accomplish?
Who/what is the target population?
What is the need or gap that the program meets?
What does the program provide?

3. Causal Chain
What is the model for expected change?

4. Evaluation Questions
Hypotheses or policy questions to be answered through evaluation
How the knowledge generated will be used

5. Intervention
What is the intervention, for the purposes of the evaluation?
Target unit/unit of intervention
Unit(s) of observation

6. Evaluation Design/ Identification Strategy
How will you define “treatment” and “comparison” groups? Or, what is the counterfactual?
What is the level of the treatment assignment? And of the analysis?
How will you confirm that both groups are similar in the absence of the intervention?

7. Outcome Indicators What will you measure? How?
What is the expected effect size? (expected change in outcomes?)
How long do you think it will take for change in outcomes to appear?
Remember SMART: Specific, Measurable, Attributable, Realistic, Targeted

8. Sampling and Data
What is the sample for the study? And from where/whom will you collect data?
At what time intervals will you make measurements?
What do you think will affect your power to detect a significant change in outcomes? (e.g. number of clusters, cluster size, time required for change to appear, expected size of effect, intra-cluster correlation)
Do you expect any spillovers?

9. Timeline for Impact Evaluation
When will you start and end? What needs to be accomplished before you can implement?
What are the steps in implementation of the evaluation?
When do you need to implement the intervention, collect data, etc?
What is your plan for dissemination?

10. Impact Evaluation Team: Staffing
Who are the stakeholders in the evaluation?
Who will manage the evaluation?
Who will provide implementation support?
Who will provide data collection and quality assurance services?
Do you need design/statistical support from technicians?
Is training required?

11. Budget What will drive the cost of the evaluation?
What categories of spending do you expect?

12. Anticipated Challenges
Operational, political, research challenges