CHI Memorial Community Benefit Evaluation
Evaluation Period: Fiscal Year July 1, 2024—June 30, 2025 

NOTICE: This link must be completed at the conclusion of the fiscal year for your award . 

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Email *
Evaluation Date:  
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Funding Award Amount:
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Organization Name:
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Organization Address:  *
Primary Contact Name *
Primary Contact Phone Number: 
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Program/Project Name:
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Explain the overall goal of the program/project pertaining to the CHI Memorial funding request:

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Select a CHI Memorial Funding Priority item for the program/project: Check all that apply.
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Required

List all outcomes and metrics as listed in your application that measured the success of the program/project (with the actual result):

EXAMPLE:    Outcome: present awareness materials to 500 people    Result: 10 presentations for 550 total people

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Who was actually served and how many were actually served by this program/project? Describe the target population and the volume of the target population.

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In the opinion of the organization, did the program/project accomplish its overall goal? If yes, then how? If no, then why?

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If any, then what learned-lessons or useful feedback did the organization acquire from beneficiaries of the program/project?
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If any, then what other community health needs were realized by the organization in administering the program/project?
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Thanks for your Community Benefits evaluation.

We truly appreciate your partnership during the FY25 fiscal year.  Enjoy your day!

A copy of your responses will be emailed to the address you provided.
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