CHI Memorial Community Benefit Evaluation

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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 .

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:

Please limit your response to 200 characters max.

Select a CHI Memorial Funding Priority item for the program/project: Check all that apply.
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Access to affordable healthcare and insurance

Mental/Behavioral Health

Affordable, healthy housing

Substance Use/Abuse

Prevention and Education

Violence

Obesity

Food insecurity

Chronic Diseases

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

Please limit your response to 200 characters max.

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.

Please limit your response to under 200 characters.

In the opinion of the organization, did the program/project accomplish its overall goal? If yes, then how? If no, then why? Please limit your response to 100 characters max.

If any, then what learned-lessons or useful feedback did the organization acquire from beneficiaries of the program/project? Please limit your response to 100 characters max.
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If any, then what other community health needs were realized by the organization in administering the program/project? Please limit your response to 100 characters max.
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Please take a moment to review before you click submit. 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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