Marketing Retarget Pixel

Impact Statement Template

  •   UMES rotunda 7421graycopy



    First Name:   Last Name: 

    Phone:   Fax:   

    Email:  Department: 

    Project Title: 


    The Issue

    Generally Accepted Fact (one sentence):   


    Local Fact (one sentence):     

    Program Focus of Concern (one sentence):     

    Program Goal/Mission (one sentence):

    Statement of Goals (The goal of this project is to . . .):   

    Specific Outputs (one or two sentences)

    What You Did:   

    Specific Outcomes (one or two sentences containing quantitative or qualitative data)

    What Changed:   

    Impact Statement (one or two sentences)

    Interpretation of Outcomes:   



    Note:  Please send clear action photos that are associated with your impact and are at least 1 MB in size to  In the subject line of the email, please type >>  *Your Last Name: Impact Form Submitted.