Impact Statement Template

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     CONTACT INFORMATION

    Title:  

    First Name:   Last Name: 

    Phone:   Fax:   

    Email:  Department: 


    IMPACT
     
    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:   

     

    FUNDING SOURCE



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