The document outlines a 3-part plan for implementing a population-based health intervention: 1) Describe the intervention using a logic model and goals/objectives informed by a needs assessment and health behavior theory. The intervention aims to improve a target population's health issue. 2) Develop a 12-month implementation timeline listing key tasks, activities, personnel, and projected completion timeframes for each objective. 3) Prepare a line-item budget and 500-word justification for the necessary funding source to carry out the intervention as planned. Budget categories include personnel, travel, equipment, supplies, consultants, and other expenses.

1. Benchmark – Program Implementation Plan
Part 1 – Description of Program and Logic Model
Describe an evidence-based intervention based on your
completed needs assessment. Your intervention should be
population-based and informed by your chosen theory and
SMART goals and objectives. Population-based interventions
can be directed at the entire population within a community, the
systems that affect the health of those populations, and/or the
individuals and families within those populations known to be
at risk. Use the Logic Model to design your proposed
intervention.
1. Description of the Intervention
0. Describe the population-based, evidence-based
program/intervention.
0. Discuss how the intervention will support improving the
health issue for the target population.
1. Goal and Objectives
1. Goal:
1. Process Objectives (the activities to be completed in a
specific time period):
1. Outcome Objectives (changes in knowledge, attitudes,
behaviors, policy, environment systems, etc.):

2. 1. Complete the Logic Model. Design your intervention using
the template on the following page:
Inputs
Long-Term Outcomes
Intermediate Outcomes
Short-Term Outcomes
Outputs
Activities
Legend
Inputs: What resources do you need to make this happen? (e.g.,
staff, space, funding)
Activities: What are you going to do? (e.g., educate and
establish partnerships)
Outputs: What will happen because of your activities? (e.g., 100
people trained)
Short-Term Outcomes: Immediate changes you expect to occur
(e.g., changes in knowledge)

3. Intermediate Outcomes: (e.g., changes in behavior)
Long-Term Outcomes: How will this program help in the future
(e.g., obesity prevention)?
Target Population (as identified by needs assessment):
Health issue affecting target population:
Theory or model used to inform an intervention:
Logic Model
Part 2 – Implementation Timeline and Action Plan
Develop a program timeline and action plan using a Gantt chart,
depicting the key tasks, activities and people involved in the
first 12 months (1 year) of implementing your program and the
projected timeframe for completion of each task. Use the
objectives you defined in Part 1.
Example:
Objective: By the end of the school year, district health

4. educators will have delivered lessons on tobacco refusal skills
to 90% of youth participants in the middle school tobacco
prevention curriculum.
Timeline for Tasks/Activities
Task/Activity
Personnel Responsible
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Train volunteers on curricula
Program coordinator
X
X
Deliver education classes
Volunteers

5. X
X
X
1. Complete the table below for your intervention (add rows, as
needed):
Objective 1:
Timeline for Tasks/Activities
Task/Activity
Personnel Responsible
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec

8. Objective 1:
Timeline for Tasks/Activities
Task/Activity
Personnel Responsible
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec

10. Objective 1:
Timeline for Tasks/Activities
Task/Activity
Personnel Responsible
Jan
Feb
Mar
Apr

11. May
Jun
Jul
Aug
Sep
Oct
Nov
Dec

13. Objective 1:
Timeline for Tasks/Activities
Task/Activity
Personnel Responsible
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec

15. Objective 1:
Timeline for Tasks/Activities
Task/Activity
Personnel Responsible
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug

16. Sep
Oct
Nov
Dec

18. Part 3 – Budget and Budget Justification
Review the "Program Budget Resource" to complete your
budget and justification. Identify a potential source of funding
for your project. Add or remove rows from the tables below, as
needed, to complete your budget.
Source of Funding:
1. Personnel
Staff Position
Yearly Salary
% of Time
Fringe Benefits
(as % or additional cost)
Total Amount
(Do not add fringe benefits twice.)

19. Total
1. Travel
Item
Description of Travel Event Expenses
Amount
Item 1
Item 2

20. Item 3
Total
1. Equipment
Equipment Item
Description
Amount
Total

21. Total
1. Supplies
Supply Item
Description
Amount
Total
Total

22. 1. Consultant
Consultant/
Organizational Affiliation
Services to Be Rendered and
Relevance to Service Project
Number of Days
Expected Rate of Compensation
Total
Total
1. Other
Item
Description
Amount or

23. Amount/Month
Total
Total
Total
1. Total Direct Costs
Budget Item
Total Amount
Personnel
Fringe

24. Travel
Equipment
Supplies
Contractual
Consultant
Other
Total
1. Budget Proposal and Justification
Write a 250-500 word justification for your budget. The
justification summarizes the resources needed and why. Provide
relevant rationale and evidence to support your summary.