Local Health Department:
Program Area(s):(may choose multiple):
Individuals/Target Audience:(may choose multiple) (the who)
Title of Success Story:(capture overall message of story; include action verb; capture reader attention)
Setting:(when/where this took place)
Overview of Problem, Issue, Challenge, Opportunity:(the why; obstacle, barrier, problem)
Project Objective:(the what)
Project Activities/Intervention:(the how; describe key activities that were critical to success)
Key Partners:(list partners who contributed to your success)
Accomplishments, Evaluation, Outcome, Impact: (the what; measurable or concrete evidence ofchange; how this success story helps us demonstrate need or measure success)
Lessons Learned:(describe what you learned; barriers/challenges and how you overcame, changes you made as a result of what was learned)
Contact Information:(name and/or agency, address, website, etc.)