Monsanto Fund: Program Goals, Objectives, and Outcomes Worksheet: SAMPLE FOR APPLICATION UPLOAD Please note, this is only a sample document (not a full program description) and is meant to illustrate how you might structure the proposed outcomes, activities, and anticipated results of your project or program.

Grant Applicants must complete the first five columns of this worksheet for APPLICATION UPLOAD. Grantees (who have already been awarded a grant) must complete the last column if you are submitting an IMPACT REPORT.

Instructions for APPLICATION UPLOAD: (for applicants submitting an application) For your application you must complete the first 5 columns of the Table below. (DO NOT COMPLETE THE LAST COLUMN- ACTUAL RESULTS) Please describe the long-term outcome and at least the top two (2) short-term outcomes for your overall proposed program, the specific total outputs for the grant period, and the w ays you intend to measure those outputs/progress towards outcomes. The Monsanto Fund looks for clear impact indicators that accurately reflect what is feasible and realistic given t he project plan, and the amount of funding requested. Please be specific about what your program plans to accomplish and detailed in your description of how you will assess the pro ject and its success. Please describe your outcomes with SMART in mind: Specific, Measurable, Achievable, Relevant, and Time-bound. -What is the overall change you are seeking? -Is the amount of change or benefit quantified? Is it clear how the change or benefit can/will be measured? -Is it specific? Is who or what is expected to change or benefit identified? -Is the location/level of where the change will occur identified (i.e. individual, community, school, etc)? -Given the program activities and amount of resources available, are the outcomes achievable and relevant to the program? -Is the timeframe noted for the anticipated change (i.e. six-week course or six-month intervention)?

Instructions for IMPACT REPORT: ( for grantees submitting an interim or final Impact Report )

For your impact report, you must complete the last column “Actual Results” on the Table below. As part of your application, you already completed the first 5 columns of the Table b elow and identified the short and long term program outcomes, and how you would measure progress against those outcomes. If you were not able to meet your proposed targets, please tell us why not. Adjust the template to the number of rows as appropriate to your program.

Name of Organization: SAMPLE – Food Program in South Africa Project Title: ELEMENTARY SCHOOL GARDENING AND NUTRITION EDUCATION PROGRAM Type of Data/ Data Collection Actual Results (FOR IMPACT REPORT Methods Anticipated Results (What were your ONLY) Key Activities or Strategies Primary Goal/ Long (How do you intend to track your target results when you started the (Please note the actual results you have Objectives/ Short you will use, and the Term Outcome(s): progress? Please tell us what project? i.e., # of people impacted, # of achieved to date. If you did not reach Term Outcome(s) TIMELINE of when information you will be collecting, events, quantifiable results of your your anticipated targets, please tell us activities will take place how you will collect, and when you activities, etc.) why the targets were not met.) will collect it). # of students, teachers, and volunteers participating (monthly participant lists/logs) Develop school gardens using At least 50 individuals will participate in developing # of schools that have a garden (program intensive gardening techniques and each school garden coordinator checklist) recycled materials (On-going, beginning early Spring 90% of project schools establish a garden and # of schools harvesting produce that is of project year) successfully harvest produce utilized in school lunches (bi-annual school reports) Increase the nutritional value of school lunches # of schools using produce (bi—annual through the incorporation school reports) of fresh produce from school gardens # of school meals per week that incorporate 70% of participating schools provide an average of produce (bi-annual school reports) two vegetables, three days per week in school Train school cafeteria workers to lunches by the end of year 2 incorporate produce from school # of workers trained (training list and test gardens scores) 75% of teachers and school food workers trained (4x’s per school year, each quarter.) score 75% of better on a post-training test on Improve nutrition and # of menu options developed (bi-annual gardening and nutrition topics increase food security for school reports) children and families in the Community Pre and Post test scores (after each training) Body Mass Index of sample of students tracked over the course of the project, Monitor nutritional status of Improve the nutritional indicating changes towards healthy weight children in the community 75% of children who are underweight at a baseline status of children in project (bi-annual school reports) (Ongoing, beginning at project start will increase their BMI by the end of year 2 schools date) Anecdotal evidence from teacher and parent feedback (bi-annual school reports) Incorporate nutrition and gardening education programs (and materials) Pre and Post participation tests for each Increase family food in schools via hands on games, program day security through enhanced 75% of participating children scored 60% or better songs, plays, drawings and other knowledge of gardening, on a year-end test on gardening and nutrition topics activities. # of children participating in schools tracked and the establishment of (On-going, at least 2x’s per month over time home gardens per participating school) Families will participate in hands-on garden training, food production and harvesting # of participants tracked over time 500 families will participate in training (On-going, at least 2x’s per month beginning early Spring)