<p> Summit Endowment 2018 Healthy People 2020 ACI Grant Logic Model</p><p>Name of Grant: Organization: Application Date: </p><p>PROBLEM/NEED STATEMENT: </p><p>PROGRAM GOAL(S): </p><p>Resources What resources do we have to work with?</p><p>Activities Outputs Short-term Outcomes Intermediate Outcomes Long-term Outcomes</p><p>What are we going to do? What are the tangible products What changes do we expect to What changes do we want to What changes do we hope to of our activities? occur within the short term? see occur after that? see over time?</p><p>Page 1 of 3 Summit Endowment 2018 Healthy People 2020 ACI Grant Logic Model</p><p>Name of Grant: Organization: Application Date: </p><p>Activities Outputs Short-term Outcomes Intermediate Outcomes Long-term Outcomes</p><p>What are we going to do? What are the tangible products What changes do we expect to What changes do we want to What changes do we hope to of our activities? occur within the short term? see occur after that? see over time?</p><p>Page 2 of 3 Summit Endowment 2018 Healthy People 2020 ACI Grant Logic Model</p><p>Name of Grant: Organization: Application Date: </p><p>Activities Outputs Short-term Outcomes Intermediate Outcomes Long-term Outcomes</p><p>What are we going to do? What are the tangible products What changes do we expect to What changes do we want to What changes do we hope to of our activities? occur within the short term? see occur after that? see over time?</p><p>External Factors: Assumptions: Facts or conditions you assume to be true. What could have an influence on our work that we may not be able to control?</p><p>Describe any potential unintended negative consequences.</p><p>Page 3 of 3</p>