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Name:
Program Name:
E-mail:
Important Notes
This feedback paper provides you with guidance for completing your OLA pilot project.
Type your responses into the form and save it to your computer.
Label the file name with your programs name (e.g. “Portland Pilot Project”) – this label will help us
keep them straight as we receive them from all the programs.
As you prepare your responses, make sure that you have addressed each of the items in the checklist.
Each item must be adequately covered to receive credit for the activity.
If you are participating in OLA with other colleagues from your program, you are encouraged to
collaborate on the activity.
Checklist Response—October 15
1. ____Of all those possible Prioritized need or program component:
needs, our staff has
selected ONE for us to
use in the pilot. I listed it
to the right.
Checklist Response
Briefly describe where you looked for models or strategies that would address your targeted
component.
Checklist Response—November 15
3. ____ I identified all of the
sources we explored to
find models and
strategies that address
our program
improvement
component.
Briefly describe the promising practice (strategy, procedure, or practice) that the workgroup selected to
pilot. Include a description of any adaptations that were made to make the strategy “fit” your
program.
Checklist Response—December 1
3. ____ I included a
description of the new
strategies selected to
pilot test.
4. ____ I included a
description of the
adaptations we made to
the new strategy and the
rationale for those
adaptations.
Checklist Response—December 15
I included a description of:
What type of training was necessary for the pilot sites? Describe how this was provided.
Checklist Response—December 15
I included a description of:
Lead Person
Interim Completion Responsible for the
Benchmarks Activities Date Activity
Planning
Implementing
Evaluating
What do you anticipate your primary financial expenditures for the pilot project will be?
Checklist Response—January 1
I included a description of:
Checklist Response—March 1
1. ____ I included an overall
narrative of the results of
the pilot.
What changes, if any, would you make before you implement the new strategy program-wide?
Checklist Response
3. ____ I included a
description of specific
changes I needed to
make before
implementing program-
wide:
a. Policy changes
b. Budget changes
Checklist Response—March 14
1. ____ I included an
overview of what I
learned from this project.