Prospective Client Intake Form - Evaluation and Learning
Thank you for reaching out to UBUNTU Research and Evaluation to provide your organization services. Research and Evaluation is a professional learning community run by black women who use liberation and beloved community frameworks to evaluate, facilitate, and strategize with individuals, organization and communities.
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What is the name of your organization? *
How many people are served by the program,  department, or organization in need of evaluation support? *
What is your overall program budget? *
What is the zip code of your organization's main address? *
Please share a link to your organization's website or other online presence. *
What is the full name of main point of contact? *
What is the main point of contact's title or position in the organization? *
What is the main point of contact's email address? *
What is the main point of contact's phone number? *
Please enter a 10 digit telephone number. ###-###-#### x###
Why have you decided to reach out to UBUNTU? *
Do you currently have part or full time evaluation support on staff? *
Is this request a part of a grant application? *
Please describe the key questions you want to evaluate. *
What questions are you looking to explore through this evaluation process.
How do you plan to utilize the results of this evaluation? *
Our goal is to provide an evaluation that gives you meaningful information that your organization can use.
When would you like to use the results of this evaluation? *
We want to get a sense of your timeline by backwards mapping. Let us know when you would like to share the results of this evaluation and that gives us an estimate of how much time is available to complete the evaluation.
What is your predicted timeframe for the evaluation process.
What is your budget range? *
Your estimated budget should be at least 20% of the program budget. If unknown, please provide relevant information that would determine the expense for your organization.
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