1. Target Population (Identify and describe the target population)

2. Health Issues (Identify and describe the health issues the program will address specific for this population

3. Proposed Interventions (Describe the components of your proposed program including physical and environmental determinants of health and strategies to target these determinants are explained)

4. Expected Outcomes (What outcomes are expected and how will this be measured)

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5. Levels of Prevention (Identify at least two levels of prevention addressed by this program and describe how specifically the program addresses each)

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6. Alignment: (Identify how the program aligns with the followingJ

a. A National Health Initiative (ie HP2020, National Brain Initiative)

b. A Behavior Change Model (ie Health Beliefs Model, Transtheoretical Model of Behavior Change)

7. Access, Quality and Safety (How are access, quality and safety addressed by the program and how does this align with PPACA?)

8. Communication and Marketing Plan (Describe how you will market the program including rationale)

9. Barriers for Implementation and Sustainability.

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