Qualtrics Survey | Qualtrics Experience Management

Share your experience with Level 4 evidence-based strategies!

The Ohio’s Evidence-Based Clearinghouse team is gathering information from educators across Ohio about how Level 4 evidence-based strategies are being used in schools and classrooms.

Use the form below to answer a few questions about what you are doing and how you are measuring your success. Note: you will need to upload a copy of your logic model.

Your responses will help the Ohio’s Evidence-Based Clearinghouse team and the Ohio Department of Education and Workforce create resources to support Level 4 implementation.

You may also be contacted by an Ohio’s Evidence-Based Clearinghouse team member to be featured on the Level 4 section of the Clearinghouse.

General Information

Name

Job Title

Organization

Email

What is the name of the school or district that implemented the Level 4 intervention?

What was the name/title of the Level 4 intervention the district/school selected?

Please provide a brief description of the intervention:

Please describe the process for selecting this intervention. What prompted the need for the intervention? How was the intervention identified? Who was involved in the selection process?

If there is a cost associated with this intervention, how much is it?

Please describe the implementation process. What did it look like in practice?

What were some unanticipated barriers your district/school encountered while planning for or implementing this intervention? How did your district/school address or overcome those barriers?

What outcomes have been identified as a result of implementing this intervention? Please describe any data sources used.

What advice or recommendations would you offer others who may be interested in implementing this intervention?

Please upload the logic model that guided your selection of this intervention (required).

Please provide any additional materials that may be helpful in telling your Level 4 story (optional).