SayPro Case Study Program Selection Form

SECTION A: General Information

1. Title of Case Study:
   [Enter proposed title]
2. Date of Submission:
   [DD/MM/YYYY]
3. Submitted By (Name & Department):
   [Full name, SayPro unit or office]
4. Contact Details:
   Email: [] | Phone: []

SECTION B: Case Study Focus

5. Primary Theme (Select one):
   • ☐ Gender Inclusion
   • ☐ Youth Empowerment
   • ☐ Rural Development
   • ☐ Digital Transformation
   • ☐ Health Program Implementation
   • ☐ Entrepreneurship & Enterprise Support
   • ☐ Education & Training
   • ☐ Environmental Sustainability
   • ☐ Other: ________________
6. Secondary Themes (Select up to 2):
   • ☐ Community Engagement
   • ☐ Monitoring & Evaluation
   • ☐ Public-Private Partnerships
   • ☐ Innovation
   • ☐ Cultural Inclusion
   • ☐ Social Impact
   • ☐ Infrastructure
   • ☐ Policy Influence
   • ☐ None

SECTION C: Case Study Description

7. Program/Project Name:
   [Full name of the SayPro program or initiative]
8. Implementation Location(s):
   [Province, District, Town/City, Country]
9. Start and End Date of Program:
   Start: [MM/YYYY] | End: [MM/YYYY or “Ongoing”]
10. Target Beneficiaries (check all that apply):
    • ☐ Women
    • ☐ Youth (15–35)
    • ☐ People with Disabilities
    • ☐ Rural Households
    • ☐ LGBTQIA+ Individuals
    • ☐ Entrepreneurs
    • ☐ Migrants
    • ☐ Other: _______________
11. Short Summary (max 100 words):
    [Describe the focus, objectives, and scale of the case study]

SECTION D: Evidence and Outcomes

12. Type of Case (Select one):
    • ☐ Success Story
    • ☐ System-Level Insight
    • ☐ Learning from Failure
    • ☐ Comparative Analysis
    • ☐ Pilot/Innovation Trial
    • ☐ Other: _______________
13. Evidence Source(s):
    • ☐ Field Observations
    • ☐ Interviews
    • ☐ Monitoring Reports
    • ☐ Surveys
    • ☐ Focus Group Discussions
    • ☐ Financial Records
    • ☐ Other: _______________
14. Key Achievements or Insights (max 150 words):
    [Highlight at least one significant outcome or insight]
15. Challenges or Lessons Learned (max 150 words):
    [Describe major challenges or opportunities for learning]

SECTION E: Documentation & Consent

16. Are relevant documents available?
    • ☐ Yes
    • ☐ No
    • If yes, list attached or linked documents: _______________
17. Have all participants signed consent forms for data and image use?
    • ☐ Yes
    • ☐ No
    • ☐ Not Applicable (no direct participants)
18. Photos or media included:
    • ☐ Yes
    • ☐ No
    • Notes: _______________________

SECTION F: Reviewer Use Only

19. Reviewed By:
    [Name & Role]
20. Date Reviewed:
    [DD/MM/YYYY]
21. Recommendation:
    • ☐ Approved for Publication
    • ☐ Needs Revisions
    • ☐ Not Suitable
22. Reviewer Notes:
    [Observations, improvement suggestions, or concerns]