Lampiran 2: Borang Pelaporan Impak
LAPORAN IMPAK JARINGAN KOMUNITI (PENARAFAN BINTANG)
COMMUNITY ENGAGEMENT IMPACT (STAR RATING) REPORT
NOTES:
1. At the end of a project, successful applicant must deliver:
i) A final report in two formats:
a) Adobe Reader (.pdf)
b) Microsoft Word (.doc)
ii) Pictures or Short videos of activities (2 minutes) copied in CD (if any).
2. A project has to achieve a minimum of three (3) Star Community Engagement (CE) Impact Rating in order to
contribute to MyRA performance. Thus, it needs to meet 3 minimum requirements:
i) The community should have a positive orientation towards the programme where the attendance
exceeds or equal to 80% from the targeted number of participants.
ii) A minimum of one (1) stakeholders’ involvement either Government Agencies, Industries, Civil
Society, NGOs, Learning Institutions, etc.:
a) Provide evidence that the community consider the programme relevant and needed.
b) Provide a formal university-community cooperation agreement.
iii) The participants exhibit the expected changes based on the objectives of the programme such as
change of attitude or increment of knowledge / skills or aspirations.
3. Additional requirements to achieve four (4) or five (5) Star CE Impact Rating:
i) The programme results in change of practice where the participants adopt the innovations that
were introduced (4 Star).
ii) The community is empowered and independently able to sustain the practices that were
introduced through the programme without UiTM’s assistance (5 Star).
4. Please note that all information will be kept confidential and will ONLY be used for university reporting.
INSTRUCTION:
1. Please fill in all required information in Table A, B, C, D, E, F, G, H and I.
2. Please note that evidence such as participant attendance list, interview question, questionnaire, video, SMS
/media social comment/ phone screenshot etc. are required for every rating level.
A PROJECT / PROGRAMME AREA OF EXPERTISE
Environmental Development
Health
ICT & Technology
PROGRAMME AREA OF EXPERTISE Entrepreneurial
Please tick (√) ONLY ONE area of Education
expertise in the space provided. Risk Management & Disaster Assistance
Preserve Heritage and Culture
* CE areas of expertise are Sports and Recreation
extracted from Minister of Higher Social Welfare
Education - UCTC Award Rural Development
Edu-Tourism
Art & Design
Others (Please specify):
Capacity Building
FOCUS AREA
Social Entrepreneurship
You may tick (√) more than 1 Improving Livelihood
focus area. Environmental Sustainability
Education Enhancement
Others (Please specify):
B BASIC INFORMATION
1. PROGRAMME TITLE
2. PROGRAMME ID.
Research Name :
RELATED RESEARCH PROJECT
3. Project No. :
NO. (Relate the current programme / activities to the research has been done previously)
PERIOD OF PROJECT Start End Duration
4.
EXECUTION Date: Date by Month:
5. LOCATION
C PROJECT COMMITTEE
6. PROJECT LEADER’S NAME
7. STAFF NO.
8. POSITION
9. FACULTY / DEPT / PTJ
10. MOBILE NO. EMAIL:
11. PROJECT MEMBERS’ NAMES Name / Staff No. PTJ / Faculty / Institution
(List the names, title, faculty; 1.
multi-disciplinary and 2.
institutional members)
3.
4.
*If the project has more than 8
members, please attach a 5.
separate committee list. 6.
7.
8.
D PROJECT BASIC INFORMATION
12. PROJECT
EXECUTIVE SUMMARY
(Overview of the project /
programme – maximum 300
words, in Arial font size 9 pt.)
13. OBJECTIVE i.
Specify the objectives;
ii.
(Minimum 3 objectives).
iii.
14. JUSTIFICATION
i) Provide a justification on the
needs to conduct the
programme.
ii) Specify the intellectual /
physical / energy resources of
the university to solve the
problem faced by the
community.
15. METHOD
Research design, sampling
technique, instrument,
analysis technique.
16. ACTIVITY
Identify / Plan / Implement /
Evaluate.
Example:
1. Meeting with stakeholders
2. Site visit
3. Conduct the programme / lab
E STAKEHODER / COMMUNITY INFORMATION
17. TARGETED PARTICIPANT
Who they are / why they are
chosen / number of people
involved.
Example:
1. SPM students or youth aged 16-
26
2. Focus group: SPM students; 200
participants
18. UiTM Student Stakeholder
ACTUAL NUMBER OF UiTM Staff Government Agency
PARTICIPANTS INVOLVED
DURING THE PROGRAMME Community Industry
Learning Institution NGO
COLLABORATIVE PARTNER (multi-stakeholders)
i. List the collaborative partners and their roles
ii. State approximate value of collaboration partners’ contribution in Ringgit Malaysia (RM).
iii. Provide evidence such as contribution letter, bank transfer, cheque etc.
19. Contribution (RM)
Name of Collaborative Partner
In kind Gift Monetary Facility Equipment Others
Government Agency:
e.g.: FELDA
Industry:
e.g.: IOI PROPERTIES
Civil Society:
e.g.: PPRT Ayer Panas
University/ Learning
Institution: e.g.: UKM
NGO:
e.g.: Buku Jalanan
Total Project Cost (RM)
F PROGRAMME ASSESSMENT
20. Analysis based on questionnaire / observation / interview (before and after the programme is conducted)
BEFORE AFTER
The community consider the programme relevant & An assessment is carried out right after the programme
needed. is conducted.
A formal university-community cooperation agreement The participants exhibit the expected changes based on
exists. the objectives of the programme such as change of
attitude or increment of knowledge / skills / aspirations.
21. PROJECT OUTCOME
Example*:
i. Facility / Tools / Equipment / Machinery / System
invented for the community
ii. MOU / MOA / LOI / IP
iii. Award
(*Please provide evidence for the project outcome)
22 IMPACT OF THE PROGRAMME
Indicate the project's impact on / or:
i. The community, the students and the lecturers
involved.
ii. The number of beneficiaries directly/indirectly
involved.
iii. The frequency of yield
iv. Time frame for yield output
v. Monetary output
vi. Economic benefits due to the change
vii. Impact to the community
23 SUSTAINABILITY VALUE FOR THE COMMUNITY
Provide evidence for the following:
i. The community can independently sustain the
practice that was introduced through the
programme.
ii. Benefit the community who continue the practice
/ change and improve their well-being (after 3 / 6
/ 8 / 12 months of programme completion)
iii. The potential to replicate project to other
interested community.
COMMUNITY TRANSFORMATION IMPACT STAR RATING FORM
G
(This Impact evaluation of the programme has to be done at the end of the programme)
RATING LEVEL
1. STAR RATING (Programme Acceptance)
The community has a positive orientation towards the programme.
An attendance exceeds or equal to 80%
*Evidence Star rating 1: Attendance List
Targeted attendance people
Actual attendance people
Percentage %
2. STAR RATING (Meeting Community Needs)
The community consider the programme relevant and needed.
A formal university-community cooperation agreement exists.
Stakeholders generally agree to the implementation of the programme.
*Evidence Star rating 2: Questionnaire / Interview Questions
Number of participants who indicated that the programme is needed people
Total number of participants people
Percentage of participants indicating programme is needed %
3. STAR RATING (Knowledge, Aspiration, Skills or Attitude Change)
The community action programme results in change in attitude/knowledge/skills or
aspirations.
Participants exhibit a change in attitude, knowledge, skills and/or aspiration.
*Evidence Star rating 3: Interview transcription, Survey form & analysis
Number of participants who indicated they know the subject matter people
Number of participants who responded positively to the change people
Number of participants who showed they have acquired the desired skills people
Number of participants who wanted to adopt the innovation people
Total number of participants %
4. STAR RATING (Adoption of Change)
The community programme results in a change of practice.
Participants adopted the innovations that were introduced
*Evidence Star rating 4: Interview transcription, observation
checklist & analysis
Number of participants who adopted the change people
Total number of participants people
Percentage of change adoption %
5. STAR RATING (Sustainability)
The community is empowered and can independently sustain the practice that was
introduced through the programme.
Participants continue to practice innovations without UiTM’s assistance
*Evidence Star rating 5: Report, observation checklist & analysis
Number of participants who continue to practice change people
Number of participants who received economic benefits due to change people
Number of participants who have improved their well-being people
Total number of participants people
Percentage of participants who continue to practice change %
Percentage of participants received economic benefits due to change %
Percentage of participants who have improved their well-being %
Average Percentage of sustainability %
H PROJECT LEADER DECLARATION
I have duly completed this form and attached the relevant supporting documents:
Please tick (√) the box and circle relevant document.
1. Programme Impact in the form of:
Star Rating 1: Attendance List
Star Rating 2: Questionnaire / Interview Questions
Star Rating 3: Survey Form, Interviews Transcription & analysis
Star Rating 4: Observation Checklist, Interview Transcription & analysis
Star Rating 5: Report, Observation Checklist & analysis
2. Media coverage / Publication in the form of:
Newspaper articles, Magazine,
Media links / blogs / Web page / Facebook
Brochures / pamphlet
3. Contribution / Funding:
RM - Copy of Bank Slip / Cheque / EFT
Letter / Note / E-mail indicating the contribution in the form of in-kind / Gift / Facilities / Equipment
4 Collaborative Partners:
MOA / MOU / LOI / LOC
Invitation Email / Letter / Certificate of Appreciation / Thank you letter
5. Additional Documents
Photographs before, during and after the implementation of the Community Programmes
End Report of the project / activities
URL of a short video of footage before and after the implementation of project / activities (maximum 2
minutes) (not compulsory)
I hereby declare that the information and documents provided are true and correct.
Date: Signature:
Stamp:
I DEAN/ DEPUTY DEAN (RESEARCH & INNOVATION)
This project has achieved at least 80% rating for dimension:
1. Programme Acceptance
2. Meeting Community Needs
3. Knowledge, Aspiration, Skills or Attitude Change
4. Adoption of Change
5. Sustainability
I hereby verify that the above information is true and correct to the best of my knowledge.
Name: Signature:
Date: Stamp:
J MyRA SECRETARIAT APPROVAL
Overall score:
Review:
Name: Signature:
Date: Stamp:
