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DocuSign Envelope ID: 78F206FF-A138-4129-88A7-AC03812E2BD1 <br /> E"6T'L'gffi'Y]'9�"A" .. <br /> Sc99od�pYYeB��oDDfi SertvYices.—FY 2015-16 <br /> Outside Agency Performance Agreement <br /> Agency Name:. The Art Therapy Institute,knc. <br /> Program Name: The Burma Art Therapy Project <br /> Funding Award: $1,000 <br /> Outline how the agency will spend Orange County's funding award. <br /> Ex ense Description Amount <br /> 10 art therapy groups $1,000 <br /> Program Services <br /> For assistance with this or the following section, please reference the Exhibit A instructions and example, located within the I <br /> contract and reporting memorandum. Outline the major activities the agency will employ to attain the Anticipated Outcomes <br /> below,by June 30,2016. <br /> ® Provide 1 art therapy group for 10 weeks to refugees in Orange County <br /> Anticipated Outcomes <br /> The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange <br /> Con , k (all Towns and municipalities). If you use percentages, you must also provide the total number of participants <br /> within that measure's description or for an earlier performance measure. <br /> Performance Measures Anticipated <br /> Results. <br /> From baseline to follow-up,40%of participating children will experience fewer emotional 4Q/ <br /> difficulties measured by SDQ(4 out of 10 children) <br /> From baseline to follow-up,40%of participating children will experience fewer`peer difficulties, 40°r, <br /> as measured by SDQ(4 out of 10 children) <br /> DocuSigned by: - <br /> �VtSRV1 UvIbly <br /> 4F1D6BCA1753408... <br /> Certified <br /> {Provider's Signature} <br />