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DocuSign Envelope ID:6CD4A528-52AE-410E-B18B-BA619068A9AB t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> m.) Work Statement <br /> This form is used to document program activities, program goals, performance measures, <br /> and actual results. (Add more rows as needed) If this is a new program, you will only <br /> document the projected information. <br /> • Program Activities should outline major activities the agency implements to accomplish its <br /> program goals. <br /> • Program Goal should explain what the program is trying to achieve/accomplish. Goals are <br /> statements about what the program should accomplish. SMART Goals <br /> • Performance Measures describe how you will evaluate the degree in which you achieved <br /> the stated goals. <br /> • Actual Program Results use program results to indicate the actual measureable <br /> achievement of goals. If goals were not met, please explain. <br /> Actual Estimated Projected <br /> 2014-15 2015-16 2016-17 <br /> Program Activity 1 MEDIATION MEDIATION MEDIATION <br /> Program Goal 650 660 650 <br /> Performance Measures Served in mediation Served in mediation <br /> Program Results 639 672 <br /> Program Activity 2 <br /> Program Goal <br /> Performance Measures <br /> Program Results <br /> Program Activity 3 <br /> Program Goal <br /> Performance Measures <br /> Program Results <br /> Program Activity 4 <br /> Program Goal <br /> Performance Measures <br /> Program Results <br /> Activity 5 <br /> Program Goal <br /> Performance Measures <br /> Program Results <br /> Main Application 5/24/2016 9:47:14 AM 0 I:° 15 of 23 <br />