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DocuSign Envelope ID:40C90B7F-D85F-4E1C-A5CA-4BC263526A8E t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Actual Estimated Projected <br /> 2014-2015 2015-2016 2016-2017 <br /> Referrals are made and Referrals are made and Referrals are made and <br /> the Meals on Wheels the Meals on Wheels the Meals on Wheels <br /> Coordinator follows up Coordinator follows up Coordinator follows up <br /> with an initial phone call with an initial phone call with an initial phone call <br /> and if qualifications are and if qualifications are and if qualifications are <br /> met, a home visit is made met, a home visit is made met,a home visit is made <br /> Program Activity 1 and meals are initiated. and meals are initiated. and meals are initiated. <br /> A total of 73 people will A total of 70 people will A total of 70 people will <br /> receive a home-delivered, receive a home-delivered, receive a home-delivered, <br /> nutritious meal five days a nutritious meal five days a nutritious meal five days a <br /> Program Goal week week week <br /> Information is recorded Information is recorded Information is recorded <br /> about dates of referral, about dates of referral, about dates of referral, <br /> interviews,and starting interviews, and starting interviews, and starting <br /> service as well as reasons service as well as reasons service as well as reasons <br /> for needing or for needing or for needing or <br /> discontinuing Meals on discontinuing Meals on discontinuing Meals on <br /> Performance Measures Wheels. Wheels. Wheels. <br /> Of the 66 individuals who Of the 70 individuals who Of the 70 individuals who <br /> received a home- receive a home-delivered receive a home-delivered <br /> delivered meal, 100% of meal, 100% of this fragile meal, 100%of this fragile <br /> this fragile population was population will be able to population will be able to <br /> able to remain in their remain in their own remain in their own <br /> own homes and maintain homes and maintain homes and maintain <br /> independence for as long independence for as long independence for as long <br /> as safely possible,other as safely possible, other as safely possible, other <br /> arrangements were made arrangements are made arrangements are made <br /> for their care,or their for their care, or their for their care, or their <br /> Program Results condition improved. condition improves. condition improves. <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 /> MarrAMpact0easures 5/25/2016 9:29:51 AM Pogo 15 of 22 <br /> Program Results <br /> Program Activity 5 <br />