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DocuSign Envelope ID:78F84828-4CC5-4A5B-B256-33C571A84687 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, and <br /> actual results. (Add more rows as needed) If this is a new program, you will only document <br /> the projected information. <br /> • Program Activities should outline major activities the agency implements to accomplish its <br /> program goals. <br /> O 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 /> o Performance Measures describe how you will evaluate the degree in which you achieved <br /> the stated goals. <br /> o Actual Program Results use program results to indicate the actual measureable <br /> achievement of goals. If goals were not met, please explain. <br /> Main Application 1/25/2016 11:54:37 AM Page 13 of 21 <br />