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000 SWnsnvolopo|o: e8osB1 1 A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> 0M.\ 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 p jected 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 /> Information and Referral Information and Referral Information and Referral <br /> Service: Connects Service: Connects community Service: Connects <br /> community members with members with local resources community members with <br /> local resources and and services after local resources and services <br /> services after assessment assessment of need. after assessment of need. <br /> of need. Resource Resource database Resource database <br /> Program Activity 1 database maintained for a maintained for a multitude of maintained for a multitude of <br /> multitude of services. services. Follow-up services. Follow-up <br /> Follow-up conducted to conducted to ensure conducted to ensure <br /> ensure connection was connection was made and connection was made and <br /> made and additional additional resources provided additional resources provided <br /> resources provided as as needed. as needed. <br /> needed. <br /> 85%of clients will report <br /> they received the 85%of clients will report they 85%of clients will report they <br /> Program Goal information or help they received the information or received the information or <br /> requested in FY 14-15.At help they requested in FY 15- help they requested in FY 16- <br /> least 750 clients will be 16. At least 650 clients will be 17.At least 800 clients will be <br /> served. served, , served. <br /> At the end of the contact, <br /> all clients are asked At the end of the contact,all At the end of the contact, all <br /> Performance Measures whether they received the clients are asked whether clients are asked whether <br /> information or help they they received the information they received the information <br /> needed.These results are or help they needed. These or help they needed.These <br /> tracked. results are tracked. results are tracked. <br /> Program Results 95% 94% at Q2 85% <br /> --- ' <br /> Youth Interpersonal Youth Interpersonal Violence Youth Interpersonal Violence <br /> Violence Prevention Prevention Education Prevention Education <br /> Education Programs: Programs: Provide age Programs: Provide age <br /> Provide age appropriate appropriate dating violence appropriate dating violence <br /> Program Activity 2 dating violence and and bullying prevention and bullying prevention <br /> bullying prevention education sessions in 6th and education sessions in 6th and <br /> education sessions in 6e 8th grade health education 8th grade health education <br /> and 8m grade health classes. classes. <br /> education classes. <br /> Main Application 1/24/2016 2:59:42 PM Page 4 3 Of 58 <br />