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DocuSign Envelope ID: B701CF6A-1C9A-46CB-9234-56F771D80955 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> I.) 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 /> Main Application 5/24/2016 9:22:20 AM 0:' a g o 13 of 2o <br />