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DocuSign Envelope ID:B32F3E9 3514F2E575e [ /\- 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, and <br /> actual results, (Add more rows as needed) If this is a new progranl, 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 /> • 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 P <br /> rojected <br /> 2D14 ��1� 2015-2016 �O1G ��17 <br /> ' - ' <br /> Partner with local Partner with local Partner with local <br /> schools, after school schools, after school schools, after school <br /> centers, non-profits, centers, non-profits, centers, non-profits, <br /> Town Housing Town Housing Town Housing <br /> Departments, etc. to Departments, etc. to Departments, etc to <br /> provide food weekly to provide food weekly to | provide food weekly to <br /> local kids through our local kids through our local kids through our <br /> Weekend Meal Weekend Meal Weekend Meal <br /> Program Activity 1 1 Backpack P Backpack Program. Backpack Program. <br /> Provide up to 400 kids Provide up to 500 kids Provide up to 600 kids <br /> with healthy food at with healthy food at with healthy food at <br /> least 34 weeks of the least 34 weeks of the least 40 weeks of the <br /> Program Goal year year year <br /> TABLE maintains a TABLE maintains a TABLE maintains a <br /> Current Numbers Sheet Current Numbers Sheet Current Numbers Sheet <br /> of children we serve of children we serve of children we serve <br /> every single week. We every single week. We every single week. We <br /> will use this to will use this to will use this to <br /> determine how many determine how many determine how many <br /> Performance Measures kids are served. kidoaresen/ed� � kids are served. <br /> ------ -- -- ---- <br /> VVenoetourgoa| of We hope to meet our <br /> We met our goal in serving 500 kids in goal by December <br /> Program Results February 2015. October 2015 2016. <br /> - ' --- ---------- <br /> Main Application 1/25/2016 11:34:49 AM P @ c; 8 1 2 0 f 2 1 <br />