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DocuSign Envelope ID: 16AB4DFA-7125-42E6-B3E7-C6B53151B77C 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, <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 /> Actual Estimated Projected <br /> 2014-2015 2015-2016 2016-2017 <br /> Program Activity 1 <br /> Program Goal:Provide weekly Voices Together music therapy sessions for <br /> students in selected Orange County School Exceptional Children's classrooms <br /> resulting in an increase in students'verbal language and speech skills. <br /> Performance Measures: Precentage of students who are able to tell someone <br /> how they feel using verbal or visual cues. N/A 25% 25% <br /> Program Results <br /> Program Activity 2 <br /> Program Goal: Voices Together will promote learning in classrooms receiving <br /> weekly music therapy sessions by working to increase a student's ability to <br /> remain seated and engaged in a group setting,and teach positive coping skills <br /> students can use that will decreasing the number of emotional or physical <br /> outbursts. <br /> Performance Measures: Precentage of students who are able to use self- <br /> regulation/coping strategies 19% 25% 25% <br /> Program Results <br /> Program Activity 3 <br /> Program Goal:Voices Together will support the development of student's <br /> communication skills by increasing their ability to speak so others can <br /> understand them and in their ability to actively listen. <br /> Performance Measures: Precentage of students who are able to acknowledge <br /> others by using appropriate N/A 20% 20% <br /> Program Results <br /> Program Activity 4 <br /> Program Goal:Provide weekly Voices Together music therapy sessions for <br /> students in selected Orange County School Exceptional Children's classrooms <br /> resulting in an increase in students'verbal language and speech skills. <br /> Performance Measures: Precentage of students who will initiate verbal or non- <br /> verbal social conversation with peers. 50% 50% 50% <br /> Program Results <br /> Program Activity 5 <br /> Program Goal: Voices Together will promote learning in classrooms receiving <br /> weekly music therapy sessions by working to increase a student's ability to <br /> remain seated and engaged in a group setting,and teach positive coping skills <br /> students can use that will decreasing the number of emotional or physical <br /> outbursts. <br /> Performance Measures: Precentage of Students who can ask for help. 40% 45% 45% <br /> Program Results <br /> Main Application 1/25/2016 1:42:01 PM Page 1 5 • f 21 <br />