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DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Work Statement <br /> I) Complete the Work Statement Chart to describe the work to be performed. <br /> Work Statement Chart for Program Boomerang <br /> 1. Program Activity Name Alternative to Suspension <br /> Program Goal 85%of students will successfully complete the alternative to <br /> suspension component <br /> Performance Measures School referral, daily attendance, qualitative notes on student <br /> participation and behavior, student External Service Note to <br /> schools/courts, internal service notes <br /> Previous Year Program Results 96% - 160 students out of 167 <br /> Current Year Estimated Results 85%- 128 out of 150 <br /> Next Year Projected Results 85% - 128 out of 150 <br /> 2. Program Activity Name Community Service <br /> Program Goal 50% (15/30)of youth will self-report learning/improving skills and <br /> will actively participate in Community Service projects <br /> Performance Measures Community service referral forms, daily timesheets, reports to <br /> Volunteers for Youth and Adult Community Service, youth surveys <br /> Previous Year Program Results 72% (#of youth completing at least 5 hours of community service <br /> in 2015-16); goal has since been revised. 1 2015-16, youth <br /> completed 720 hours of service. <br /> Current Year Estimated Results 50% <br /> Next Year Projected Results 50% <br /> 3. Program Activity Name What's Next? <br /> Program Goal 75%of youth attending What's Next?life skills workshops will <br /> report having significantly improved knowledge of subject area <br /> Performance Measures Post-session surveys <br /> Previous Year Program Results 86% (percentage of youth attending Boomerang's "What's Next?" <br /> workshops will complete at least 2 group sessions); goal has since <br /> been revised. In addition,16 individual youth participated in an 8- <br /> week What's Next? Entrepreneurship Development Workshop, <br /> provided by Boomerang for summer interns registered with <br /> EmPowerment's Career Explorers program; this was an in-kind <br /> contribution to an FSA partner. <br /> Current Year Estimated Results 75% <br /> Next Year Projected Results 75% <br /> 4. Program Activity Name Intensive Follow Up <br /> Program Goal 50%of youth (6/12) identified for intensive follow up services will <br /> show an increase in social connectedness (positive peers, family, <br /> school, community) by the end of the school year <br /> Performance Measures Readiness to Change scale, post-surveys, school/family feedback, <br /> decreased recidivism <br /> Previous Year Program Results 50% <br /> Current Year Estimated Results 50% <br /> Next Year Projected Results 50% <br /> P g 11 of 15 <br />