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onnunign Envelope ID: 1**noenn-0o44-4Ao1*eec-3n4xFoecAc41 <br /> EXHIBIT <br /> PROVIDERS OUTSIDE AGENCY APPLICATION <br /> Work Statement <br /> m) Complete the Work Statement Chart to describe the work to be performed. <br /> This chart 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 /> docu/nentthe p �eohed/nfonna�on. Eve(yp/ognyrn /srmqu�edtohaveATLEA��TYFr7gna <br /> Activity, which should be SMART (Specific, Measurable, Achievable, Relevant, and Time- <br /> bound. Click on SMART Goals to learn more. <br /> • Program Activities should outline major activities the agency implements to accomplish its <br /> program goals. (i.e. Deliver meals to elderly/disabled residents.) <br /> • Program Goal should explain what the program is trying to achieve/accomplish. Goals are <br /> statements about what the program should accomplish. (i.e. Deliver 100 meals per day, <br /> Monday-Friday.) <br /> • Performance Measures describe how you will evaluate the degree in which you achieved <br /> the stated goals. (i.e. Will track the number of meals delivered each day.) <br /> • Actual Program Results use program results to indicate the actual measureable <br /> achievement of goals. If goals were not nnet, please explain. (i.e. Delivered an average of <br /> 105 meals per day.) <br /> Work Statement Chart for Program CCSA Child Care Scholarshi ramm <br /> - ' ----- <br /> Program Activity Name Eligibility Assessment, Selection and Enrollment of Families <br /> • Accept applications from Orange County families seeking <br /> assistance with child care for approximately 120 children birth to <br /> 12 years old. <br /> • Determine family-eligibility based on family income and activity <br /> requirements. Income requirements are based on median <br /> income levels for Orange County (as opposed to the state <br /> median income guidelines used by DSS). Families are required <br /> to be working, looking for work, or attending school/training <br /> programs. <br /> • Award scholarships based on enrollment priorities and program <br /> guidelines. Families are awarded scholarships based on <br /> greatest need (i.e., lowest income). Enrollment priorities include <br /> homeless families, teen porento, and children with special <br /> needs. Priorities also include children residing in the Family <br /> Success Alliance priority Zones 4 and 6 and families affiliated <br /> with UNC-CH. <br /> Program Goal Assist families in attaining and sustaining employment, education, <br /> and/or .obtnainin• b removin. barriers to child care <br /> Performance Measures 1. % of families receiving scholarship assistance because of <br /> employment, education or training needs (assessed through <br /> ongoing documentation and data tracking, per child, of <br /> parental activities and child care need) <br /> 2. % of families who report that child care scholarship assistance <br /> enabled employment, education or training (assessed through <br /> annual evaluation surveys conducted on sample of families <br /> each spring) <br /> Previous Year Program Measure 1: 9796 Measure 2: 99% <br /> Results <br /> Current Year Estimate |' K8easuns1: 90Y6 Measure 2: 90% <br /> PROGRAM INFORMATION 1/27/2017 8:51:47AM P 8 1 5 <br />