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DocuSign Envelope ID:8A1AB1 BF-ACDB-42A1-A3DE-9E9549E569B4 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> • Program Goal should explain what the program is trying to achieve/accomplish. <br /> Goals are statements about what the program should accomplish. (i.e. Deliver 100 <br /> meals per day, Monday-Friday.) <br /> • Performance Measures describe how you will evaluate the degree in which you <br /> achieved 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 met, please explain. (i.e. Delivered an <br /> average of 105 meals per day.) <br /> Work Statement Chart for Program: Donation Station Program <br /> 1. Program Activity Donation Station Program <br /> Name <br /> Program Goal Ensure that fresh produce is regularly urchased from <br /> local farmers and collected to donate to recipient <br /> agencies. We aim to feed 9,000 people, support 200 <br /> local farmers and collect 20,000 pounds of food. 1 <br /> Community Food Share site set up in Orange and <br /> serving 75 community members fresh food and <br /> education around fresh food. <br /> Performance Measures Number of people fed, number of farmers supported, and <br /> pounds of food collected. Pilot Community Foodshare <br /> site will run through scheduled time (June-October) and <br /> serve 75 individuals with fresh food. <br /> Previous Year Program 7,900 people fed, 150 number of farmers supported and <br /> Results 16,000 pounds of food collected. <br /> Current Year a ._...__...._.�........�. .��.... �__.........� ......_.....__...� .....____.... .................................................................................................. <br /> a_ Estimated 8,300 people fed, 200 number of farmers supported and <br /> Results 20,000 pounds of food collected. <br /> Next Year Projected 9,000 people fed, 200 number of farmers supported and <br /> Results 20,000 pounds of food distributed. As part of the pilot <br /> CFS project, we aim to set up 1 new site in Orange <br /> County where 225 individuals have access to fresh food <br /> purchasing through Wholesale Market, are provided <br /> education, and can host community meals/gatherings <br /> with community members. <br /> n) Program Budget- hull for Dummtahon Math m111111H l m mlmfim m:iiu <br /> 1. Submit your program budget. You may complete the provided template <br /> (separate xls file) or you may submit your own budget file (as long as it <br /> contains the same information, in the same format, as requested in the <br /> provided template). <br /> Page 16 of 20 <br />