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DocuSign Envelope ID: E865EBC7-DCBB-4CE6-A224-13D663E29E12 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION - .-,.......m <br /> Total I. .... 821 725 . ................._.............. 775 <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 /> document the projected information. Every program is required to have AT LEAST 1 <br /> Program Activity, which should be SMART(Specific, Measurable, Achievable, Relevant, and <br /> Time-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 met, please explain. (i.e. Delivered an average of <br /> 105 meals per day.) <br /> Work Statement Chart for Program: Self-Sufficiency Programs: Legal Information, Financial <br /> Education & Career Preparedness <br /> 1. Program Activity Name Legal Information: Provide accessible, understandable, and <br /> respectful free legal information to clients who cannot afford <br /> legal representation. Services include telephone <br /> appointments <br /> f ents with attorneys and legal workshops. <br /> Program Goal 85% ...., p attorneys f e. . . �. <br /> ° clients will report the information presented was <br /> helpful to their situation in FY 17-18. At least 50 clients will be <br /> served in legal workshops. <br /> Performance Measures Participants attending legal workshops are asked to complete <br /> an evaluation and results are tracked. <br /> Previous Year Program Results FY 15-16 Result: 98% <br /> Current Year Estimated Results FY 16-17 6-17 Goal: 85%, Estimated Result: 95% <br /> Next Year Projected Results FY 17-17 Goal: 85%, Pro`ecte� <br /> ed Result: 95% <br /> 2. Program Activity Name Legal Information: Provide accessible, understandable, and <br /> respectful free legal information to clients who cannot afford <br /> legal representation. Services include in-person <br /> appointments with UNC Law students (supervised by <br /> attorneys). <br /> �- -Program Goal . ... .._.... <br /> knowledgeable <br /> about their situation in FY 17-18. At least 30 client sessions <br /> s ons <br /> will be held. <br /> Performance Measures Individual...... �....,ee with <br /> s who meet with law students are asked to <br /> complete an evaluation and results are tracked. <br /> Previous Year Program Results FY 15-16 6 Result: 98% <br /> Current Year Estimated Results FY 16-17 Goal. 85%, Estimated Result: 95% <br /> PROGRAM INFORMATION 1/30/2017 4:02:21 PM II ,i ( 3 1 o 1 3 <br />