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DocuSign Envelope ID:88377437-EE99-4E08-B6B1-CD4F113C0672 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Current Year Estimated Results 100% of athletes will perform a skills test during each season. <br /> Next Year Projected Results 100 %of athletes will perform a skills test in each season and will <br /> record growth between seasons. <br /> 2. Program Activity Name Boccia Personal/Social Development: Goal Cards <br /> Program Goal Practice will be structured to provide an avenue for social <br /> development: communication, self-understanding, and the <br /> opportunity for community engagement. <br /> Performance Measures Participants will create goal cards outlining academic, personal, <br /> skills, and team goals which will be checked every four weeks to <br /> evaluate progress and outcomes. <br /> Previous Year Program Results 100%Athletes created, maintained and completed season-end <br /> analysis of goal cards. <br /> Current Year Estimated Results 100%Athletes will create, maintain and compete season-end <br /> analysis of goal cards. <br /> Next Year Projected Results 100%Athletes will create, maintain and complete season-end <br /> analysis of goal cards and records growth between seasons. <br /> 3. Program Activity Name Boccia Participants <br /> Program Goal Increase number of participants <br /> Performance Measures We will increase athlete participation by 5-7 individuals as we <br /> partner with local schools through our school initiative campaign <br /> and by targeting a new age demographic with the Durham VA. <br /> Previous Year Program Results <br /> Current Year Estimated Results 5-7 new athletes are recruited to boccia program <br /> Next Year Projected Results 5-8 new athletes are recruited to boccia program <br /> 4. Program Activity Name Boccia Tournaments <br /> Program Goal Tournaments are organized to apply sport specific skills and team <br /> solidarity. <br /> Performance Measures Host 1-2 local tournaments in the Triangle area to facilitate social <br /> networking and physical competition among peers with similar <br /> disabilities. <br /> Previous Year Program Results Hosted 1 tournament in Triangle are while assisting with external <br /> local and national competitions. <br /> Current Year Estimated Results Host 2 tournaments in Triangle area; 15 athletes served; 20 college <br /> students volunteer; bring awareness to 30 community members. <br /> Next Year Projected Results Host 2 tournaments &one clinic in Triangle area; 20 athletes <br /> served/25 students volunteer; bring awareness to 35 community <br /> members <br /> PROGRAM INFORMATION 1/27/2017 3:48:29 PM Pago 15 of 2G <br />