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DocuSign Envelope ID:A13A145D-D67A-4FF7-ABA9-312E380D8DD9 <br /> EXHIBIT A <br /> PROVIDER'S 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 /> 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 Volunteers for Youth <br /> 1. Program Activity Name Mentoring <br /> Program Goal At least 80% of youth will complete their mentoring matches. <br /> Performance Measures Track client progress through contact with mentors and clients. <br /> Previous Year Program Results 98% of youth completed their mentoring matches. <br /> Current Year Estimated Results 90% of youth will complete their mentoring matches. <br /> Next Year Projected Results 85% of youth will complete their mentoring matches. <br /> 2. Program Activity Name Community Service <br /> Program Goal At least 80% of youth will have no new charges while in the <br /> program. <br /> Performance Measures Track client progress through contact with youth, court counselors. <br /> Previous Year Program Results 93% of youth had no new charges while in the program. <br /> Current Year Estimated Results 90% of youth will have no new charges while in the program. <br /> Next Year Projected Results 85% of youth will have no new charges while in the program. <br /> 3. Program Activity Name Teen Court <br /> Program Goal At least 80% of youth will have no new charges while in the <br /> program. <br /> Performance Measures Track client progress through contact with youth, court counselors. <br /> Previous Year Program Results 94% of youth had no new charges while in the program. <br /> Current Year Estimated Results 90% of youth will have no new charges while in the program. <br /> Next Year Projected Results 85% of youth will have no new charges while in the program. <br /> 4. Program Activity Name <br /> Program Goal <br /> Performance Measures <br /> Previous Year Program Results <br /> Current Year Estimated Results <br /> Next Year Projected Results <br /> PROGRAM INFORMATION 2/8/2017 10:03:24 AM 0 ' ago °" 8 00 22 <br />