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DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Work Statement <br /> j) 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- To provide staff and upkeep for the Burwell School Historic <br /> Site and offer experiences and opportunity for visitors and provide them with safe conditions and <br /> the site be open and available for visitors and residents to learn about history and participate in <br /> hands on experiences and enrich themselves with cultural history and ways of life for residents in <br /> Hillsborough and students who attended the Burwell School in earl vs to mid 1800s. We provide <br /> inspiration to visitors who learn about individuals such as The Burwell Family and students of the <br /> Burwell School including slave girl Elizabeth Keck ly and the Collins Family. <br /> PROGRAM INFORMATION 1/31/2017 4:15:48 PM q e 1 6 o f 2 2 <br />