Orange County NC Website
DocuSign Envelope ID: 571863E8-F892-43F0-B73F-4AB062ACBOBF XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Orange County Breakdown <br /> Chapel Hill Public Housing <br /> Town of Chapel Hill (Non-Public Housing) <br /> Town of Carrboro <br /> Town of Hillsborough <br /> City of Mebane (Orange County) <br /> Orange County (Outside Municipalities) 75 75 85 <br /> Total 385 295 420 <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 <br /> measures, and actual results. (Add more rows as needed) If this is a new program, <br /> you will only document the projected information. Every program is required to have <br /> AT LEAST 1 Program Activity, which should be SMART (Specific, Measurable, <br /> Achievable, Relevant, and Time-bound. Click on SMART Goals to learn more. <br /> • Program Activities should outline major activities the agency implements to <br /> accomplish its program goals. (i.e. Deliver meals to elderly/disabled residents.) <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 <br /> 1. Program Activity Specialized music therapy program that teaches <br /> Name communication and social/emotional skill building <br /> Program Goal Increase in students' social/emotional learning <br /> Performance Measures Percentage of students able to tell someone how they <br /> feel <br /> Previous Year Program 43% <br /> Results <br /> Current Year Estimated 47% <br /> Results <br /> DO NOT SUBMIT THIS PAGE 1/26/2017 11:10:15 AMIII'age 25 •r 31 <br />