Orange County NC Website
Browse       Search
DocuSign Envelope ID: FCA96EA6-6080-4E8E-8EFF-B03ECA597827 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Geographic Location <br /> ,I,MVPMMVP,,,M71,TIOMM,,",,,, irin ininiiiininnnnornin mini, <br /> Alamance Count 1 <br /> iinnnininian*M...iniann n Si maw, (........M . Mr6v,./ <br /> ''..1 <br /> Chatham Count!) <br /> ! <br /> 1 1 <br /> Durham Count!, 382 ! 400 <br /> Wake Count , ! <br /> Orange County Breakdown 71 90 <br /> - , <br /> Chapel Hill Public Housing <br /> . ......... , <br /> Town of Chapel Hill (Non-Public Housing 10 10 <br /> _.. <br /> Town of Carrbors 15 <br /> ! 20 <br /> VinOnn,iiiiiii.nnininVII 0 n,,, 1...Min _ <br /> Town of Hillsboroug 5 <br /> City of Mebane(Orange County <br /> 1 <br /> Orange County(Outside Municipalities!' ! <br /> Total 0 453 490 <br /> Work Statement <br /> d) 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 <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 meals <br /> per day, Monday-Friday) <br /> • Performance Measures describe how you will evaluate the degree in which you <br /> achieved the stated goals. (L 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 /> PROGRAM INFORMATION1/26/2017 14:54:11 a1/p1 Pa g e 18 o f 22 <br />