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DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 <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(lpecific, 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. (Le. 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: ECH Center for Employment and Leadership <br /> 1. Program Activity Name Day Laborer Project <br /> Program Goal 325 individuals will seek CEL for work-related services/assistance <br /> Performance Measures #of workers registered; #of employers registered; <br /> Previous Year Program Results 264 total individuals registered; 101 workers and 161 Employers <br /> Current Year Estimated Results 325 Goal; 145 total persons registered; 68 workers & 77 employers <br /> as of 12/31/16 <br /> Next Year Projected Results At least 325 <br /> 2. Program Activity Name Worker Education and Training <br /> Program Goal 100 individuals served <br /> Performance Measures # of individuals educated/trained; # of ind securing employment; # <br /> of ind reporting no loss in wages; # of ind reporting improved <br /> wages <br /> Previous Year Program Results 74 workers attended training <br /> Current Year Estimated Results 150 Goal <br /> Next Year Projected Results At least 100 <br /> 3. Program Activity Name Financial Literacy and Asset-Building Initiative <br /> Program Goal 75 individuals will receive financial literacy counseling <br /> Performance Measures #of individuals served <br /> Previous Year Program Results n/s; new goal <br /> Current Year Estimated Results 75 Goal <br /> Next Year Projected Results At least 75 <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 1/31/2017 3:16:25 PM Page 23 of 32 <br />