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DocuSign Envelope ID:E519448F-9F6D-4100-BF62-D7625621FFEB XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Town of Chapel Hill (Non-Public Housing) 918 507 519 <br /> Town of Carrboro 461 427 449 <br /> Town of Hillsborough 10 <br /> City of Mebane (Orange County) 61 74 <br /> Orange County(Outside Municipalities) 185 <br /> Total 1564 995 1,052 <br /> *Do not currently collect data on public housing differentiation <br /> Work Statement <br /> O 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 document <br /> the projected information. Every program is required to have AT LEAST 1 Program Activity, <br /> which should be SMART(Specific, Measurable, Achievable, Relevant, and Time-bound. Click <br /> on SMART Goals to learn more. <br /> O Program Activities should outline major activities the agency implements to accomplish its <br /> program goals. (La Deliver meals to elderly/disabled residents.) <br /> O 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 /> O 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 Transplanting Traditions Community Farm <br /> 1. Program Activity Name Workshops in Sustainable Agriculture <br /> Program Goal Decrease food insecurity in the refugee and low-wealth communities <br /> in Orange County(80% of participants will report a decrease in food <br /> insecurity) <br /> Performance Measures Surveys, interviews, number of individuals served, number of <br /> workshops <br /> Previous Year Program Results 100% of participants will report a decrease in food insecurity <br /> Current Year Estimated Results 100% of participants will report a decrease in food insecurity <br /> Next Year Projected Results 100% of participants will report a decrease in food insecurity <br /> 2. Program Activity Name Share a Share <br /> Program Goal Decrease food insecurity in the refugee and low-wealth communities <br /> in Orange County(80% of participants will report a decrease in food <br /> insecurity) <br /> Performance Measures Surveys, interviews, number of individuals served <br /> Previous Year Program Results 118 refugee families served through Share a Share <br /> Current Year Estimated Results 118 refugee families served through Share a Share <br /> Next Year Projected Results 118 refugee families served through Share a Share <br /> PROGRAM INFORMATION 1/31/2017 3:59:06 PM Page 15 of 18 <br />