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DocuSign Envelope ID: EA54395E-EA79-461 B-8A4A-AODF56E9A02D <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Work Statement Chart for Program Caregiving Collaborative <br /> 1. Program Activity Name Volunteer Companion Care <br /> Program Goal Provide companionship, escorted medical transportation, in home <br /> assistance, meal preparation and respite care to a minimum of 160 <br /> Orange County low income seniors. <br /> Performance Measures We will track the number of scheduled visits along with tasks <br /> performed in each visit. <br /> Previous Year Program Results Over 150 clients were provided these companion care services. <br /> Current Year Estimated Results 160 or more clients will be provided these companion care services. <br /> Next Year Projected Results 180 clients will be provided these companion care services. <br /> 2. Program Activity Name Pre Health Internship <br /> Program Goal Train and assign 40 pre health interns to Orange County seniors in <br /> need of companion services, with the goal of enhancing future <br /> practitioner's understanding of the realities of aging in our culture. <br /> Additionally, working to connect these interns to the greater <br /> community and impact their long term views on aging and service. <br /> Performance Measures We will be conducting a pre and post test to gauge the understanding <br /> and empathy levels of participating interns. <br /> Previous Year Program Results 35 pre health interns participated in this program last year. <br /> Current Year Estimated Results 40 pre health interns will participate in this program. <br /> Next Year Projected Results 40 pre health interns will participate in this program. <br /> 3. 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 /> 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 3:19:07 PM <br />