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DocuSign Envelope ID:64D61581-25C0-4408-84C2-991109E2DF4C XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> reported as <br /> homeless or <br /> stranded <br /> Total 4878 4672 4600 <br /> Work Statement <br /> z) 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 accomplish its <br /> program goals. (i.e. 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 FoodFirst <br /> 3. Program Activity Name Food Programs: Food Pantry <br /> Program Goal The Food Pantry will collect or purchase enough non- <br /> perishable food items to provide groceries as often as <br /> once per month to member households <br /> Performance Measures Community Services Director and Client Services Reps <br /> track number of bags of groceries and holiday dinners <br /> distributed <br /> Previous Year Program Results 13,393 bags of groceries and 773 holiday dinners <br /> Current Year Estimated Results 12,744 bags of groceries and 786 holiday dinners <br /> Next Year Projected Results 12,500 bags of groceries and 700 holiday dinners <br /> 4. Program Activity Name Food Programs: Community Kitchen <br /> Program Goal A hot, nutritious meal will be served to homeless <br /> residents and any hungry person who shows up at <br /> mealtimes at the Community Kitchen <br /> Performance Measures Kitchen Coordinator determines number of meals <br /> served by counting trays at the end of each meal <br /> service <br /> Previous Year Program Results 38,611 hot meals <br /> PROGRAM INFORMATION 1/31/2017 11:43:55 AM Page 25 of 35 <br />