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DocuSign Envelope ID:64D61581-25C0-4408-84C2-991109E2DF4C XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Orange County(Outside Municipalities) 30 30 <br /> Total 0 301 426 <br /> Work Statement <br /> I) 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: Food For the Summer <br /> 1. Program Activity Name Food For the Summer Meal Service <br /> Program Goal To provide healthy lunches on weekdays to children and youth in <br /> the CHCCS system who qualify for Free & Reduced Lunch <br /> throughout the entire summer break. <br /> Performance Measures Number of meal sites; Number of days served; Number of meals <br /> served; Number of volunteers engaged; <br /> Previous Year Program Results <br /> Current Year Estimated Results Meal Sites: 15 <br /> Days Served: 54 <br /> Total Meals Served: 48,145 <br /> Volunteer-delivered meals: 24,512 <br /> Volunteers engaged: 650+ <br /> Volunteer slots filled: 1,748 <br /> Next Year Projected Results Meal Sites: 15—20 <br /> Days Served: 54 <br /> Total Meals Served: 55,000 <br /> Volunteers engaged: 650—700 <br /> Volunteer Slots: 1,748—2,000 <br /> 2. Program Activity Name Food For the Summer— Literacy& Enrichment <br /> Program Goal To provide enrichment opportunities at meal sites <br /> Performance Measures #programs offered <br /> Previous Year Program Results <br /> Current Year Estimated Results Primarily volunteer driven; <br /> Fun buckets available daily at every site <br /> Distributed 3,500 books on "Free Book Wednesdays" <br /> Visits from police &fire department, Kidzu at a few sites <br /> PROGRAM INFORMATION 2/9/2017 10:30:46 AM Page 6i <br />