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DocuSign Envelope ID: E85EF868-A4BB-49ED-96E1-165F3DADBAE4 XHIBIT 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 Program <br /> Activity, which should be SMART (Specific, Measurable, Achievable, Relevant, and Time- <br /> bound. Click on SMART Goa s 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 imeasureable <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 Community Education <br /> 1. Program Community Education: Present educational programs to youth and adults in <br /> Activit Name the community. <br /> Program Goal OCRCC will provide 1,030 programs to 15,400 individuals. <br /> Performance Program record sheets maintained and monitored by OCRCC education staff. <br /> Measures <br /> Previous Year In FY2015-2016, we provided education programs to 15,904 individuals in the <br /> Program Results communit . <br /> Current Year In FY2016-2017, we estimate that we will provide education programs to <br /> Estimated Results 15,000 individuals in the community. <br /> Next Year Projected In FY2017-2018, we estimate that we will provide education programs to <br /> Results 15,400 individuals in the communi <br /> 2. Program Safe Touch: Present Safe Touch educational programs in CHCCS, OCS, and <br /> Activit Name indesendent elementary schools. <br /> Program Goal At least 90% of teachers and counselors whose classrooms receive Safe <br /> Touch programs will report an increase in student awareness of personal <br /> safety and protection against sexual violence. <br /> Performance For each program within a school setting, the OCRCC will provide each <br /> Measures teacher and school counselor with an evaluation asking them to assess <br /> whether the program resulted in an increased awareness of personal safety 1 <br /> and protection against sexual violence among students. OCRCC staff will <br /> review evaluations periodically_and compile results biannually. <br /> Previous Year In FY2015-2016, 94.7% of teachers and counselors at schools that received <br /> Program Results OCRCC Safe Touch programs reported an increase in student awareness of <br /> sersonal safety and protection against sexual violence. <br /> Current Year In FY201612017, we estimate that at least 90% of teachers and counselors at <br /> Estimated Results schools that receive OCRCC Safe Touch programs will report an increase in <br /> student awareness of personal safety and protection against sexual violence. <br /> Next Year Projected in FY2017-2018, we estimate that at least 90% of teachers and counselors at <br /> Results schools that receive OCRCC Safe Touch programs will report an increase in <br /> student awareness of personal safety and protection against sexual violence. <br /> DO NOT SUBMIT THIS PAGE 1/30/2017 5:14:05 PM P q 2 1 i) I 22 <br />