Orange County NC Website
DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> **Please note that the actuals reported for 2015-2016 reflect all participant contacts through the <br /> program, The projected numbers reflect only those participants outlined in the program goals, <br /> however,we anticipate that we will meet or exceed the 2015-2015 figures in both 2015-2017 and <br /> 2017-2018. <br /> Work t <br /> m) Complete the Work Statement Chart to describe the work to e or . <br /> This chart is used to document program activities, program oals, performance measures, <br /> and actual results. more rows as needed) If this is new ra , you ill only <br /> document the projected information. Every program is required to have AT LEAST <br /> Program ctivity, which should SMART(Ssecific, Measurable, Achievable, Relevant, and <br /> Time-bound". Click on SMART Goad§to learn more. <br /> • Program iii should outline major activities the ency implements to accomplish its <br /> program oals. (Le. Deliver meals to elderly/disabled residents) <br /> O Program l should explain h t the program is hying to chi v / acco lis Goals are <br /> statements about h t the program should cco lis . (La Deliver 100 meals per day, <br /> Monday-Friday.) <br /> * Performance Measures escri a how you ill evaluate the degree in which you achieved <br /> the stated oals. (Le. Will track the number of meals delivered each clay.) <br /> • Actual r use program results to indicate the actual measureable <br /> achievement of o ls. If goals were not met, please explain. (i.e. Delivered an average of <br /> 105 meals per day) <br /> Work Statement Chart for Program Sexual 1 Education r c <br /> 1. Program ctivi Using the i ng a Responsible Tea curriculum, <br /> provide a dive group of teens with training aro issues <br /> of sexuality, a y relationships, a stM e <br /> contraceptive options, communication and ecisi - ki <br /> sills and goal setting. <br /> Program Goal Recruit at least 15 teens (ages 14— 16). All participants will <br /> demonstrate at least a 1 % increase in o 1 e about <br /> preventing r c Sib. <br /> Performance e res PPSAT will measure the competency vela of <br /> participants through pre- and post-program tests. The <br /> pre-test i t be administered at the beginning of the first <br /> session, the post-test will be administered <br /> immediately fo to r the conclusion of the program. <br /> Measurable outcomes include change in n le , <br /> attitudes, and behaviors. <br /> Previous r r Results ici is demonstrated a 10% increase i knowledge <br /> using pre ost testinameasurements. <br /> current Year Estimated Results All participants will demonstrate at least a 10% increase <br /> in knowledge about preventing pregnancy ls. <br /> Next Year Projected Results All a ici will str t. at least a 10% increase <br /> in le . about *r ve tin• .reline= and STIs. <br /> 2. Program ctiv Name Peer-educators ill work within their schools and <br /> PROGRAM INFORMATION 1/27/2017 3: <br />