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DocuSign Envelope ID: DDOCFB62- 8EDD- 4B57- ACF6- 9C98BO78AA95 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 <br />Program Activity, which should be SMART (,2pecific, Measurable, Achievable, Relevant, and <br />Time- bound. Click on SMART Goalsto 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 Adult Literacy. <br />1. Program Activity <br />Fulltime student status <br />Name <br />Program Goal <br />60% of all students will receive 12 or more hours of <br />instruction <br />Tutors /instructors track collect student attendance and <br />Performance Measures <br />report this information monthly to Orange Literacy staff. <br />Data is tracked in LACES, an online database provide <br />and monitored by the NC Community College System. <br />Previous Year Program <br />63% (329 of 527) became fulltime students <br />Results <br />65% <br />Current Year Estimated <br />Results <br />Next Year Projected <br />'66% <br />Results <br />2. Program Activity <br />Post - testing <br />Name <br />60% of students who reach fulltime status will be post - <br />Program Goal <br />tested <br />Performance Measures <br />Students are pre- tested on entry into the program. <br />Students who reach the prescribed number of hours <br />according to the testing instrument CASAS or TABE <br />Previous Year Program <br />64% (212 of 329) of fulltime students were post- tested <br />Results <br />Current Year Estimated <br />65% <br />Results <br />PROGRAM INFORMATION 1/31/2017 10:54:56 AM P a g e 1 4 o f 2 6 <br />