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DocuSign Envelope ID: 134C4810- 3CA5- 4008- 9E74- 2A07D3AECED8 <br />EXHIBIT A - PROVIDER'S OUTSIDE AGENCY APPLICATION <br />PROGRAM INFORMATION 2/9/2017 1:51:06 PM Page 20 of 26 <br />resume writing, benefit counseling and goal - planning. <br />We hold a weekly employment support meeting with employment staff <br />to go over goals, progress and skills. <br />Program Goal <br />40 Club Nova members will return to paid employment in the community <br />through our Transitional and Supported Employment (SE) program. <br />Performance Measures <br />Club Nova will: <br />• Maintain logs of member participation in employment programs <br />• Maintain logs of members attending weekly Employment meetings <br />•Maintain logs of the number of TE & SE sites available through Club <br />Nova <br />Previous Year Program Results <br />100% of Club Nova members had access to our TE and SE services, as well <br />as, educational and /or job skills opportunities. 45 members returned to <br />paid employment through these supports. These services led to the <br />following outcomes: <br />• Increased financial stability & independence <br />• Increased self- esteem <br />• Reduced community stigma <br />• Increased member civic engagement <br />Current Year Estimated Results <br />100% of Club Nova members will have access to our TE and SE services, <br />as well as, educational and /or job skills opportunities. An estimated 45 <br />members will return to paid employment through these supports. These <br />services will lead to the following outcomes: <br />• Increased financial stability & independence <br />• Increased self- esteem <br />• Reduced community stigma <br />• Increased member civic engagement <br />Next Year Projected Results <br />100% of Club Nova members will have access to our TE and SE services, <br />as well as, educational and /or job skills opportunities. At least 48 <br />members will return to paid employment through these supports. These <br />services will lead to the following outcomes: <br />• Increased financial stability & independence <br />• Increased self- esteem <br />• Reduced community stigma <br />• Increased member civic engagement <br />4. Program Activity Name <br />Club Nova provides high - quality programming related to housing, <br />employment, wellness and social engagement to members living in <br />Orange County and the townships within. Club Nova maintains necessary <br />staff to execute programming. <br />Program Goal <br />Club Nova will operate six days a week, 54 -60 hours per week and on all <br />major holidays, to provide our members the full range of programming <br />and safety -net services, such as housing support, crisis prevention and <br />intervention, and access to healthcare, inherent in a Clubhouse Model. <br />Club Nova will: <br />*Ensure housing supports to secure and maintain safe, affordable, <br />dignified housing for members, and to avert homelessness. <br />• Provide crisis prevention and intervention to save lives and avoid costly <br />ER and hospitalization costs. <br />• Assist in accessing and navigating quality healthcare, including access to <br />primary care. <br />Performance Measures <br />Data on our general operating costs are maintained in our financial <br />books. We will track costs of utilities, payroll, and other daily supplies via <br />receipts and Quickbooks to reflect the basic expenses of Clubhouse <br />programming. We will keep record of all paper invoices /receipts. <br />PROGRAM INFORMATION 2/9/2017 1:51:06 PM Page 20 of 26 <br />