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MAIN APPLICATION <br />m.) Work Statement <br />This form 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. <br />• Program Activities should outline major activities the agency implements to accomplish its <br />program goals. <br />• Program Goal should explain what the program is trying to achieve /accomplish. Goals are <br />statements about what the program should accomplish. SMART Goals <br />• Performance Measures describe how you will evaluate the degree in which you achieved <br />the stated goals. <br />• Actual Program Results use program results to indicate the actual measureable <br />achievement of goals. If goals were not met, please explain. <br />Main Application 1/24/2016 2:59:42 PM Page 43 of 58 <br />Actual <br />Estimated <br />Projected <br />2014 -15 <br />2015 -16 <br />2016 -17 <br />Information and Referral <br />Information and Referral <br />Information and Referral <br />Service: Connects <br />Service: Connects community <br />Service: Connects <br />community members with <br />members with local resources <br />community members with <br />local resources and <br />and services after <br />local resources and services <br />services after assessment <br />assessment of need, <br />after assessment of need. <br />of need. Resource <br />Resource database <br />Resource database <br />Program Activity 1 <br />database maintained for a <br />maintained for a multitude of <br />maintained for a multitude of <br />multitude of services. <br />services. Follow -up <br />services. Follow -up <br />Follow -up conducted to <br />conducted to ensure <br />conducted to ensure <br />ensure connection was <br />connection was made and <br />connection was made and <br />made and additional <br />additional resources provided <br />additional resources provided <br />resources provided as <br />as needed. <br />as needed. <br />needed. <br />85% of clients will report <br />they received the <br />85% of clients will report they <br />85% of clients will report they <br />Program Goal <br />information or help they <br />received the information or <br />received the information or <br />requested in FY 14 -15. At <br />help they requested in FY 15- <br />help they requested in FY 16- <br />least 750 clients will be <br />16. At least 650 clients will be <br />17. At least 800 clients will be <br />served. <br />served. <br />served. <br />At the end of the contact, <br />all clients are asked <br />At the end of the contact, all <br />At the end of the contact, all <br />Performance Measures <br />whether they received the <br />clients are asked whether <br />clients are asked whether <br />information or help they <br />they received the information <br />they received the information <br />needed. These results are <br />or help they needed. These <br />or help they needed. These <br />tracked. <br />results are tracked. <br />results are tracked. <br />Program Results <br />95% <br />94% at Q2 <br />85% <br />Youth Interpersonal <br />Youth Interpersonal Violence <br />Youth Interpersonal Violence <br />Violence Prevention <br />Prevention Education <br />Prevention Education <br />Education Programs: <br />Programs: Provide age <br />Programs: Provide age <br />Provide age appropriate <br />appropriate dating violence <br />appropriate dating violence <br />Program Activity 2 <br />dating violence and <br />and bullying prevention <br />and bullying prevention <br />bullying prevention <br />education sessions in 61h and <br />education sessions in 61" and <br />education sessions in 61" <br />8th grade health education <br />8`" grade health education <br />and 8`" grade health <br />classes. <br />classes. <br />education classes. <br />Main Application 1/24/2016 2:59:42 PM Page 43 of 58 <br />