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Work Statement <br />a)Complete the Work Statement Chart to describe theworktobeperformed. <br />This chart is usedto document program activities, program goals, performance <br />measures, and actual results. (Add more rows as needed) If this is a new program, <br />you will only document the projected information. Every program is required to <br />have AT LEAST 1 Program Activity, which should be SMART (Specific, <br />Measurable, Achievable, Relevant, and Time-bound. Click on SMART Goals to <br />learn more. <br />x Program Activities should outline major activities the agency implements to <br />accomplish its program goals. (i.e. Deliver meals to elderly/disabled residents.) <br />x Program Goal should explain what the program is trying to achieve/accomplish. <br />Goals are statements about what the program should accomplish. (i.e. Deliver 100 <br />meals per day, Monday-Friday.) <br />x Performance Measures describe how you will evaluate the degree in which you <br />achieved the stated goals. (i.e. Will track the number of meals delivered each day.) <br />x 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 <br />average of 105 meals per day.) <br />Work Statement Chartfor Program Community AndSite-Based Mentoring <br />1.Program Activity <br />Name <br />Match-Making –we match at-risk children, ages six to 14, <br />with professionally screened and trained adult mentors <br />who will serve as positive role models in their lives. <br />Program Goal We have two main goals: to increase the number of <br />matches we make; and to continue to increase the length <br />of our matches. Studies show that relationships that last <br />12 months or longer show the most dramatic impact on <br />children both academically and socially. <br />Performance Measures Wetake great care in evaluating our measurable impact. <br />Once a match is made, program staff members call or <br />meet monthly with Bigs, Littles, and their parents. All <br />information is tracked in our Agency Information <br />Management (AIM) system, producing a written record of <br />the relationship. We give pre-and post-surveys to Littles <br />in both Community-and Site-Based matches to help <br />evaluate the effectiveness of our work. We enter this into <br />AIM as well. We are quickly able to pull reports that <br />Exhibit A: <br />Provider's Outside Agency Application <br />DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606