Orange County NC Website
Browse       Search
DocuSign Envelope ID: E8DFACF7 -45BE- 435E- 9B5A- BB177E968F07 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Work Statement <br />o) 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, and <br />actual results. (Add more rows as needed) If this is a new program, you will only document the <br />projected information. Every program is required to have A T LEAST 1 Program Activity, which <br />should be SMART (Specific, Measurable, Achievable, Relevant, and Time- bound. Click on <br />SMART Goals to 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 the <br />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 achievement <br />of goals. If goals were not met, please explain. (i.e. Delivered an average of 105 meals per <br />day.) <br />Work Statement Chart for Program See Attached <br />1. Program Activity Name <br />Program Goal <br />Performance Measures <br />Previous Year Program Results <br />Current Year Estimated Results <br />Next Year Projected Results <br />2. Program Activity Name <br />Program Goal <br />Performance Measures <br />Previous Year Program Results <br />Current Year Estimated Results <br />Next Year Projected Results <br />3. Program Activity Name <br />Program Goal <br />Performance Measures <br />Previous Year Program Results <br />Current Year Estimated Results <br />Next Year Projected Results <br />4. Program Activity Name <br />Program Goal <br />Performance Measures <br />Previous Year Program Results <br />Current Year Estimated Results <br />Next Year Projected Results <br />DO NOT SUBMIT THIS PAGE 1/19/2018 112:42-41 PM Page 0 of 11 <br />