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DocuSign Envelope ID: C5C1 1 FD4-56CD-48FD-BBD1 -95F2AFF7112B <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, <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 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 elderlyfdisabled 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 <br />1. Program Activity Name Burwell School Historic Site Visitor Services and Accessibility <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 Coal <br />Performance Measures <br />Previous Year Program Results <br />Current Year Estimated Results <br />Next Year Projected Results <br />PROGRAM INFORMATION <br />Improved access, safety and enrichment of visitors to the site <br />7000 visitors <br />6500 visitors <br />7000 visitors <br />7000 visitors <br />Keckly Bicentennial Year 2018 <br />Carry out four programs for adults and children including 3 hands - <br />on workshops <br />400 + participants including youth, scholars, adults, and educators <br />NA <br />Three programs scheduled Feb. 2018 — June 2018 <br />400 + participants and national media coverage <br />Outreach to educators re the Keckly Bicentennial Year <br />Increase awareness and inspiration from the Keckly story in <br />Orange County/Chapel Hill- Carrboro Schools. <br />Four additional school group visits including at least one high <br />school group <br />450 students <br />400 students <br />500 students <br />1/23/2018 12.28:35 PM Page 23 of 27 <br />