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DocuSign Envelope ID: 1640431D- 872F- 4BC9- ACA1- 2226D9788920 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Total 1 1,040 1 1,197 1 1,197 <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 document <br />the projected information. Every program is required to have AT LEAST 1 Program Activity, <br />which should be SMART ( &ecific, Measurable, Achievable, Relevant, and Time - bound. Click <br />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 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 <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 Transplanting Traditions Community Farm <br />1. Program Activity Name <br />Workshops in Sustainable Agriculture <br />Program Goal <br />Decrease food insecurity in the refugee and low- wealth communities <br />in Orange County (80% of participants will report a decrease in food <br />insecurity) <br />Performance Measures <br />Surveys, interviews, number of individuals served, number of <br />workshops <br />Previous Year Program Results <br />100% of participants will report a decrease in food insecurity <br />Current Year Estimated Results <br />100% of participants will report a decrease in food insecurity <br />Next Year Projected Results <br />100% of participants will report a decrease in Mind incprurity <br />2. Program Activity (Name <br />Share a Share <br />Program Goal <br />Decrease food insecurity in the refugee and low- wealth communities <br />in Orange County (80% of participants will report a decrease in food <br />insecurity) <br />Performance Measures <br />Surveys, interviews, number of individuals served <br />Previous Year Program Results <br />125 refugee families served through Share a Share <br />Current Year Estimated Results <br />125 refugee families served through Share a Share proposed; 125 <br />estimated <br />Next Year Projected Results 1 <br />125 refugee families served thrnunh Sharp a Sharp- <br />3. Program Activity Name <br />Business and Market Education with the Community Supported <br />Program Goal In order to improve economic well -being in the refugee community, <br />provide agricultural initiatives, business planning and market <br />education focusing on financial risk management, farm production <br />costs and developing markets <br />Performance Measures At least 5 refugee farmers will participate in the CSA connecting to <br />at least 150 CSA customers and 2 refugee farmers with the Chapel <br />Hill Farmer's market; maintain a refugee farmer's market stand in <br />PROGRAM INFORMATION 1/22/2018 6:18:22 PM Page 17 of 22 <br />