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DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Work Statement Chart for Program _Chapel Hill Impact Program <br />1. Program Activity Name <br />Homework Assistance and Tutoring <br />Program Goal <br />To increase grades in reading and /or math by 1 point (scale <br />1 -4) for 20% of regularly attending youth members (for the <br />2017 -2018 school year, that will be approximately 10 students <br />at Northside and Smith Middle). <br />Performance Measures <br />Report card measurement <br />Previous Year Program <br />Met goal <br />Results <br />Current Year Estimated <br />Already exceeded by 20% over goal for the 2017 -2018 school <br />Results <br />year. <br />Next Year Projected Results <br />Expect to reach or exceed goal. <br />1 <br />imm <br />2. Program Activity Name <br />Improve interpersonal and social skills of youth members <br />Program Goal <br />75% of youth members will meet standards set by school in all <br />four categories (approximately 35 youth at Northside and <br />Smith). <br />Report card indicators: <br />1. Follows classroom rules <br />2. Takes responsibility <br />for behaviors and actions. <br />3. Respects and cooperates with others. <br />4. Follows directions. <br />Performance Measures <br />Report card measurement <br />Previous Year Program <br />92% success in reaching goal so far and expect goal will be <br />Results <br />fully met. <br />Current Year Estimated <br />On pace to exceed 75% goal <br />Results <br />Next Year Projected Results <br />Expect to reach or exceed goal <br />