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DocuSign Envelope ID: C5305795- 2DF5- 4A04- B090- 9F458AA520CB <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />the families are eligible for the financial support of the O.C. Dept. on Aging and Dept. of <br />Social Services. Some of the families are engaged in family caregiving partially because <br />their financial resources are insufficient to afford residential care in an assisted living <br />facility or skilled nursing home. <br />1) What efforts do you make to seek feedback about your program from your target <br />population (e.g. survey, evaluations, etc. ?) <br />Charles House conducts an annual survey of client caregivers. All client families in the <br />year are invited to participate and provide their feedback. Response to this survey is <br />consistently strong, with response rates over 50 %. This survey is compiled in a report for <br />board members, staff and other interested parties. The importance of this survey is <br />exhibited in that it is included in the outcomes measures for the Outside Agency Grants. <br />m) Include any other pertinent information. <br />PROGRAM INFORMATION 1/22/2018 2:17:04 PM P a g e 10 of 15 <br />