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DocuSign Envelope ID: E30588DE -A1 BC- 443D- A5C4- 3BE790331500 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Work Statement Chart for Program: Bridge II Sports Adapted Sport Programing <br />7. Program Activity Name <br />Physical Development: Skills Test <br />Program Goal <br />Practices are structured to develop the physical health <br />and sport specific skills of athletes. <br />Performance Measures <br />During each season, execute a skills development test at <br />the start, middle, and end of each season. Skills will test <br />endurance, distance, and accuracy. <br />Previous Year Program Results <br />6 athletes completed a skills test for each sport season. <br />Current Year Estimated Results <br />10 athletes will perform a skills test during each season. <br />Next Year Projected Results <br />15 athletes will perform a skills test in each season and <br />will record growth between seasons. <br />Z. Program Ac #ivifiy Namo' -;' <br />Personal /Social Development: Goal Cards <br />Program Goal <br />Practice will be structured to provide an avenue for social <br />development: communication, self - understanding, and <br />the opportunity for community engagement. <br />Performance Measures <br />Participants will create goal cards outlining academic, <br />personal, skills, and team goals which will be checked <br />every four weeks to evaluate progress and outcomes. <br />Previous Year Program Results <br />6 Athletes created, maintained and completed season - <br />end analysis of goal cards. <br />Current Year Estimated Results <br />10 Athletes will create, maintain and complete season - <br />end analysis of goal cards. <br />Next Year Projected Results <br />15 Athletes will create, maintain and complete season - <br />end analysis of goal cards and records growth between <br />seasons. <br />Program ,c iYy Name `' <br />Partici ants <br />Program Goal <br />Increase number of participants. <br />Performance Measures <br />We will increase athlete participation by 5 -7 individuals <br />as we partner with local schools through our school <br />initiative campaign and by targeting a new age <br />demographic with the Durham VA. <br />Previous Year Program Results <br />Ended season with 6 athletes participating. <br />Current Year Estimated Results <br />Keep current 6 athletes and grow to 10 adding 4 new. <br />Next Year Projected Results <br />Keep 10 athletes and grow to 5 more. <br />4 Program Actwity Name ' <br />Tournaments <br />Program Goal <br />Tournaments are organized to apply sport specific skills <br />and team solidarity. <br />Performance Measures <br />Host 1 -2 local tournaments in the Triangle area to <br />facilitate social networking and physical competition <br />among peers with similar disabilities. <br />Previous Year Program Results <br />Hosted 2 tournaments in Triangle area while assisting <br />with external local and national competitions. <br />Agency Information 2/20/2018 11:26:09 AM Page 17 of 30 <br />