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DocuSign Envelope ID: A899BE5E- BAEC- 40F3 -91 E1- A9D77FC4C488 <br />Work Statement EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <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 (Specific, 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 measurable achievement <br />of goals. if goals were not met, please explain. (i.e. Delivered an average of 105 meals per <br />day.) <br />Work Statement Chart for Program: ECH- Center for Employment and Leadership <br />PROGRAM INFORMATION 1122/2018 10 :14:21 AM Page 2� of 3"A <br />