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DocuSign Envelope ID: EBOFBDBE -FD15- 4428- 899B- 19A867F94OCC <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 <br />document the projected information. Every program is required to have AT LEAST 7 <br />Program Activity, which should be SMART (Specific, Measurable, Achievable, Relevant, and <br />Time- bound. Click on SMART Goals to team more. <br />• Program Activities should outline major activities the agency implements to accomplish its <br />program goals. (i.e. Deliver meals to elderlyldisabled 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: Samaritan Relief Ministry <br />1. Program Activity Name <br />Provide emergency groceries to food insecure households <br />Program Goal <br />Provide a week's worth of groceries to referred households a <br />maximum of seven times in 12 months. <br />Performance Measures <br />Track the number of times individual households receive food <br />through Access database. Produce monthly report of total number <br />of individuals receiving assistance. <br />_ <br />Previous Year Program Results <br />8,872 individuals 3,169 households) received fond in 2017. <br />Current Year Estimated Results <br />9,000 individuals (- 3,214 households) will receive food in 2018 <br />Newt Year Projected Results <br />9,100 individuals ("3,250 households) will receive food in 2019 <br />2. Program Activity Name <br />Provide emergency financial assistance for rent and utilities <br />Program Goal <br />130 households will receive emergency financial assistance to be <br />able to retain housing and utilities. _ <br />Track the amount of financial assistance individual households <br />receive through Access database. Produce monthly report of total <br />amount of financial assistance given. <br />Performance Measures <br />Previous Year Program Results <br />238 households received emergency financial assistance for rent <br />and utilities in 2017. <br />Current Year Estimated Results <br />242 households will receive emergency financial assistance for <br />rent and utilities in 2018 <br />Next Year Projected Results <br />_ <br />246 households will receive emergency financial assistance for rent <br />and utilities in 2019. <br />3. Program Activity Name <br />Program Goal <br />Performance Measures <br />Previous Year Program Results <br />— <br />Current Year Estimated Results <br />Next Year Projected Results <br />PPr)r, PAhA inlFr)PA 4 TinAi 719qI9n1 R .Q-A 4 -.Qd Am <br />