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DocuSign Envelope ID:3457204A-7765-4E36-8B42-227F6F673AF6 XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 1. YOLD <br /> Work Statement <br /> 1) 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(,2pecific, 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 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 Youth Organizing and Leadership Development <br /> 1. Program Activity Name Freedom School workshops on social justice issues. <br /> Program Goal Building youth passion for social justice issues. <br /> Performance Measures Create youth organizing leaders on social justice issues that affect <br /> youth. <br /> Previous Year Program Results Youth recorded lessons from camp and created a system to keep <br /> each other accountable on their social justice issues. <br /> Current Year Estimated Results Youth will record lessons from camp. Youth will create a monthly <br /> reporting system to keep themselves accountable to each other on <br /> their social justice initiatives throughout the following year. <br /> Next Year Projected Results Youth will have recorded lessons from camp and created a system <br /> to keep each other accountable on issues. <br /> 2. Program Activity Name Freedom School workshops on social justice issues. <br /> Program Goal Educating youth organizing leaders. <br /> Performance Measures Develop skills of 15 youth organizing leaders on social justice issues <br /> that engage in organizing and action affect their peers in the 12 <br /> months following the program. <br /> Previous Year Program Results Youth filled out evaluations for workshops, participated in quizzes, <br /> went through mock situations, and wrote in journals. One of the <br /> trainees is now part of YCP's leadership council. <br /> Current Year Estimated Results Youth will evaluate workshops individually for takeaways. Youth will <br /> be quizzed on and successfully demonstrate advancement in <br /> leadership and organizing skills. Youth will use mock situations to <br /> practice and then demonstrate their organizing and assertiveness. <br /> Next Year Projected Results Youth will have filled out evaluations for workshops, participated in <br /> quizzes, gone through mock situations, and written about their <br /> experiences and thoughts in journals. <br /> 3. Program Activity Name Training as advocates for themselves and peers. <br /> PROGRAM INFORMATION 1/31/2017 12:37:26 PM Page 18 of 45 <br />