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DocuSign Envelope ID:3457204A-7765-4E36-8B42-227F6F673AF6 XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 3. Reintegration Support Network <br /> Previous Year Program Results Program start up. 3 referrals of youth but none completed the <br /> program due to relapse and incarceration. <br /> Current Year Estimated Results Program will recruit 8 recovering youth 6 of whom will fully engage <br /> as mentees in the program. <br /> Next Year Projected Results Program will recruit 12 recovering youth 8 of whom will fully engage <br /> as mentees in the program. <br /> 3. Program Activity Name Partnerships, Collaborations And Support Circles <br /> Program Goal RSN will have established effective local partnerships,collaborations <br /> and support circles that create sustainable structures that enhance <br /> youth recovery and the ability of support circles to operate. This <br /> model will be: 1) based on local experiences and pre-existing <br /> structures; and 2 created to be flexible and adaptable. <br /> Performance Measures Conduct end-of-year interviews with key informants from <br /> collaborating agencies and professionals qualitatively assess <br /> connectedness, integration of effort, degree of coordination, goal <br /> alignment, and mutual support. <br /> Previous Year Program Results Networked with over 24 agencies, schools and practitioners <br /> Current Year Estimated Results Continued networked with over 24 agencies, schools and <br /> practitioners and developed relationships for ongoing referrals. Will <br /> have conducted outreach to recruit volunteers from over 12 <br /> community organizations and places of worship. <br /> Next Year Projected Results Continued networked with over 24 agencies, schools and <br /> practitioners and developed relationships for ongoing referrals. Will <br /> have conducted outreach to recruit volunteers from over 20 <br /> community organizations and places of worship. <br /> 4. Program Activity Name <br /> Program Goal <br /> Performance Measures <br /> Previous Year Program Results <br /> Current Year Estimated Results <br /> Next Year Projected Results <br /> DO NOT SUBMIT THIS PAGE 1/31/2017 12:37:26 PM Page 34 of 45 <br />