2017-665-E Finance - ARC of the Triangle outside agency agreement

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DocuSign Envelope ID:7B55B196-3912-4C1A-ADB4-A753058DFEFD XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Work Statement m) Complete the Work Statement Chart to describe the work to be performed. This chart is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. Every program is required to have AT LEAST 1 Program Activity, which should be SMART (Specific, Measurable, Achievable, Relevant, and Time-bound. Click on SMART Goals to learn more. • Program Activities should outline major activities the agency implements to accomplish its program goals. (i.e. Deliver meals to elderly/disabled residents.) • Program Goal should explain what the program is trying to achieve/accomplish. Goals are statements about what the program should accomplish. (i.e. Deliver 900 meals per day, Monday-Friday.) • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. (i.e. Will track the number of meals delivered each day.) • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. (i.e. Delivered an average of 105 meals per day.) Work Statement Chart for Program The Arc of the Triangle: Social, Volunteer and Individual Services 1. Program Activity Name Engagement in Inclusive and Civic-Minded Community Activities: Petals with a Purpose and HOPE Community Gardens Program Goal Using a combination of paid Direct Support Professionals and Volunteers, thirty-two people with IlDD will increase engagement in non-segregated environments where individuals participate in civic minded and community activities such as the Petals with a Purpose program and volunteering at the HOPE gardens that give back to the community at large. Performance Measures Person-centered plans, daily service notes and annual surveys provide data to verify this information. Previous Year Program Results Out of one hundred-ninety two people served, half (ninety-six) increased their participation in community activities that included but were not limited to: educational opportunities, volunteer and paid work, advocacy activities, community minded activities, religious activities and social functions. Thirty people have participated in activities such as Petals with a Purpose and HOPE Gardens that give back to the community at large Current Year Estimated Results Out of two-hundred twenty one people served, half (one-hundred ten) people will increase their participation in community activities that include but are not limited to: educational opportunities, volunteer and paid work, advocacy activities, religious activities and social functions. Thirty-two people participate in activities such as Petals with a Purpose and HOPE Gardens that give back to the community at large. Next Year Projected Results Out of two-hundred fifty four people served, half (one-hundred twenty seven) will increase their participation in community activities that include but are not limited to: educational opportunities, volunteer and paid work, advocacy activities, reli ious activities and social functions. Thirty six people will PROGRAM INFORMATION 1/25/2017 5:52:39 PM Page 22 of 26