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DocuSign Envelope ID:7B55B196-3912-4C1A-ADB4-A753058DFEFD XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> participate in activities such as Petals with a Purpose and HOPE <br /> Gardens that give back to the community at large. <br /> 2. Program Activity Name Relationship Building and Social Capital: Community <br /> Connections Partner Program <br /> Program Goal Twenty persons served will increase the number of relationships <br /> and people in their circle of support by having a Community <br /> Connection Partner. <br /> Performance Measures Person-centered plans, daily service notes and annual surveys <br /> provide data to verify this information. <br /> Previous Year Program Results Twenty participants increased the number of relationships and <br /> people in their circle of support by having a Community <br /> Connections Partner. <br /> Current Year Estimated Results Twenty participants have increased the number of relationships <br /> and people in their circle of support by having a Community <br /> Connections Partner. <br /> Next Year Projected Results Twenty-three participants will increase the number of relationships <br /> and people in their circle of support by having a Community <br /> Connections Partner. <br /> 3. Program Activity Name Healthier Lifestyles: Exercise, Social and Nutrition Classes <br /> Program Goal Using a combination of paid Direct Support Professionals and <br /> Volunteers, sixty people served will learn about and participate in <br /> leading healthy lifestyles. This includes participation in Cooking <br /> Classes, Friday Fun Day, HOOPS basketball and Spin Class. <br /> Performance Measures Person-centered plans, daily service notes and annual surveys <br /> provide data to verify this information. <br /> Previous Year Program Results Fifty people increased their health by participating in Cooking <br /> Classes, Friday Fun Day, HOOPs basketball and Spin class. <br /> Current Year Estimated Results Sixty people increased their health by participating in Cooking <br /> Classes, Friday Fun Day, HOOPs basketball and Spin Class, <br /> Next Year Projected Results Seventy people will increase their health by participating in cooking <br /> and nutrition classes, Friday Fun Day, and exercise classes. <br /> PROGRAM INFORMATION 1/2612017 5:52:39 PM P a a e 2 o f 2 6 <br />