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DocuSign Envelope ID:C4C09F35-022B-45DE-8313-4A1ED7AF458B XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Work Statement <br /> m) 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 1 <br /> Program Activity, which should be SMART(.,Specific, Measurable, Achievable, _Relevant, and <br /> Time-bound. Click 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 General Support of The ArtsCenter <br /> 1. Program Activity Name AfterSchool Arts Immersion (AAI) &Youth Art Classes <br /> Program Goal Serve 60 youth monthly through AAI and Youth Art Classes <br /> Performance Measures AAI &Class registrations <br /> Previous Year Program Results Served 55 youth monthly through AAI and Youth Art Classes <br /> Current Year Estimated Results Serve 70 youth monthly through AAI and Youth Art Classes <br /> Next Year Projected Results Serve 60 youth monthly through AAI and Youth Art Classes <br /> 2. Program Activity Name Artist in Residence (AIR) residencies <br /> Program Goal Hold 14 AIR residencies in 3 Title 1 Orange Co Schools for 1200 <br /> students <br /> Performance Measures Artist contracts, class records, content tests <br /> Previous Year Program Results Offered 14 residencies for 1410 students <br /> Current Year Estimated Results Offer 16 residencies for 1275 students <br /> Next Year Projected Results Offer 16 residencies for 1200 students: if we can afford to add <br /> Grady Brown Elementary, then 20 residencies for 1600 students <br /> 3. Program Activity Name School Shows <br /> Program Goal Present 50 School Schools at the ArtsCenter& in area schools that <br /> enhance NC curricula <br /> Performance Measures School Show schedule, contacts, &teacher guides <br /> Previous Year Program Results Presented 75 School Shows; received 85% positive evaluations <br /> Current Year Estimated Results Present 54 School Shows; receive 85% positive evaluations <br /> Next Year Projected Results Present 50 School Shows; receive 85% positive evaluations <br /> 4. Program Activity Name Summer Arts Camps & Mini-Camps <br /> Program Goal Offer 10-11 wks of camps and teen classes (depending on schools) <br /> Performance Measures Summer camps &youth class schedule <br /> Previous Year Program Results Offered 11 wks of camp and teen class for 847 youth via 1500 units <br /> Current Year Estimated Results Offer 10 wks of camp/teen class reaching 800 youth via 1500 units <br /> Next Year Projected Results Offer 10-11 wks of camp/teen class for 800 youth via 1500 units <br /> PROGRAM INFORMATION 2/8/2017 5:24:23 PM P a g e 17 of 2 0 <br />