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DocuSign Envelope ID:3B67A5FD-6776-4322-9152-0531CA4BC4BD 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 Program <br /> Activity, which should be SMART (Specific, Measurable, Achievable, Relevant, and Time- <br /> 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 _WCOM_Community Radio <br /> 1. Program Activity Name On Air Broadcasting <br /> Program Goal 100% of the time on air <br /> Performance Measures Time on air broadcasting <br /> Previous Year Program Results 99.7% <br /> Current Year Estimated Results 99.25% <br /> Next Year Projected Results 99.8% <br /> 2. Program Activity Name Training new broadcasters <br /> Program Goal 15 people trained per year <br /> Performance Measures Number trained <br /> Previous Year Program Results 12 <br /> Current Year Estimated Results 14 <br /> Next Year Projected Results 15 <br /> 3. Program Activity Name Adding new programming <br /> Program Goal 7 new programs added per year <br /> Performance Measures Number of new shows added <br /> Previous Year Program Results 6 <br /> Current Year Estimated Results 12 <br /> Next Year Projected Results 10 <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 2/8/2017 9:06:10 AM P a g e 1 5 o f 1 8 <br />