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DocuSign Envelope ID: EB294A71-C7D1-4EE4-8287-60A6149320D4 <br /> Work Statement <br /> o) 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 (�pecific, Measurable, Achievable, Relevant, and Time- <br /> bound. Glick 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 achievelaccomplish. 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 Food Security Programs: Food Pantry, Community Kitchen <br /> 1. Program Activity Name Food Security Programs: Food Bantry <br /> Program Goal The Food Pantry will collect or purchase enough non-perishable <br /> food items to provide groceries as often as once per month to <br /> member h_ ouseholds <br /> Performance Measures Staff will track number of bags of groceries and holiday dinners <br /> distributed <br /> Previous Year Program Results 13,275 bags of groceries <br /> Current Year Estimated Results 13,880 bags of groceries <br /> Next Year Projected Results 13,000 bags of groceries <br /> 2. Program Activity Name Food Security Programs: Community'Kitchen <br /> Program Goal A hot, nutritious meal will be served to any hungry person who <br /> shows up at mealtimes at the Community Kitchen <br /> Performance Measures Staff determines number of meals served by counting trays at the <br /> end of each meal service <br /> Previous Year Program Results 68,845 hot meals <br /> Current Year Estimated Results 65,224 hot meals <br /> Next Year Projected Results 65,000 hot meals <br /> p) Program Budget <br /> 13. Submit your program budget. You may complete the provided template (separate xls <br /> file) or you may submit your own budget file(as long as it contains the same information, <br /> in the same format, as requested in the provided template). included as attachment. <br /> Program Budgets are required to define budget amounts for the previous program <br /> year, current program year, and next program year for the following categories: <br /> • Revenues <br /> .. .......... <br /> DG NOT SUBMIT THIS PAGE 1/23/2018 2:06:13 PM Page 36 of 37 <br />