2018-752-E Finance - The Arc of the Triangle outside agency agreement

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DocuSign Envelope ID:9F461F1C-C86C-42DC-B78C-50FC18D204DF EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Work Statement e) 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 100 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: Community Programs and Individual Services 1. Program Activity Name Petals with a Purpose and HOPE Community Gardens Program Goal Using a combination of Direct Care Staff and Volunteers, 25 individuals with I/DD will participate 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 Attendance records, participant annual surveys Previous Year Program Results Approximately 50 individuals were served in all of our community programs in the Orange County area, participated in Petals with a Purpose and HOPE Gardens. 171 individuals are served through Individual services in Orange County. Current Year Estimated Results Approximately 50 individuals were served in our community programs in the Orange County area. 185 individuals are served through Individual services in Orange County. Next Year Projected Results Out of approximately 185 individuals served Orange County, 25 or more will participate in Petals with a Purpose and HOPE Gardens. 2. Program Activity Name Community Connections Partner Program Program Goal 25 individuals with I/DD will participate regularly in community based social and recreational activities through the Community Connections program; volunteer partners will also increase to 25 Performance Measures Reports form the individual and partner as to times met, activities enjoyed, length of time met. Participant and Partner annual surveys. Previous Year Program Results Approximately 50 individuals were served in our community programs in the Orange County area. 185 individuals are served through Individual services in Orange County. 18 participants had a Communit Connections Partner. Current Year Estimated Results 20 participants Next Year Projected Results 30 participants will 130participate and have matches. At least 10 will be new to the program. PROGRAM INFORMATION 1/20/2018 3:58:40 PM Page 19 of 24