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DocuSign Envelope ID:2F348727-C96D-44CB-A423-F125131FB250C <br /> ORANGE COUNTY <br /> i1oRn l CAROLINA <br /> Outside Agencies/Human Services <br /> Please use the drop down menu below to select which function area best aligns with your agency <br /> and program(s) in which you are requesting funding. Please select only one from the drop down <br /> menu below. <br /> Senior Services <br /> If you selected other, please tell us what function area best aligns with your organization: <br /> Please indicate three program goals/performance measures below. <br /> A few notes: <br /> • If you use percentages, please put the actual number equivalence. <br /> • Please ensure your performance measures are outcome based and not outputs. <br /> Program Goal # 1 The Program will meet/exceed state standards <br /> The Program will continue to meet the requirements for NC State <br /> Performance Measure Certification <br /> (Hory will you accomplish your goal?) <br /> Charles House was successfully re-certificated in July, 2018 <br /> Actual Results <br /> (Outcome) <br /> Ending F118-19 <br /> Projected Results Charles House was successfully re-certificated in July, 2019 <br /> (Outcome) <br /> Enclirt FY202U <br /> Projected Results Charles House will be successfully re-certificated in July, 2020 <br /> (Outcome) <br /> Ew in FY2021 <br /> Families are supported in their caregiving of family members with frailty <br /> Program Goal# 2 and challenges of aging, <br /> 50%of enrolled fconilies in the f nding year will have the calmeily to <br /> Performance Measure continue providing care in the home and not require, or delcq', <br /> (Hon)vill,you accomplish yourgoal?) residential care placement_for their participant/enrolled fancily member, <br /> 56.7%(38 of 67)of the families enrolled at the beginning of the grant <br /> Actual Results year continued caregiving with Charles House support at the end of the <br /> (Outcome) grant year <br /> Ending FY18-19 <br /> Projected Results 60%of enrolled families in the finding year will have the capacity to <br /> (Outcome) continue providing care ill the home and not require,or delay,residential <br /> Ending FY2020 care piacement for their participant/enrolled family member. <br /> Program informatics P a g e :I. 1 0 1 ). 0 <br />