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DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 <br /> ORANGE COUNTY <br /> NI )It I I t ±8 YI IN � <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 <br /> Performance Measure #of medical appointment visits according to individual <br /> (How willyou accomplish your goal?) daily visit reports. <br /> Actual Results 172 clients indicated they had improved access to <br /> (Outcome) healthcare <br /> Ending FY18-19 <br /> Projected Results 152 clients will indicate that they have improved access to <br /> (Outcome) healthcare <br /> Ending FY2020 <br /> Projected Results 152 clients will be escorted to at least 2 medical <br /> (Outcome) appointments per month. <br /> Ending FY2021 <br /> Program Goal#2 <br /> Performance Measure # of trips provided to increase physical activity and <br /> (How will you accomplish your goal?) mental stimulation <br /> Actual Results 692 trips provided to increase physical activity and <br /> (Outcome) mental stimulation <br /> Ending FY18-19 <br /> Projected Results 700 trips provided to increase physical activity and <br /> (Outcome) mental stimulation <br /> Endin FY2020 <br /> Projected Results 700 trips provided to increase physical activity and <br /> (Outcome) mental stimulation <br /> Ending FY2021 <br />