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Outside Agencies/Human Services <br />Cover Page P a g e 12 o f 21 <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 />Public Health and Health Education <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 Adolescents will engage with the program and learn new life <br />skills <br />Performance Measure <br />(How will you accomplish your goal?) <br />Number of adolescents who participate in multi-session, <br />evidence-based curricula; average increase in knowledge <br />about pregnancy and STI prevention. <br />Actual Results <br />(Outcome) <br />Ending FY18-19 <br />22; 27% <br /> Projected Results <br />(Outcome) <br />Ending FY2020 <br />25; 10% <br />Projected Results <br />(Outcome) <br />Ending FY2021 <br />30; 25% <br />Program Goal # 2 Parents will have the skills and information they need to talk <br />to their children about sexuality <br />Performance Measure <br />(How will you accomplish your goal?) <br />Number of parents reached through parent workshops; <br />percentage of parents who report an increased comfort in <br />talking about sexuality with their children <br />Actual Results <br />(Outcome) <br />Ending FY18-19 <br />15; 75% <br />Projected Results <br />(Outcome) <br />15; 75% <br />_________________ <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: 85EEB66F-62C6-4225-BF1E-4AC3A8F524AB