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Outside Agencies/Human Services <br /> <br />Program information Page 12 of 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 />Behavior Health <br />If you selected other, please tell us what function area best aligns with your organization: <br /> <br /> <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 /> <br />Program Goal # 1 Increased language skills <br />Performance Measure <br />(How will you accomplish your goal?) <br />Number of students who have increased their language and <br />vocalization <br /> <br />Actual Results <br />(Outcome) <br />Ending FY18-19 <br />N/A because of change in evaluation method <br /> Projected Results <br />(Outcome) <br />Ending FY2020 <br />2 out of 8 <br />Projected Results <br />(Outcome) <br />Ending FY2021 <br />3 out of 9 <br /> <br />Program Goal # 2 Increased leadership skills (self-advocacy) <br />Performance Measure <br />(How will you accomplish your goal?) <br />Number of students who have increased their ability to ask <br />for help <br /> <br />Actual Results <br />(Outcome) <br />Ending FY18-19 <br />N/A because of change in evaluation method <br />Projected Results <br />(Outcome) <br />Ending FY2020 <br />2 out of 8 <br />_________________ <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: 81A61471-345A-47F9-8A2D-36F7929A6637