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~ORTI! 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 />Behavior Health <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 />PrQgram. Goal# 1 <br />P¢l"fo.-mance:W.easnl"e <br />(l{ow Wlll)'Oil accomplls/l,y91lrgoal?) <br />Program information <br />The goal is to ensure that all members have full access <br />to Club Nova's comprehensive, integrated supports and <br />opportunities by providing our Transportation Program <br />that removes the transportation barrier to Clubhouse <br />participation and recovery. <br />Club Nova transportation serves members who live in <br />areas not accessible to public transportation or are <br />unable to utilize the bus system for various reasons <br />(including symptoms related to diagnoses like paranoia) <br />and need viable transportation to Club Nova. <br />Club Nova will maintain a full transportation program <br />that employs and trains 100% (4 .25 FTEs) of <br />transportation staff, maintains its vehicles, and provides <br />our membership with approximately 44,329 miles of <br />transportation to and from Club Nova (plus socials and <br />occasional medical appointments) throughout Orange <br />County six days a week and on all major holidays. <br />Club Nova will: <br />Ensure Club Nova transportation staff receives <br />necessary training and certification. Staff maintains <br />vehicles. <br />• Maintain logs in each vehicle to track ridership and <br />milea e for all tri s <br />Page 18 of 3S <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: D48DD7FB-D87E-4B89-8F49-216C48CF34E2