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Certified by: _______________________ Title: __________________________ Date: ____________ <br /> (Provider’s Signature) <br /> <br /> <br />EXHIBIT “B” <br /> <br />Scope of Services – FY 2021-2022 <br />Outside Agency Performance Agreement <br /> <br />Agency Name: Duke HomeCare & Hospice <br />Program Name: Camp ReLEAF <br />Funding Award: $1134 <br /> <br />Outline how the agency will spend Orange County’s funding award. <br />Program Services <br />Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2022. <br />• Activities designed to assist in the development of grief coping skills <br />• interactive activities designed to enhance the connection to the deceased <br />• Opportunities to learn about grief process and learn from peers. <br /> <br />Anticipated Outcomes <br />The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange <br />County, only (all Towns and municipalities). If you use percentages, you must also provide the total number of participants <br />within that measure’s description or for an earlier performance measure. <br />Performance Measures Anticipated <br />Results <br />Participants will report a positive experience from their participation in camp 95% of <br />participants; # <br />of participants <br />to be capped <br />due to <br />pandemic and <br />is as yet <br />undertermined <br />Camper Surveys are completed prior to the conclusion of camp 95% see <br />above <br />Registration fee waived upon request 35% <br /> <br /> <br />Expense Description Amount <br />Supplies $400 <br />Facilities Rentals $400 <br />Salary $334 <br /> <br /> <br /> <br />DocuSign Envelope ID: 462ADBBD-2FE6-4E97-872F-55A8C45CC400 <br />10/18/2021Assoc. Vice President- DHCH