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Outside Agencies/Human Services <br />Program information P a g e 11 o f 20 <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 <br />Performance Measure <br />(How will you accomplish your goal?) <br />Actual Results <br />(Outcome) <br />Ending FY19-20 <br /> Projected Results <br />(Outcome) <br />Ending FY2021 <br />Projected Results <br />(Outcome) <br />Ending FY2022 <br />Program Goal # 2 <br />Performance Measure <br />(How will you accomplish your goal?) <br />Actual Results <br />(Outcome) <br />Ending FY19-20 <br />Projected Results <br />(Outcome) <br />Ending FY2021 <br />_________________ <br />Number of adolescents who participate in multi-session, evidence-based curricula; average <br />increase in knowledge about pregnancy and STI prevention. <br />Adolescents will engage with the program and learn new life skills. <br />32; 47% <br />30; 25% <br />30; 25% <br />Parents will have the skills and information they need to talk to their children about sexuality. <br />Number of parents reached through parent workshops; percentage of parents who report <br />an increased comfort in talking about sexuality with their children <br />6; 100% <br />15; 75% <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: 3B9D32F2-BCE5-494E-B2DF-78A17389E8BADocuSign Envelope ID: 01146459-28D7-41C1-ADA0-09401D3877AD