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Outside Agencies/Human Services <br /> <br />Program information P a g e 25 o f 55 <br />Please use the drop down menu below to select which function area best aligns with your <br />agency and program(s) in which you are requesting funding. Please select only one from the <br />drop-down 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 equivale nce. <br /> Please ensure your performance measures are outcome based and not outputs. <br /> <br />Program Goal # 1 <br /> <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 /> <br />Club Nova’s 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 <br />paranoia) and need viable transportation to Club Nova. <br />Performance Measure <br />(How will you accomplish <br />your goal?) <br />When the physical Clubhouse reopens, Club Nova will <br />maintain a full transportation program that employs and <br />trains 100% (4 .25 FTEs) of transportation staff, <br />maintains its vehicles, and provides our membership <br />with approximately 44,329 miles of transportation to <br />and from Club Nova (plus socials and occasional <br />_________________ <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: 11DA72B8-CC83-439E-A25C-F64DE607C614