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Program information P a g e 19 of 32 <br />Unknown <br />Total 60 <br />Income <br />Low-income (80% of the Area Median Income and Below) Please see income <br />table in the attachments <br />60 <br />Total 0 0 0 60 <br />9.Cost Per Individual <br />This cost per individual must reflect the total program budget divided by the total number of program <br />individuals in this application. <br />Actual 2020-2021 Projected 2021-2022 Projected 2022-2023 <br />Total Cost of Program 75000 <br />Total # of Individuals 60 <br />Cost Per Individual 1250 <br />10.Performance Indicators <br />For Chapel Hill and Carrboro applicants: <br />Please complete the following chart with information about the Strategic Objective, Intermediate Result, and <br />the Agency Performance Indicator for each program for which you are applying for funding. Please see the <br />Results Framework in the Attachments section as a reference. <br />Program Name: Rape Crisis Victim’s Services <br />Strategic <br />Objective <br />(please choose one from <br />the Results Framework) <br />† Children improve their educational outcomes <br /> Residents Increase their livelihood security <br />X Residents improve their health outcomes <br />Intermediate <br />Result <br />(please choose one from <br />the Results Framework) <br />Insert Intermediate Result here. <br />Intermediate Result 2.1: Residents access the most appropriate social safety net <br />services <br />RESULTS Actual <br /> 2020-2021 <br />Projected <br /> 2021-2022 <br />Projected <br /> 2022-2023 <br />Performance <br />Indicators <br />(Please choose at least <br />one performance <br />indicator to report on <br />from the Results <br />Framework, and add <br />additional performance <br />indicators that you <br />% and # of program participants <br />that report they have access to <br />behavioral care <br />n/a n/a 60 (85% of those <br />who contact the <br />agency for <br />services) will <br />gain access to <br />high quality <br />mental health <br />care free of <br />charge through <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: D5354C91-47B9-4630-B4CE-FB86A8E9DAB6