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<br />Outside Agencies/Human Services <br /> <br />Program information P a g e 1 4 o f 2 4 <br />Please select which function area best aligns with your agency and program(s) in which you are <br />requesting funding. Please select only one from the list below: <br /> <br />! Behavior Health ܆ Public Health & Health Education <br />! Food & Nutritional Service ! Recreational <br />! Housing ! Senior Services <br />܈ Human Rights & Community Services ! Youth Services <br />! Juvenile & Adult Justice Services ! Other <br /> <br /> <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 equivalence. <br />• Please ensure your performance measures are outcome based and not outputs. <br /> <br />Program Goal # 1 <br />Upon completion, people primarily with visual/print disabilities <br />will know how to use assistive <br />technology hardware and software to access mainstream <br />technology which increases employability, <br />reduces unemployment, and encourages independent living <br />Performance Measure <br />(How will you accomplish your <br />goal?) <br />Progress will be measured via end-of- <br />course exams and follow up surveys <br />Actual Results <br />(Outcome) <br />Ending FY2022 <br />30 <br /> Projected Results <br />(Outcome) <br />Ending FY2023 <br />30 <br />Projected Results <br />(Outcome) <br />Ending FY2024 <br />30 <br /> <br />_________________ <br />DocuSign Envelope ID: D33CE11B-4D47-490F-AD8B-A92F0A8ECFE9