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Outside Agencies/Human Services <br /> <br />Program information  P a g e  13 of 23  <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 />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 />Performance Measure <br />(How will you accomplish your goal?) <br /> <br />Actual Results <br />(Outcome) <br />Ending FY2022 <br /> <br /> Projected Results <br />(Outcome) <br />Ending FY2023 <br /> <br />Projected Results <br />(Outcome) <br />Ending FY2024 <br /> <br />  <br />Program Goal # 2 <br />Performance Measure <br />(How will you accomplish your goal?) <br /> <br />DocuSign Envelope ID: FA3F2ECF-06D9-4DBA-B3E6-E15E73BCA275