2017SCOPE OF SERVICES
AGENCY NAME:TOTAL PARTNERSHIP AWARD: / $ / TOTAL AGENCY BUDGET: / $
Complete a Program / Project Scope of Service forEACHProgram that you receive Partnership Funding, including Management/Administration. It is important that you are realistic in stating the outputs and outcomes below.This information is the framework of your contractual obligations and will be used to monitor the results of the services provided.
PGM. # / PROGRAM/PROJECT NAME:TOTAL PROGRAM BUDGET: / $ / PARTNERSHIP FUNDS: / $
PARTNERSHIP FUNDS ARE / % OF TOTAL PROGRAM BUDGET (Partnership Funds Total Program Budget)
INDIRECT COSTS included in Program Budget: / $ / INDIRECT COSTS ARE: / % of TOTAL PROGRAM BUDGET
DESCRIPTION OF SCOPE OF SERVICES
Describe the services you will providewith Pueblo County/City of Pueblo Partnership Funds, the Target Population (include appropriate demographic information such as age, ethnicity, gender, elderly, low-income, single parent, etc.) for which this program is intended, and the unmet needs of the community it will address in bulleted form.
Services:
Target Population:
Unmet Needs:
PERFORMANCE MEASURES
State the program/project performance measures below in terms of outputs and outcomes.
OUTPUTS: (Outputs are the quantity of services or work provided)
# INDIVIDUALS SERVED / Proposed 2017: / Duplicated Unduplicated
# INDIVIDUALS SERVED / Projected 2016: / Duplicated Unduplicated
# INDIVIDUALS SERVED / Actual 2015: / Duplicated Unduplicated
If you track unduplicated individuals please describe the methods you use below:
UNIT DESCRIPTION (i.e. meal, hours, trips, persons, museum visitors, concerts, classes, sessions, food sacks, etc.):
# UNITS PROVIDED: / UNIT COST (2017 Program Budget # Units): $
PROGRAM OUTCOMES: (Outcomes are the measurable impacts, benefits, or changes for participants during or after your services. The changes in participants are expressed in terms of knowledge and skills, attitudes or behaviors,status or condition.
1.
2.
3.
MEASUREMENT and EVALUATION:
1. / Describe the tools (i.e. surveys, pre and post questionnaires, evaluations, testimonials, etc.) used to
determine and measure the effectiveness of your services.
2. / How will you evaluate progress towards your goals?
3. / What steps do you take to address goals that are not progressing as projected?
Agency Name: 2017 Scope of Services 1