Seniors Template

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                                                                                                             2009 - 2010 CSBG ARRA
                                                                                                                  Program Term

                                                                                                        WV CAA Program Work Plan

      Agency Name:                                                                                                                           Program Funding Period:
        Dimension:                                                    Independent Living                                                     WV System Program Name:                        Dependent Care - Seniors - Independent Living
   Agency Program Title:                                                                                                                       Action Plan Template:                                  Seniors - Independent Living

                               Task
                                                                                                                                                                                                                                   Reporting Detail
                            Projections


          Tasks                                    Interventions or Services                              ROMA GOAL                                  Outcomes                               Indicators                               PROJECTED
                                #                                                                                                                                                                                           # of Households / customers to
                                                                                                                                                                                                                                   achieve outcomes


             1                  2                               3                                                 4                                       5                                      6                                        7

        Application


         Ineligible


          Eligible


      Pre-Assessment


        Enrollment


        Home Visit

                                                                                               6 - Low-Income people, especially
                                                                                              vulnerable populations, achieve their                                         NPI 6.1.A - Seniors receive services that
    TOTAL # Served>>>                               Senior support services                                                                  NPI 6.1 - Independent Living
                                                                                           potential by strengthening family and other                                      support independent living.
                                                                                                       supportive services.

                                          This program supports counties in specific service delivery areas.                                                                           Document County Here:
                                           EX: Emergency Services - County A, Emergency Services - County B, Emergency Services - County C
                                           EX: Weatherization - County A, Weatherization - County B, Weatherization - County C
                                           EX: Head Start - County A, Head Start - County B, Head Start - County C
                                           Note: Some agencies prefer to complete Head Start Work Plans by Site vs. County

                                          This program supports multiple counties or Service Districts en-mass.                                                                 Document Counties/Service Districts Here:
                                           IE: Mass Transportation, Information and Referral, Linkages.

Program Needs Statement



Program Mission Statement