Jefferson County Service Information Forms

Instructions to complete the Service Information Forms.

  1. Enter your County’s name(s) on the blank line provided.
  2. Under “ESTIMATED NUMBER OF PEOPLE TO BE SERVED” enter the number of clients that you expect to receive serves under this program during the contract fiscal year.
  3. Under “TARGETED OUTCOMES” write a Target, Benchmark or Change statement.  The statement should be Specific, Measurable, Attainable, Realistic, and Time-bound.
    • Target Statements - state specific levels of achievement.
    • Benchmark Statements - include comparative targets, generally related to other time periods or organizations.
    • Change Statements - include the increase, maintenance, or decrease in behavior, skill, knowledge or attitude, etc.
      • Ideas for outcomes can be selected from:  the Criteria for Evaluation; the County Guidelines, Washington State’s approved plan for the Individuals with Disabilities Education Act (IDEA) tool
      • The County Plan where the focus is on quality improvement and/or
      • Other best practices documents.
  4. Under “GOAL” indicated what is to be achieved - typically a broad statement responsive to real needs, challenges, opportunities, or potentials for the future.