Common use of OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE Clause in Contracts

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: D7DAB463-6790-4694-B95C-6CDAFCAACC54 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: D7DAB4636E273622-67903A1B-44C9-4694-B95C-6CDAFCAACC54 AA3C-077881B99D41 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: D7DAB463AFA7D21D-6790ABA6-46944CD7-B95C-6CDAFCAACC54 83B6-FC84E830BBB5 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 1 To be completed and submitted as part of Q4 only.Docusign Envelope ID: AFA7D21D-ABA6-4CD7-83B6-FC84E830BBB5 1B Symptom Improvement - Anxiety YES GAD-7 1D Symptom Improvement - PTSD YES PCL-C 3 Resiliency YES CYRM-R 6A Rate Reduction - Hospitalization YES N/A 6B Rate Reduction - Emergency Room Use YES N/A 10A Academic Progress - Attendance YES N/A 10B Academic Progress - Behavior YES N/A 10C Academic Progress - Grades YES N/A

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: D7DAB4633598EB6A-6332-67904E64-4694-B95C-6CDAFCAACC54 ACFB-083A68FF2420 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: D7DAB46336E922F0-6790E70C-4001-4694BF58-B95C-6CDAFCAACC54 35916C8A1F88 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: D7DAB4633986959B-6790FB3A-4BFE-4694-B95C-6CDAFCAACC54 A9FC-853E6176281D Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 1 To be completed and submitted as part of Q4 only.Docusign Envelope ID: 3986959B-FB3A-4BFE-A9FC-853E6176281D 1A Symptom Improvement - Depression YES PHQ-9 1B Symptom Improvement - Anxiety YES GAD-7 1D Symptom Improvement - PTSD YES PCL-5 10A Academic Progress - Attendance YES N/A

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: D7DAB463E46E8EC8-679066B8-4694493B-845F-B95C-6CDAFCAACC54 CBA1E83E03BD Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: D7DAB463810536CA-5E03-67904D9F-4694B3E9-B95C-6CDAFCAACC54 22D442ADCDCA Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: D7DAB46392D5E900-67907744-46944E6F-84D3-B95C-6CDAFCAACC54 7894CFDCA226 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: D7DAB4631AF8BE11-6790F933-46944C04-B95C-6CDAFCAACC54 BCAC-A951488DD0C6 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: 1AF8BE11-F933-4C04-BCAC-A951488DD0C6 OUTCOMES 1A Symptom Improvement - Depression YES PHQ-9 1B Symptom Improvement - Anxiety YES GAD-7 1D Symptom Improvement - PTSD YES PCL-5 3 Resiliency YES CYRM-R 4 Quality of Life YES Q-LES-Q 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: D7DAB4639CCA6DF9-679090F1-469440B7-B95C-6CDAFCAACC54 BC50-C456F623BE27 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: D7DAB4634110F1C7-6790EA57-469449F4-B95C-6CDAFCAACC54 8645-68A48D20508D Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 1 To Before starting, ensure cell C8 is set to filter for 'YES'. 2 Complete the Output and Outcomes measures that appear below by entering info white cells. If Outcome and/or Output measures appear that you were not negotia contact your contract manager. All Outputs and Outcomes must be completed reported cumu date. Shaded cells are locked and submitted as part where applicable will fill in automatically. 3 Enter explanatory notes, if any, into the Performance Notes column(s). r Metric Selected for Reporting Performance Expectation or Target OUTPUTS 1 Unduplicated Number of Q4 only.Participants Receiving Services YES 428 2 Participant Retention YES Performance Expectation: 100% with an allowable variance of 10% OUTCOMES 3 Resiliency YES BRS 4 Quality of Life YES AQol 5 Social Supports YES SSQ6 xxxxxx into the xxx for reporting, latively, year to

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: D7DAB4630B1260BD-5848-6790405E-4694AE7A-B95C-6CDAFCAACC54 FA1C26DEE6F0 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: 0B1260BD-5848-405E-AE7A-FA1C26DEE6F0 8A Employment - Obtain YES N/A 8B Employment - Maintain YES N/A 9A Housing - Obtain YES N/A 9B Housing - Maintain YES N/A 1 To be completed and submitted as part of Q4 only.