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DocuSign Envelope ID: 1007B77C-A009-4AA3-964B-3B03B9585341 <br /> txnibit A-continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Program: Adapted Sports: Adapted Sports Day <br /> Program Beneficiary Demographics <br /> Actual Estimated Projected <br /> 2014-15 2015-16 2016-17 <br /> Gender <br /> Male 500 1,000 7,500 <br /> Female 500 1,000 7,500 <br /> Total 1,000 2,000 15,000 <br /> Of the females, how many are single- <br /> female Head of Households (Omit for <br /> Human Services) <br /> Ethnicity <br /> African-American 22% 22% 35% <br /> American Indian or Alaska Native 1% 1% 1% <br /> Asian 3% 3% 3% <br /> Caucasian 63% 63% 63% <br /> Native Hawaiian or other Pacific <br /> Islander 0% 0% 1% <br /> Other 11% 11% 11% <br /> Total 100% 100% 100% <br /> Of the above, how many <br /> Hispanic/Latino 9% 9% 9% <br /> Of the above, how many non- <br /> Hispanic/Latino 91% 91% 91% <br /> Total 100% 100% 100% <br /> Age <br /> 0-5 years 5% 5% 5% <br /> 6-18 years 95% 95% 95% <br /> 19-50 years 0 0 25% <br /> 51-61 years 0 0 0 <br /> 62+ years 0 0 0 <br /> Total 100% 100% 100% <br /> Geographic Location <br /> Durham City 25% <br /> Durham County <br /> Carrboro 0% 0% 33.33% <br /> Chapel Hill 20% 25% 33.33% <br /> Chapel Hill Public Housing Residents <br /> Orange County 25% 33.33% <br /> Raleigh 30% <br /> Wake County 25% 25% <br /> Total 100% 75% 100% I <br /> Income Level —See following chart <br /> (Omit for HS) <br /> Main Application 5/24/2016 9:03:13 AM P I of 2 <br />