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DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 t it A continued <br /> Provider's MAI 1 API�LICATIONication <br /> Caucasian 21 19 18 <br /> Native Hawaiian or other Pacific <br /> Islander <br /> Other 2 2 2 <br /> Total 45 42 40 <br /> Of the above, how many <br /> Hispanic/Latino 2 2 2 <br /> Of the above, how many non- <br /> Hispanic/Latino 43 40 38 <br /> Total 45 42 40 <br /> Age <br /> 0-5 years <br /> 6-18 years 1 2 2 <br /> 19-50 years 43 39 37 <br /> 51-61 years 1 1 1 <br /> 62+ years <br /> Total 45 42 40 <br /> Geographic Location <br /> Durham City 4 3 3 <br /> Durham County <br /> Carrboro 15 12 10 <br /> Chapel Hill 10 10 11 <br /> Chapel Hill Public Housing Residents 1 2 3 <br /> Orange County 15 15 13 <br /> Raleigh <br /> Wake County <br /> Total 45 42 40 <br /> Income Level—See following chart j <br /> (Omit for HS) <br /> < 30%Area Median Income 42 40 39 <br /> 31-50%Area Median Income 3 2 1 <br /> 51-80% Area Median Income <br /> > 80%Area Median Income <br /> Total 45 42 40 <br /> Special Needs (Omit for HS) <br /> Elderly(Over 62) 0 1 1 <br /> Disabled (not elderly) 1 2 1 <br /> Homeless 2 2 2 <br /> People with HIV/Aids <br /> Total 3 5 4 <br /> Main Application 1/20/2016 4:35:53 PM Page 10 of 21 <br />