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EXHIBIT A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> not be able to increase our contacts with businesses or certifications over our current level. Our other goals <br /> would be equally suppressed. If a reduced allocation is made,we would be able to increase our services <br /> proportionate to the percent of our request that is granted. <br /> 1) Include any other pertinent information. <br /> ProaramlProlect Information <br /> j) Complete the Target Population and Program Beneficiary Demographics Chart <br /> k) Complete the Schedule of Positions Chart for Program Staff <br /> 1) Disclosure of Potential Conflicts of Interested must be signed <br /> m) Complete the Work Statement Chart to describe the work to be performed,and be sure to attach <br /> copies of all data collection tools that will be used to verify achievement of program goals and <br /> objectives. Describe who will be responsible for monitoring progress. <br /> Information to Complete <br /> J.)Target Population <br /> Complete the following tables to the best of your ability. Show numbers of participants and <br /> percentages, as applicable, in each category. <br /> Please Note: We do not collect information on individual employees. We are following the practice of <br /> other certification programs that have been our models,including those in Durham and Asheville. <br /> Therefore,we are unable to address most of the categories in the table. We consider only employees who <br /> are eighteen years of age or older. We make an effort to target businesses in low-paying industries,so many <br /> of the employees of certified businesses fall into the<30 percent of area median income. All of the <br /> businesses/organizations are In Orange County and all of the employees work in the county. <br /> Please indicate whether this project/program will serve: **❑ Persons **❑ Households **❑ <br /> Units <br /> Program: Orange County Living <br /> Wage Program <br /> Program Ban ficlary Derriographim <br /> Actual Estimated Projected <br /> 2014-15 2015-16 2016-17 <br /> Gender <br /> Male <br /> Female <br /> Total 0 8,000 12,000 <br /> Of the females, how many are single- <br /> female Head of Households(Omit for <br /> Human Services) <br /> Ethnicity <br /> African-American <br /> American Indian or Alaska Native <br /> Asian <br /> Caucasian <br /> 11A.sin Annlinalinn 1MRnnir% 41.1!1.77 ARA D _ _ ^ O _ f 7 7 <br />