Orange County NC Website
Browse       Search
DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Program/Project Information <br /> j) Complete the Target Population and Program Beneficiary Demographics Chart <br /> k) Complete the Schedule of Positions Chart for Program Staff <br /> I) 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 <br /> attach copies of all data collection tools that will be used to verify achievement of program <br /> goals and 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 indicate whether this project/program will serve: X Persons ❑ Households ❑ Units <br /> Program: ECH Center for Education and Leadership <br /> Program Beneficiary Demographics <br /> Actual Estimated Projected <br /> 2014-15 2015-16 2016-17 <br /> Gender <br /> Male 90 120 275 <br /> Female 21 45 50 <br /> Total 111 165 325 <br /> Of the females, how many are single- <br /> female Head of Households (Omit for <br /> Human Services) <br /> Ethnicity <br /> African-American 22 25 30 <br /> American Indian or Alaska Native 0 <br /> Asian 1 <br /> Caucasian 10 15 15 <br /> Native Hawaiian or other Pacific <br /> Islander <br /> Other 78 125 280 <br /> Total 111 165 325 <br /> Of the above, how many <br /> Hispanic/Latino 78 125 280 <br /> Of the above, how many non- <br /> Hispanic/Latino 33 40 45 <br /> Total 111 165 325 <br /> Age <br /> 0-5 years <br /> 6-18 years 1 1 7 <br /> 19-50 years 79 137 280 <br /> Main Application 5/24/2016 4:43:09 PM Pag 6 of 11 <br />