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DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> 19-50 years 75 n/a <br /> 51-61 years <br /> 62+ years <br /> Unknown <br /> Total 150 44 150 <br /> Geographic Location <br /> Durham City <br /> Durham County <br /> Carrboro 50 50 <br /> Chapel Hill 60 20 60 <br /> Chapel Hill Public Housing Residents 13 <br /> Orange County 30 4 30 <br /> Raleigh <br /> Wake County <br /> Other 10 7 10 <br /> Total 150 44 150 <br /> Income Level —See following chart <br /> (Omit for HS) <br /> < 30%Area Median Income <br /> 31-50% Area Median Income <br /> 51-80% Area Median Income <br /> > 80%Area Median Income <br /> Total 0 0 0 <br /> Special Needs (Omit for HS) <br /> Elderly(Over 62) <br /> Disabled (not elderly) <br /> Homeless <br /> People with HIV/Aids <br /> Total <br /> k.) Schedule of Positions <br /> Please include program staff positions followed by volunteer positions; these financial figures <br /> should match the personnel figures in your Agency Comparative Budget Excel Form. Similar <br /> positions can be combined. (i.e., 8 Occupational Therapists can be inserted as one line item). <br /> If provided, <br /> indicate: <br /> Position Titles FTE* program Actual Estimated Projected %Total Retirement <br /> *= Position Vacant * Staff+ 2014-15 2015-16 2016-17 Budget Plan <br /> (H) Health <br /> Plan <br /> 0.08 <br /> President/CEO 1 $9,360.00 $4,992 5.9 (R) <br /> Main Application 5/24/2016 4:41:23 PM P 6 of <br />