Orange County NC Website
DocuSign Envelope ID: 5BF9183D-3BD5-4FD7-80DE-F437539D2E9F t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <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 /> Native Hawaiian or other Pacific <br /> Islander <br /> Other <br /> Total 5262 9000 9000 <br /> Of the above, how many <br /> Hispanic/Latino <br /> Of the above, how many non- <br /> Hispanic/Latino <br /> Total 5262 9000 9000 <br /> Age <br /> 0-5 years <br /> 6-18 years <br /> 19-50 years <br /> 51-61 years <br /> 62+ years <br /> Total 5262 9000 9000 <br /> Geographic Location <br /> Durham City <br /> Durham County <br /> Carrboro <br /> Chapel Hill <br /> Chapel Hill Public Housing Residents <br /> Orange County <br /> Raleigh <br /> Wake County <br /> Total 5262 9000 9000 I <br /> Income Level —See following chart <br /> (Omit for HS) N/A <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) N/A <br /> Elderly(Over 62) <br /> Main Application 5/25/2016 9:07:15 AM P , 12 of <br />