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DocuSign Envelope ID: 5BF9183D-3BD5-4FD7-80DE-F437539D2E9F t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Durham County <br /> Carrboro <br /> Chapel Hill <br /> Chapel Hill Public Housing Residents <br /> Orange County <br /> Raleigh <br /> Wake County <br /> Total 28 30 30 <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 /> Disabled (not elderly) <br /> Homeless <br /> People with HIV/Aids <br /> Total 0 0 0 <br /> *The Museum does not capture statistics on gender, ethnicity, and age <br /> from museum visitors, program participants, or individual researchers. <br /> Main Application 5/25/2016 9:07:15 AM P 141 of <br />