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DocuSign Envelope ID: D2CB2439-4B3B-42E7-A090-286FDDD6E948 t A - continued <br /> Provider's Outside Agency Application <br /> • We collaborate with student volunteers to provide mentoring and after school tutoring to <br /> families who are struggling to adjust to life in the United States. <br /> • We utilize student volunteers to provide weekly Tech and Jobs classes at our offices in <br /> Carrboro. <br /> h) Describe what would happen if requested funding is not awarded at all or if a reduced <br /> allocation is recommended. <br /> Immigrants and refugees in the community, which receives limited services from other <br /> agencies after 90-180 days would be missing an important resource and advocate on their <br /> behalf. <br /> i) Include any other pertinent information. <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 <br /> to attach copies of all data collection tools that will be used to verify achievement of <br /> program 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 ❑ <br /> Units <br /> Program: Food Empowerment <br /> Program Beneficiary Demographics <br /> Actual Estimated Projected <br /> 2014-15 2015-16 2016-17 <br /> Gender <br /> Male 4 4 5 <br /> Female 30 35 40 <br /> Total 34 39 45 <br /> Of the females, how many are <br /> single-female Head of Households(Omit <br /> for Human Services) <br /> Ethnicity <br /> African-American 3 4 5 <br /> American Indian or Alaska Native <br /> Asian 21 24 27 <br />