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DocuSign Envelope ID: D2CB2439-4B3B-42E7-A090-286FDDD6E948 t A - continued <br /> Provider's Outside Agency Application <br /> Caucasian 1 2 2 <br /> Native Hawaiian or other Pacific Islander <br /> Other 9 13 16 <br /> Total 34 39 45 <br /> Of the above, how many Hispanic/Latino 9 13 16 <br /> Of the above, how many <br /> non-Hispanic/Latino 0 0 0 <br /> Total 34 39 45 <br /> Age <br /> 0-5 years 0 0 0 <br /> 6-18 years 2 2 3 <br /> 19-50 years 30 34 38 <br /> 51-61 years 2 3 4 <br /> 62+years <br /> Total 34 39 45 <br /> Geographic Location <br /> Durham City 0 0 0 <br /> Durham County 0 0 0 <br /> Carrboro 32 37 43 <br /> Chapel Hill 2 2 2 <br /> Chapel Hill Public Housing Residents <br /> Orange County <br /> Raleigh <br /> Wake County <br /> Total 34 39 45 <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 <br /> Special Needs (Omit for HS) <br /> Elderly(Over 62) <br /> Disabled (not elderly) <br /> Homeless <br /> People with HIV/Aids <br /> Total <br />