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DocuSign Envelope ID: D2CB2439-4B3B-42E7-A090-286FDDD6E948 t A - continued <br /> Provider's Outside Agency Application <br /> Total 8 10 12 <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 /> Please indicate whether this project/program will serve: x❑ Persons ❑ Households ❑ Units <br /> Program: Bridge Builders <br /> Program Beneficiary Demographics <br /> Actual Estimated Projected <br /> 2014-15 2015-16 2016-17 <br /> Gender <br /> Male 46 50 56 <br /> Female 69 80 84 <br /> Total 115 130 140 <br /> Of the females, how many are <br /> single-female Head of Households(Omit <br /> for Human Services) <br /> Ethnicity <br /> African-American 0 0 0 <br /> American Indian or Alaska Native <br /> Asian 115 130 140 <br /> Caucasian <br /> Native Hawaiian or other Pacific Islander <br /> Other <br /> Total 115 130 140 <br /> Of the above, how many Hispanic/Latino 0 0 0 <br /> Of the above, how many <br /> non-Hispanic/Latino 0 0 0 <br /> Total 115 130 140 <br /> Age <br /> 0-5 years 29 33 36 <br /> 6-18 years 44 51 56 <br />