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DocuSign Envelope ID:38357F45-0Fo1-474F-992F-A2000A42A3E2 [ A- CO[tiOUed <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> African-American 15 14 15 <br /> ' ------ <br /> American Indian or Alaska Native 0 0 0 <br /> Asian 1 0 0 <br /> Caucasian 85 116 125 <br /> __ <br /> Native Hawaiian or other Pacific <br /> Islander 0 0 0 <br /> Other 12 16 28 <br /> „ <br /> Total 113 156 168 <br /> _ <br /> Of the above, how many <br /> Hispanic/Latino 1 2 2 . <br /> Of the above, how many non- <br /> Hinpanic/Lodno 112 154 106 <br /> Total 113 156 | 168 <br /> 0-5 years 0 0 0 <br /> 6-18 years 0 0 0 <br /> 10-50 yea/s __ 3 _ 2 3 <br /> 51-61 years 7 10 11 <br /> 62+ years , 103 144 154 <br /> � <br /> Total 113 156 168 <br /> Durham City O , 0 0 <br /> Durham County 0 0 0 <br /> Carrboro 6 8 9 <br /> Chapel Hill 41 64 69 <br /> Chapel Hill Public Housing Residents <br /> Orange County 66 84 98 <br /> Raleigh 0 0 0 <br /> Wake County __ 0 0 0 <br /> Total 113 156 168 <br /> < 30%Area Median Income <br /> 31-50% Area Median Income <br /> 51-80% Area Median Income IIIIIIIIIIIIIII <br /> IMIIIIIMIIIIIIII <br /> > 80%Area Median Income <br /> Total 0 0 0 <br /> 0 <br /> Elderly (Over 62) 103 144 154 <br /> Disabled (not elderly) <br /> Homeless <br /> People with HIV/Aids MEM <br /> Total 103 144 154 <br /> Main Application 1/25/2016 11:36:35 AM Page 7 of 16 <br />