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DocuSign Envelope ID: ED6C5D54-7108-4169-9541-C2FDA3EC8CA6 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Program: <br /> Program Beneficiary Demographics <br /> Actual Estimated Projected <br /> 2014-15 2015-16 2016-17 <br /> Gender <br /> Male 175 180 180 <br /> Female 325 335 335 <br /> Total 500 515 515 <br /> Of the females, how many are single- <br /> female Head of Households (Omit for <br /> Human Services) <br /> Ethnicity <br /> African-American 300 300 300 <br /> American Indian or Alaska Native <br /> Asian <br /> Caucasian 195 195 195 <br /> Native Hawaiian or other Pacific <br /> Islander <br /> Other 5 5 5 <br /> Total 0 0 0 <br /> Of the above, how many <br /> Hispanic/Latino 5 5 5 <br /> Of the above, how many non- <br /> Hispanic/Latino <br /> Total 500 500 800 <br /> Age <br /> 0-5 years <br /> 6-18 years 50 50 50 <br /> 19-50 years 325 325 325 <br /> 51-61 years 125 125 125 <br /> 62+ years <br /> Total 0 0 0 <br /> Geographic Location <br /> Durham City <br /> Durham County <br /> Carrboro <br /> Chapel Hill 250 250 250 <br /> Chapel Hill Public Housing Residents 150 150 150 <br /> Orange County 50 50 50 <br /> Raleigh <br /> Wake County <br /> Total 450 450 450 I <br /> Income Level —See following chart <br /> (Omit for HS) <br /> Main Application 5/25/2016 9:25:11 AM P of 2 <br />