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DocuSign Envelope ID:2164F437-BF9D-46A1-B13B-7740B02003DA t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Of the females, how many are single- <br /> female Head of Households (Omit for <br /> Human Services)N/A N/A N/A <br /> Ethnicity <br /> African-American Not open 25 44 <br /> American Indian or Alaska Native " 0 0 <br /> Asian " 2 6 <br /> Caucasian " 3 11 <br /> Native Hawaiian or other Pacific Islander 0 <br /> Other" 2 5 <br /> Total I 0 32 66 <br /> Of the above, how many Hispanic/Latino " 3 10 <br /> Of the above, how many non- <br /> Hispanic/Latino " 33 56 <br /> Total 0 32 66 <br /> Age <br /> 0-5 years Not open 6 9 <br /> 6-18 years " 26 57 <br /> 19-50 years " 0 <br /> 51-61 years " 0 <br /> 62+ years " 0 <br /> Total I 0 32 66 I <br /> Geographic Location <br /> Durham City Not open 0 <br /> Durham County " 0 <br /> Carrboro " 16 15 <br /> Chapel Hill" 41 <br /> Chapel Hill Public Housing Residents" unk 10 <br /> Orange County " 0 <br /> Main Application 5/24/2016 8:59:25 a5/p5 III. 11 o of 23 <br />