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DocuSign Envelope ID:99BDCA4A-2934-455A-8D45-0C865AD016D0 it A continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Age <br /> 0-5 years 0 0 0 <br /> 6-18 years 1068 1030 1072 <br /> 19-50 years 0 0 0 <br /> 51-61 years 0 0 0 <br /> 62+ years 0 0 0 <br /> Total 1068 1030 1072 <br /> Geographic Location <br /> Durham City 359 348 356 <br /> Durham County 5 3 7 <br /> Carrboro 31 28 32 <br /> Chapel Hill 103 101 105 <br /> Chapel Hill Public Housing Residents <br /> Orange County 15 12 16 <br /> Raleigh 364 358 368 <br /> Wake County 191 180 188 <br /> Total 1068 1030 1072 <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 0 0 0 <br /> Special Needs (Omit for HS) <br /> Elderly(Over 62) <br /> Disabled (not elderly) <br /> Homeless <br /> People with HIV/Aids <br /> Total 0 0 0 <br /> Main Application 5/24/2016 8:51:19 AM Pag e 12 of 25 <br />