Orange County NC Website
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DocuSign Envelope ID: 10Ao4orA-7125-42E0-a3E7-C6o53151o77C [ /\ - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Other <br /> Total 0 0 0 <br /> Of the above, how many <br /> Hispanic/Latino <br /> Of the above, how many non- <br /> Hispanic/Latino <br /> Total 0 0 0 <br /> Age <br /> 0-5 years <br /> 6-18 years 18 18 25 <br /> 19-50 years <br /> 51-61 years <br /> 62+ years <br /> Total 18 18 25 <br /> Geographic Location <br /> Durham City <br /> Durham County <br /> Carrboro <br /> Chapel Hill <br /> Chapel Hill Public Housing Residents <br /> Orange County 18 18 25 <br /> Raleigh <br /> Wake County <br /> | | <br /> Total | 18 18 25 | <br /> Income Level—See following chart <br /> (Omit for HS) <br /> < 3096 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) 18 18 25 <br /> Homeless <br /> People with HIV/Aids <br /> Total 18 18 25 <br /> Main Application 1/25/2016 1:42:01 PM Page 1111 of 211 <br />