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DocuSign Envelope ID: EB541A3B-1E01-49AB-9E09-7987ECAEC1C4 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Please indicate whether this project/program will serve: I 1 Persons [1 <br /> Households n Units <br /> Program: Back to School Bash <br /> Program Beneficiary Demographics <br /> Actual Estimate Prole( <br /> 2014- d d <br /> 15 2015-16 2016- <br /> Gender <br /> Male 158 200 <br /> Female 183 200 <br /> Total 0 341 4 <br /> Of the females, how many are single-female Head of Households (Omit for Human <br /> Services) <br /> Ethnicity --African-American _ 190 200 <br /> American Indian or Alaska Native 0 0 <br /> Asian 134 150 <br /> Caucasian 2 20 <br /> Native Hawaiian or other Pacific Islander _ <br /> Other 15 30 <br /> Total 0 0 4 <br /> Of the above, how many Hispanic/Latino 15 25 <br /> Of the above, how many non-Hispanic/Latino 326 <br /> Total 0 15 <br /> Age <br /> 0-5 years 121 150 <br /> 6-18 years 200 225 <br /> 19-50 years 20 ! 25 <br /> 51-61 years <br /> 62+years <br /> Total 0 0 <br /> Geographic Location — <br /> Durham City <br /> Durham County <br /> Carrboro 37 _ 50 <br /> Chapel Hill 226 250 <br /> Chapel Hill Public Housing Residents <br /> Orange County — 78 100 <br /> Raleigh <br /> Wake County <br /> Total 0 341 4 <br /> Main Application1/25/2016P a g e 12 of 3 <br />