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DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> • Our vision for our community is one where all youth view themselves — and others <br /> view them — as whole and worthy community members. <br /> j) Describe what would happen if requested funding is not awarded at all or if a reduced <br /> allocation is recommended. <br /> If the requested funding is not awarded or is at a reduced level, Boomerang would need to <br /> reconsider the number of youth served, and potentially reduce after school programming. <br /> Additional Program Information <br /> k) Target Population <br /> Complete the following tables, with numbers (not percentages) of individuals served and to be <br /> served, to the best of your ability, <br /> Program Target Population Demographics—ALTERNATIVE TO SUSPENSION <br /> Actual Estimated Projected <br /> 2015-16 2016-17 2017-18 <br /> Gender <br /> Male 120 105 105 <br /> Female 47 45 45 <br /> Total 167 150 150 <br /> Ethnicity <br /> African-American 82 65 65 <br /> American Indian or Alaska Native 0 0 0 <br /> Asian 0 0 0 <br /> Caucasian 69 75 75 <br /> Native Hawaiian or other Pacific Islander 0 0 0 <br /> Other: Multi-Racial 16 10 10 <br /> Total 167 150 150 <br /> Of the above, how many Hispanic/Latino 37 45 45 <br /> Of the above, how many non-Hispanic/Latino 130 105 105 <br /> Total 167 150 150 <br /> Age <br /> 0-5 years 0 0 0 <br /> 6-18 years 162 145 145 <br /> 19-50 years 5 5 5 <br /> 51+years 0 0 0 <br /> Total 0 150 150 <br /> Geographic Location <br /> Orange County Breakdown <br /> Chapel Hill (27514, 27516, 27517) 80 75 75 <br /> Carrboro (27510) 31 30 30 <br /> Other Orange County 56 45 45 <br /> Total 167 150 150 <br /> Pago 13 f 15 <br />