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onnunign Envelope ID: 1**noenn-0o44-4Ao1*eec-3n4xFoecAc41 <br /> EXHIBIT <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Additional Program Information <br /> I) 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 /> | <br /> � Program Target Population Demographics <br /> ' <br /> Actual Estimated Projected <br /> 2015'16 2018'17 2017'18 <br /> Gender -- <br /> Male 57 55 61 <br /> � <br /> Female 56 55 59 <br /> Total 113 110 120 <br /> Ethnicity <br /> - <br /> African-American 28 27 30 <br /> American Indian or Alaska Native <br /> Asian MIMI 24 <br /> 1 iiiM <br /> Caucasian <br /> Native Hawaiian or other Pacific Islander <br /> Other: Hispanic or Did not specify 28 30 <br /> Total =MEI 110 120 <br /> Of the above, how many Hispanic/Latino 8 8 8 <br /> _ <br /> Of the ebove, how many non-Hispanic/Latino 95 92 101 <br /> Total IMEMBIIMIIMIIMEMI <br /> Age <br /> 0-5 years 110 107 117 <br /> 6-18 years <br /> 19-50 years <br /> 51+ years <br /> =EMI= <br /> Total =MI 110 120 <br /> Geographic Location <br /> Alamance County 4 4 4 <br /> Chatham County 2 2 2 <br /> Durham County 24 23 25 <br /> Wake County 7 7 _ 7 <br /> Other County 2 2 2 <br /> Orange County Breakdown <br /> Chapel Hill Public Housing <br /> Town of Chapel Hill (Non-Public Housing) 58 56 _ 62 <br /> Town of Carrboro 12 12 13 <br /> r-- <br /> TovvnnfHiUobonough --- 2 2 ------- 2 <br /> City of Mebane (Orange County) 1 1 1 <br /> Orange County (Outside Municipalities) 1 1 1 <br /> Total 113 110 120 <br /> PROGRAM INFORMATION 1/27/2017 8:51:47 AM P ij 0 1 4 Of i 8 <br />