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DocuSign Envelope ID:8E4BA2A0-F8F0-406A-A380-E6C66CCD78B4 I <br /> EXHIBIT A I <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Additional piro ram 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 <br /> Actual Estimated Projected <br /> 2015-16 2016-17 2017-18 <br /> Gender <br /> Male 43 45 48 <br /> Female 61 65 70 <br /> Total 104 110 118 <br /> Ethnicity <br /> African-American 8 10 12 <br /> American Indian or Alaska Native <br /> Asian 2 3 4 <br /> Caucasian 93 95 99 , <br /> — , <br /> Native Hawaiian or other Pacific Islander <br /> Other: specify Hispanic 1 2 3 <br /> Total 104 110 118 <br /> Of the above, how many Hispanic/Latino <br /> Of the above, how many non-Hispanic/Latino . .......... <br /> Total 0 0 0 <br /> Age <br /> 0-5 years <br /> 6-18 years <br /> 19-50 years <br /> 51+ years 110 118 <br /> .... .. <br /> Total j 0 0 0 <br /> Geographic Location <br /> Alamance County 2 3 3 <br /> Chatham County 15 16 18 <br /> Durham County 27 28 30 <br /> Wake County 2 2 2 <br /> Orange County Breakdown <br /> Chapel Hill Public Housing _ <br /> Town of Chapel Hill (Non-Public Housing) 46 48 50 <br /> Town of Carrboro 5 6 7 <br /> Town of Hillsborough 1 1 1 <br /> City of Mebane (Orange County) <br /> Orange County (Outside Municipalities) 6 6 7 <br /> Total 104 110 118 <br /> PROGRAM INFORMATION 1/27/2017 4:52:00 PM Page 11 of 1 6 <br />