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DocuSign Envelope ID: 5D25D6E0-716B-4244-AEA3-02E6A45FD852 <br /> EXHIBIT A <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 /> Program Target Population Demographics <br /> Actual Estimated Projected <br /> 2015-16 2016-17 2017-18 <br /> Gender <br /> Male 308 305 311 <br /> Female 248 260 264 <br /> Total 556 565 575 <br /> Ethnicity <br /> African-American 296 299 304 <br /> American Indian or Alaska Native 18 19 20 <br /> Asian 3 4 5 <br /> Caucasian 159 161 164 <br /> Native Hawaiian or other Pacific Islander 1 1 2 <br /> Other: specify Multi-racial 79 81 80 <br /> Total 556 565 575 <br /> Of the above, how many Hispanic/Latino 10 11 15 <br /> Of the above, how many non-Hispanic/Latino 546 554 560 <br /> Total 556 565 575 <br /> Age <br /> 0-5 years 0 0 0 <br /> 6-18 years 0 0 0 <br /> 19-50 years 281 286 290 <br /> 51+ years 275 279 285 <br /> Total 556 565 575 <br /> Geographic Location <br /> Alamance County 3 3 3 <br /> Chatham County 2 2 2 <br /> Durham County 21 17 18 <br /> Wake County 5 5 5 <br /> Orange County Breakdown <br /> Chapel Hill Public Housing 17 25 28 <br /> Town of Chapel Hill (Non-Public Housing) 387 390 395 <br /> Town of Carrboro 99 101 102 <br /> Town of Hillsborough 16 16 16 <br /> City of Mebane (Orange County) 2 2 2 <br /> Orange County(Outside Municipalities) 4 4 4 <br /> Total 556 565 575 <br /> PROGRAM INFORMATION 1/31/2017 11:04:24 AM P a g e 1 .f 2 <br />