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DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Additional Program Information <br /> x) 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 30 51 50 <br /> Female 66 58 60 <br /> Total 106 109 110 <br /> Ethnicity <br /> African-American 45 54 53 <br /> American Indian or Alaska Native <br /> Asian <br /> Caucasian 58 49 54 <br /> Native Hawaiian or other Pacific Islander <br /> Other: specify Hispanic/Latino 3 6 3 <br /> Total 106 109 110 <br /> Of the above, how many Hispanic/Latino 3 6 3 <br /> Of the above, how many non-Hispanic/Latino 103 103 106 <br /> Total 106 109 110 <br /> Age <br /> 0-5 years <br /> 6-18 years 4 5 5 <br /> 19-50 years 84 88 89 <br /> 51+ years 18 16 16 <br /> Total 106 109 110 <br /> Geographic Location <br /> Alamance County 4 5 5 <br /> Chatham County 2 5 5 <br /> Durham County <br /> Wake County <br /> Orange County Breakdown <br /> Chapel Hill Public Housing <br /> Town of Chapel Hill (Non-Public Housing) 39 37 38 <br /> Town of Carrboro 26 24 24 <br /> Town of Hillsborough 6 8 8 <br /> City of Mebane(Orange County) 3 2 2 <br /> Orange County(Outside Municipalities) 26 28 28 <br /> Other <br /> Total 106 109 110 <br /> DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 22 of <br />