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DocuSign Envelope ID:ODO4B5DD-363F-41 FF-BD24-FAD291133B51 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Additional Program Information <br /> I) Target Population. An estimate of the total number of employees working for our 109 <br /> certified living wage employers is provided. We are unavailable to provide a <br /> breakdown of these employees' demographics at this time. <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 <br /> Female <br /> Total 6510 7200 7800 <br /> Ethnicity <br /> African-American <br /> American Indian or Alaska Native <br /> Asian <br /> Caucasian <br /> Native Hawaiian or other Pacific Islander <br /> Other: specify <br /> Total 6510 7200 7800 <br /> Of the above, how many Hispanic/Latino <br /> Of the above, how many non-Hispanic/Latino <br /> Total 6510 7200 7800 <br /> Age <br /> 0-5 years <br /> 6-18 years <br /> 19-50 years <br /> 51+ years <br /> Total 6510 7200 7800 <br /> Geographic Location <br /> Alamance County <br /> Chatham County <br /> Durham County <br /> Wake County <br /> Orange County Breakdown <br /> DO NOT SUBMIT THIS PAGE 12/15/2016 9:57:17 AMII'age 24 .f 32 <br />