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DocuSign Envelope ID: E865EBC7-DCBB-4CE6-A224-13D663E29E12 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Additional Pro,t rani 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 /> L <br /> Program Target Population Demographics <br /> Actual Estimated Projected <br /> 2015-16 2016-17 2017-18 <br /> Gender <br /> Male 97 100 100 <br /> 123 <br /> Female 1227 1230 0 <br /> Total 1324 1330 1330 <br /> Ethnicity' <br /> African-American 144 160 160 <br /> American Indian or Alaska Native 2 <br /> Asian 2 2 <br /> ...................................................... ..... _._._....._ _ . ........... ................ <br /> 22 25 25 <br /> Caucasian 264 270 270 <br /> Native Hawaiian or other Pacific Islander 0 0 <br /> 0 <br /> Other: Bi-racial, Latino, Middle-Eastern, 170 <br /> Nigerian, Latino(also noted below) 163 170 <br /> Unknown 729 703 703 <br /> Total 1324 1330 1330 <br /> Of the above, how many Hispanic/Latino 146 <br /> Of the above, how many non-Hispanic/Latino 1178 <br /> Total 1324 1330 1330 <br /> Age _ mm., <br /> 0-5 years 4 5 5 <br /> 6-18 years 22 25 25 <br /> 19-50 years 254 260 260 <br /> 51+ years 60 65 65 <br /> Unknown i 984 975 975 <br /> Total 1324 1330 I 1330 <br /> Geographic Location <br /> Alamance County 27 28 28 <br /> Chatham County 23 40 40 <br /> Durham County 85 1 88 88 <br /> Wake County 51 53 53 <br /> Orange County Breakdown �� �� � <br /> Chapel Hill Public Housing Unknown Unknown .... <br /> Unknown <br /> Town of Chapel Hill (Non-Public Housing) 420 428 428 <br /> Town of Carrboro 83 85 85 <br /> Town of Hillsborough 1 105 ....1____ <br /> g 10 110 <br /> PROGRAM INFORMATION 1/30/2017 4:02:21 PM p::' n .m o 1 9 o 1 4 8 <br />