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DocuSign Envelope ID: E865EBC7-DCBB-4CE6-A224-1 3D663E29E12 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Additional Pro 6 ram 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 1403 1400 1400 <br /> Female 3217 3220 3220 <br /> Total 4620 4620 4620 <br /> Ethnicity — <br /> .. African-American 515 650 650 <br /> American Indian or Alaska Native 12 12 12 <br /> Asian 302 315 315 <br /> Caucasian 2790 2800 2800 <br /> Native Hawaiian or other Pacific Islander 0 0 0 <br /> Other: Unknown, Persian, Bi-Racial, Nigerian, <br /> Thai, Arab, Latino (also noted below) <br /> 1001 843 843 <br /> Total <br /> 4620 <br /> 4620 <br /> 4620 <br /> Of the above, how many Hispanic/Latino 330 350 350 <br /> Of the above, how many non-Hispanic/Latino 4290 4270 4270 <br /> Total 4620 4620 4620 <br /> Age <br /> 0-5 years 0 0 0 <br /> 6-18 years 1514 1514 1514 <br /> 19-50 years 2136 2136 2136 <br /> 51+ years 970 970 970 <br /> Total 4620 1 4620 4620 <br /> Geographic Location <br /> Alamance County 11 10 10 <br /> Chatham County 21 25 25 <br /> Durham County 54 55 55 <br /> Wake County 31 <br /> Orange County Breakdown <br /> Chapel Hill Public Housing Unknown 30 30 <br /> 1 _, <br /> Unknown Unknown <br /> Town of Chapel Hill (Non-Public Housing) 1051 1050 1050 <br /> Town of Carrboro 797 800 800 <br /> Town of Hillsborough 43 50 50 <br /> City of Mebane (Orange County) 12 15 15 <br /> Orange County(Outside Municipalities) 24 30 30 <br /> Other/Unknown 2576 2555 2555 <br /> PROGRAM INFORMATION 1/30/2017 4:02:21 PM <br />