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DocuSign Envelope ID:88377437-EE99-4E08-B6B1-CD4F113C0672 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Additional Proclram Information <br /> a) 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 /> The athlete numbers provided below include only those athletes who are considered paid <br /> members of Bridge II Sports. The numbers below exclude the following: athletes <br /> considered nonmembers, athletes competing with BITS from external teams, athletes and <br /> participants competing in BITS tournaments, athletes and participants who actively engage <br /> and obtain benefit from BITS community events and outreach activities, UNC experiential <br /> learning experiences in wheelchair basketball programming, and #EverybodyPlaysNC <br /> school initiative wheelchair basketball programming. The total number of all BITS <br /> wheelchair basketball athletes who are paid members, plus the number of people <br /> mentioned in the categories above who are not included in the Program Target Population <br /> Demographics below, equates to 373 people in 2016. <br /> Program Target Population Demographics <br /> Actual Estimated Projected <br /> 2015-16 2016-17 2017-18 <br /> Gender <br /> Male 15 16 16 <br /> Female 7 8 10 <br /> Total 22 24 26 <br /> Ethnicity <br /> African-American 5 6 6 <br /> American Indian or Alaska Native 1 1 2 <br /> Asian 0.5 1.5 1.5 <br /> Caucasian 14 14 14 <br /> Native Hawaiian or other Pacific Islander 1 <br /> Other: specify 1.5 1.5 1.5 <br /> Total 22 24 26 <br /> Of the above, how many Hispanic/Latino 0.5 1.5 2.5 <br /> Of the above, how many non-Hispanic/Latino 21.5 22.5 23.5 <br /> Total 22 24 26 <br /> Age <br /> 0-5 years <br /> 6-18 years 15 16 16 <br /> 19-50 years 2 3 4 <br /> 51+years 5 5 6 <br /> Total 22 24 26 <br /> Geographic Location <br /> Alamance County <br /> Chatham County <br /> Durham County 6 6 6 <br /> PROGRAM INFORMATION 1/27/2017 3:48:29 PM Pago 21 of 2 6 <br />