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DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Additional Program 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 (6 months) (12 mos.) <br /> Male 5 110 <br /> Female 3 12 <br /> Total 0 8 122 <br /> Ethnicity _ <br /> African-American 2 48 <br /> American Indian or Alaska Native <br /> Asian 9 <br /> Caucasian 6 65 <br /> Native Hawaiian or other Pacific Islander <br /> Other: specify <br /> Total 0 8 122 <br /> Of the above, how many Hispanic/Latino 2 15 <br /> Of the above, how many non-Hispanic/Latino 6 107 <br /> Total 0 8 122 <br /> Age.. <br /> 0-5 years <br /> 6-18 years 2 7 <br /> 19-50 years 5 103 <br /> 51+ years 1 12 <br /> Total 0 8 122 <br /> Geographic Location <br /> Alamance County <br /> Chatham County <br /> Durham County <br /> Wake County <br /> Orange County Breakdown <br /> Chapel Hill Public Housing 1 31 <br /> Town of Chapel Hill (Non-Public Housing) 2 34 <br /> Town of Carrboro 1 5 <br /> Town of Hillsborough 2 14 <br /> City of Mebane (Orange County) 0 6 <br /> Orange County(Outside Municipalities) 2 32 <br /> Total 0 8 122 <br /> PROGRAM INFORMATION 1/30/2017 10:59:56 AM Page 16 of 21 <br />