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DocuSign Envelope ID:A13A145D-D67A-4FF7-ABA9-312E380D8DD9 <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 <br /> Male 88 91 100 <br /> Female 84 88 95 <br /> Total 172 179 195 <br /> Ethnicity <br /> African-American 63 65 70 <br /> American Indian or Alaska Native <br /> Asian 8 3 5 <br /> Caucasian 88 104 113 <br /> Native Hawaiian or other Pacific Islander <br /> Other: specify_Biracial 13 7 7 <br /> Total 172 179 195 <br /> Of the above, how many Hispanic/Latino 32 42 45 <br /> Of the above, how many non-Hispanic/Latino 140 137 150 <br /> Total 172 179 195 <br /> Age <br /> 0-5 years <br /> 6-18 years 172 179 195 <br /> 19-50 years <br /> 51+ years <br /> Total 172 179 195 <br /> Geographic Location <br /> Alamance County <br /> Chatham County <br /> Durham County 4 2 2 <br /> Wake County <br /> Orange County Breakdown <br /> Chapel Hill Public Housing (estimate) 10 10 10 <br /> Town of Chapel Hill (Non-Public Housing) 71 73 80 <br /> Town of Carrboro 10 17 20 <br /> Town of Hillsborough 39 40 42 <br /> City of Mebane (Orange County) 11 9 10 <br /> Orange County (Outside Municipalities) 27 28 31 <br /> Total 172 179 195 <br /> PROGRAM INFORMATION 2/8/2017 10:03:24 AM p a g g °' 7" a 1 2 2 <br />