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DocuSign Envelope ID:9B26E979-2C09-4BE7-801C-3DDB484D92EE XHIBIT A <br /> PROVIDER"S OUTSIDE AGENCY APPLICATION <br /> Additional Proclram Information <br /> k) 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 *2 months <br /> Male 13 17 17 <br /> Female 29 33 33 <br /> Total 42 50 50 <br /> Ethnicity <br /> African-American 9 13 13 <br /> American Indian or Alaska Native 0 <br /> Asian 0 <br /> Caucasian 33 37 37 <br /> Native Hawaiian or other Pacific Islander <br /> Other: specify <br /> Total 42 50 50 <br /> Of the above, how many Hispanic/Latino <br /> Of the above, how many non-Hispanic/Latino <br /> Total 0 0 0 <br /> Age <br /> 0-5 years <br /> 6-18 years <br /> 19-50 years 1 2 2 <br /> 51+ years 41 (avg 81.3) 48 48 <br /> Total 42 50 50 <br /> Geographic Location <br /> Alamance County <br /> Chatham County <br /> Durham County <br /> Wake County <br /> Orange County Breakdown <br /> Chapel Hill Public Housing <br /> Town of Chapel Hill (Non-Public Housing) <br /> Town of Carrboro <br /> Town of Hillsborough 1 2 2 <br /> City of Mebane(Orange County) 2 2 2 <br /> Orange County(Outside Municipalities) 39 46 46 <br /> Total 42 50 50 <br /> PROGRAM INFORMATION 2/8/2017 4:36:09 PM Page 11 • .f I "' ' <br />