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DocuSign Envelope ID:6D821DA0-CO6F-4D38-BB4F-DB28CB54AD8E XHIBIT 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 109 109 109 <br /> Female 101 101 101 <br /> Total 210 210 210 <br /> Ethnicity <br /> African-American 91 91 91 <br /> American Indian or Alaska Native 1 1 1 <br /> Asian 10 10 10 <br /> Caucasian 103 103 103 <br /> Native Hawaiian or other Pacific Islander 0 0 0 <br /> Other: specify Hispanic/Latino 5 5 5 <br /> Total 210 210 210 <br /> Of the above, how many Hispanic/Latino 5 5 5 <br /> Of the above, how many non-Hispanic/Latino 205 205 205 <br /> Total 210 210 210 <br /> Age <br /> 0-5 years 0 0 0 <br /> 6-18 years 20 20 20 <br /> 19-50 years 128 128 128 <br /> 51+ years 62 62 62 <br /> Total 210 210 210 <br /> Geographic Location <br /> Alamance County 1 1 1 <br /> Chatham County 2 2 2 <br /> Durham County 7 7 7 <br /> Wake County 1 1 1 <br /> Orange County Breakdown <br /> Chapel Hill Public Housing N/A-OE does not collect data on Public Housing <br /> Town of Chapel Hill (Non-Public Housing) N/A-OE does not collect data on Public Housing <br /> Town of Chapel Hill 74 74 74 <br /> Town of Carrboro 31 31 31 <br /> Town of Hillsborough 9 9 9 <br /> City of Mebane (Orange County) 3 3 3 <br /> Orange County (Outside Municipalities) 82 82 82 <br /> Total 210 210 210 <br /> Work Statement <br /> PROGRAM INFORMATION 1/31/2017 8:24:51 AM Page 16 of 20 <br />