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DocuSign Envelope ID:80528E57-64B2-4BCE-A558-776533408604 XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Additional Program Information: Preservation and Conservation <br /> • Target Population <br /> Complete the following tables, with numbers (not percentages) of individuals served and to <br /> be 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 17 15 15 <br /> Female 18 15 15 <br /> Total 35 30 30 <br /> Ethnicity <br /> African-American <br /> American Indian or Alaska Native <br /> Asian <br /> Caucasian <br /> Native Hawaiian or other Pacific Islander <br /> Other: specify <br /> Total 0 0 0 <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 <br /> 51+ years <br /> Total 0 0 0 <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 <br /> City of Mebane (Orange County) <br /> Orange County (Outside Municipalities) <br /> Total 35* 30* 30* <br /> PROGRAM INFORMATION 2/9/2017 1:10:02 PM Page 32 o If 3 , <br />