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DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 <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 78 80 80 <br /> Female 100 110 110 <br /> Total 178 _ 190 _ 190 <br /> Ethnicity <br /> African-American <br /> American Indian or Alaska Native <br /> Asian 28 30 30 <br /> Caucasian <br /> Native Hawaiian or other Pacific Islander <br /> Other: specify Hispaicn 150 160 160 <br /> Total 178 190 190 <br /> Of the above, how many Hispanic/Latino 150 160 160 <br /> Of the above, how many non-Hispanic/Latino 28 30 30 <br /> Total 178 190 190 <br /> Age <br /> 0-5 years 34 34 34 <br /> 6-18 years MEMMI <br /> 19-50 years 144 156 156 <br /> 51+ years <br /> Total 178 190 190 <br /> Geographic Location <br /> Alamance County <br /> Chatham County <br /> Durham County 5 5 5 <br /> Wake County <br /> Orange County Breakdown <br /> Chapel Hill Public Housing 32 32 32 <br /> Town of Chapel Hill (Non-Public Housing) <br /> Town of Carrboro 18 18 18 <br /> Town of Hillsborough 2 2 2 <br /> City of Mebane (Orange County) 2 2 2 <br /> Orange County(Outside Municipalities) 116 131 131 <br /> Total 178 190 190 <br /> PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 29 of 32 <br />