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DocuSign Envelope ID: EA54395E-EA79-461 B-8A4A-AODF56E9A02D <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Additional Program Information <br /> I) Target Population <br /> Program Target Population Demographics <br /> Actual Estimated Projected <br /> 2015-16 2016-17 2017-18 <br /> Gender <br /> Male 60 70 80 <br /> Female 200 210 220 <br /> Total 260 280 300 <br /> Ethnicity <br /> African-American 40 60 80 <br /> American Indian or Alaska Native 0 0 0 <br /> Asian 0 0 0 <br /> Caucasian 214 200 200 <br /> Native Hawaiian or other Pacific Islander 0 0 0 <br /> Other: specify 3 20 20 <br /> Total 0 0 0 <br /> Of the above, how many Hispanic/Latino 3 20 20 <br /> Of the above, how many non-Hispanic/Latino 257 260 280 <br /> Total 260 280 300 <br /> Age <br /> 0-5 years <br /> 6-18 years <br /> 19-50 years <br /> 51+ years 260 280 300 <br /> Total 260 280 300 <br /> Geographic Location <br /> Alamance County <br /> Chatham County 15 15 15 <br /> Durham County 95 100 100 <br /> Wake County 3 5 5 <br /> Orange County Breakdown <br /> Chapel Hill Public Housing 30 40 50 <br /> Town of Chapel Hill (Non-Public Housing) 85 85 85 <br /> Town of Carrboro 22 25 35 <br /> Town of Hillsborough 10 10 10 <br /> City of Mebane(Orange County) 0 0 0 <br /> Orange County(Outside Municipalities) <br /> Total 260 280 300 <br /> PROGRAM INFORMATION 1/31/2017 3:19:07 PM <br />