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DocuSign Envelope ID:71415AD7-DCDD-4CF6-89A9-F93F72D8DC62 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 /> 2016 2017 2018 <br /> 2015-16 2016-17 2017-18 <br /> Gender <br /> Male 4879 4879 5025 <br /> Female 5833 5833 6008 <br /> Total 10,712 10,712 11,034 _ <br /> Ethnicity by HOUSEHOLD <br /> African-American 1549 1549 1591 <br /> American Indian or Alaska Native <br /> Asian – <br /> Caucasian 1971 1971 2026 <br /> Native Hawaiian or other Pacific Islander <br /> Other:specify_Latino 217 217 233 <br /> Total 3,737 3,737 3850 <br /> -- ----— <br /> Of the above, how many Hispanic/Latino 217 217 233 <br /> Of the above, how many non-Hispanic/Latino 3520 3520 3617 <br /> Total 3,737 3,737 3850 <br /> Age <br /> 0-5 years 1471 1471 1520 -- <br /> 6-18 years 2921 2921 3013 <br /> 19-50 years 6032 6032 6226 <br /> 65+years 257 257 275 <br /> Total 10,712 10,712 , 11,034 <br /> Geographic Location by HOUSEHOLD <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 2291 2291 2360 <br /> *City of Mebane (Orange County) 524 524 540 <br /> Orange County(Outside Municipalities) 922 922 950 <br /> Total 3,737 3,737 3850 <br /> PPnr4RAlui INFrVailATInAl 1/11/7(117 R41 74 AM P :.4 r: 1_, c f) f Q <br />