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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 Complete the following tables, with numbers (not percentages) of <br /> individuals served and to be 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 25 27 32 <br /> Female 56 59 65 <br /> Total 81 86 97 <br /> Ethnicity <br /> African-American 38 40 43 <br /> American Indian or Alaska Native <br /> Asian _ <br /> Caucasian 43 46 43 <br /> Native Hawaiian or other Pacific Islander <br /> Other:specify <br /> Total 81 86 97 <br /> Of the above, how many Hispanic/Latino <br /> Of the above, how many non-Hispanic/Latino 81 86 97 <br /> Total 81 86 97 <br /> Age <br /> 0-5 years <br /> • <br /> 6-18 years <br /> 19-50 years 2 2 2 <br /> 51+years 79 84 95 <br /> Total 81 86 97 <br /> Geographic Location <br /> Alamance County <br /> Chatham County <br /> Durham County <br /> Wake County <br /> Orange County Breakdown <br /> Chapel Hill Public Housing =MI <br /> Town of Chapel Hill(Non-Public Housing) <br /> Town of Carrboro <br /> Town of Hillsborough 50 52 <br /> City of Mebane (Orange County) IFMMMII 2 2 <br /> Orange County(Outside Municipalities) 29 33 43 <br /> PRCV-V2A AA IA/FnRAA4 TlnAl 1/11/2fl17 R-QF.nc4 AAA P r; r) 1 7 n 9 <br />