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DocuSign Envelope ID:64D61581-25C0-4408-84C2-991109E2DF4C XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Additional Proclram Information <br /> mm) Target Population (see previous table for Food Programs and Support Circles) <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 <br /> Female <br /> Total <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 Clients identified as Multi-racial <br /> Total <br /> Of the above, how many Hispanic/Latino <br /> Of the above, how many non-Hispanic/Latino <br /> Total <br /> Age <br /> 0-5 years <br /> 6-18 years <br /> 19-50 years <br /> 51+years <br /> Total <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 /> PROGRAM INFORMATION 1/31/2017 11:43:55 AM Pago 31 of 35 <br />