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DocuSign Envelope ID: E85EF868-A4BB-49ED-96E1-165F3DADBAE4 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 /> 1-----Actuaf Estimated Projected <br /> 2015-16 2016-17 2017-18 <br /> Gender <br /> Male 71 87 90 <br /> Female 371 452 460 <br /> Other 8 13 15 <br /> Unknown* 96 98 I 110 <br /> Total - 546 650 1 675 <br /> Ethnicity ___ <br /> African-American 21 24 30 <br /> American Indian or Alaska Native 0 0 0 <br /> Asian 3 3 5 <br /> Caucasian 163 211 215 <br /> Native Hawaiian or other Pacific Islander 1 0 I 0 0 <br /> Other 79 77 80 <br /> Unknown* 280 335 345 <br /> Total 546 650 675 <br /> 1 <br /> Of the above, how many Hispanic/Latino 1 78 I 72 80 <br /> Of the above, how many non-Hispanic/Latino 468 578 595 <br /> Total 546 650 675 <br /> Age <br /> 1 <br /> 0-5 years 0 I 2 0 <br /> 6-18 years _. _ 9 15 15 <br /> 19-50 years 176 190 200 I <br /> 51+ years _ 34 43 45 <br /> Unknown* I 327 1 400 415 <br /> Total 546 I 650 675 <br /> Geographic Location <br /> Alamance County 20 9 15 <br /> Chatham County 10 3 5 <br /> Durham County 29 41 35 <br /> Wake County 31 I 24 25 <br /> Orange County :reakdown <br /> Chapel Hill Public Housing N/A N/A N/A <br /> Town of Chapel Hill (Non-Public Housing) 148 190 200 1 <br /> Town of Carrboro 28 ' 22 1 25 <br /> Town of Hillsborough 8 I 26 30 <br /> City of Mebane(Orange County) 9 7 10 <br /> Orange County (Outside Municipalities) N/A N/A N/A <br /> Other 55 58 60 ' <br /> Unknown* 208 1 270 270 <br /> ......_ <br /> Total 546 I 650 675 <br /> * A large amount of our contact with clients is over the phone on our 24-Hour Help Line. Many <br /> clients may be experiencing a mental or physical crisis situation, in which case it may not be <br /> appropriate to ask demographic questions. Further, because of the nature of our work, many <br /> clients may feel very nervous about calling us, and they greatly value anonymity. Out of respect for <br /> their confidentiality, it may not be appropriate to ask demographic questions. Therefore, a large <br /> amount of demographic data for our client services program is unknown. <br /> Agency Information 1/30/2017 5:14:05 RI 11 P d q H 1 2 il 22 <br />