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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 our ability, <br /> Actual Estimated Projected <br /> 2015-16 2016-17 2017-18 <br /> Gender <br /> Male N/A lr N/A j N/A <br /> Female N/A A N/A <br /> Total _ N/A N/A N/A <br /> Ethnicity <br /> African-American N/A I N/A N/A <br /> American Indian or Alaska Native N/A N/A N/A <br /> Asian N/A N/A I N/A <br /> Caucasian N/A N/A N/A <br /> Native Hawaiian or other Pacific Islander N/A N/A N/A <br /> Total L N/A N/A 1 N/A _ <br /> Of the above, how many Hispanic/Latino N/A N/A N/A <br /> Of the above, how many non-Hispanic/Latino N/A N/A N/A <br /> Total 1 N/A N/A N/A <br /> Age <br /> 0-5 years II_ 2077 2000 2000 <br /> 6-18 years I 12199 11500 12000 <br /> 19-50 years 1628 I 1300 1400 I <br /> 51+ year 1 <br /> 14800 I 15400 <br /> Total 15904 <br /> Geographic Location .., .... <br /> Alamance County 0 I 0 0 <br /> Chatham County 65 I 50 1 50 <br /> ............. <br /> Durham County 1830 1500 I 1550 I <br /> Wake County 14 0 0 <br /> Orange County Breakdown <br /> Chapel Hill Public Housing N/A N/A N/A <br /> Town of Chapel Hill (Non-Public Housing) 7838 7700 7600 1 <br /> Town of Carrboro . 2004 1750 1750 <br /> Town of Hillsborough 3490 3400 3450 <br /> City of Mebane (Orange County) 0 1 0 _ 0 <br /> _....._ <br /> Orange County(Outside Municipalities) 549 500 500 <br /> Other/Unknown 114 100 <br /> 100 <br /> Total 15,904 15,000 15,400 <br /> * We are not able to track education programs based on Gender or Ethnicity since they typically have <br /> large, mixed audiences, With the vast majority of our programs taking place in the local school districts, <br /> we can assume that our outreach numbers reflect county-wide demographic data. Figures for Geographic <br /> Location are determined based on where the program was delivered (e.g., a program at Carrboro <br /> Elementary School will place all participants in the Town of Carrboro). <br /> DO NOT SUBMIT THIS PAGE 1/30/2017 5:14:05 PM IP 2 0 (d d 2 2 <br />