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DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Additional Program Info ation <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 /> 2015-16 2016-17 2017-18 <br /> Gender <br /> Male 136 94 94 <br /> Female 389 269 269 <br /> Total 525 373 373 <br /> Ethnicity <br /> African-American 117 82 82 <br /> American Indian or Alaska Native <br /> Asian <br /> Caucasian 172 123 123 <br /> Native Hawaiian or other Pacific Islander <br /> Other: specify 236 168 168 <br /> Total 525 373 373 <br /> Of the above, how many Hispanic/Latino 92 65 65 <br /> Of the above, how many non-Hispanic/Latino 263 308 308 <br /> Total 525 373 373 <br /> Age <br /> 0-5 years <br /> 6-18 years 336 238 238 <br /> 19-50 years 189 134 134 <br /> 51+ years <br /> Total 525 373 _ 373 <br /> Geographic Location <br /> Alamance County <br /> Chatham County <br /> Durham County _ <br /> Wake County <br /> Orange County Breakdown <br /> Chapel Hill Public Housing N1111111111111111=11111 <br /> Town of Chapel Hill (Non-Public Housing) 155 110 110 <br /> Town of Carr oro 150 106 106 <br /> Town of Hillsborough <br /> 1111111111111111 <br /> City of Mebane (Orange County) <br /> Orange County (Outside Municipalities) 220 <br /> Other <br /> Total 525* _ 373 373 <br /> PROGRAM INFORMATION 1/27/2017 3:10:56 PM <br />