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DocuSign Envelope ID:39EEFC69-D47C-4CE3-8A5C-0A87B55C2CD0 XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Additional Program Information <br /> a) 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 38 55 60 <br /> Female 19 35 40 <br /> Total 57 90 100 <br /> Ethnicity <br /> African-American 17 30 35 <br /> American Indian or Alaska Native 0 0 0 <br /> Asian 0 0 3 <br /> Caucasian 33 40 37 <br /> Native Hawaiian or other Pacific Islander 0 0 0 <br /> Other: specify Hispanic,Bi-racial. Arab 7 20 25 <br /> Total 57 90 100 <br /> Of the above, how many Hispanic/Latino 3 20 25 <br /> Of the above, how many non-Hispanic/Latino 54 70 75 <br /> Total 57 90 100 <br /> Age <br /> 0-5 years 57 90 100 <br /> 6-18 years <br /> 19-50 years <br /> 51+ years <br /> Total 0 0 0 <br /> Geographic Location <br /> Alamance County 2 0 <br /> Chatham County 3 4 <br /> Durham County 0 0 <br /> Wake County 0 0 <br /> Orange County Breakdown <br /> Chapel Hill Public Housing 0 0 5 <br /> Town of Chapel Hill (Non-Public Housing) 17 30 30 <br /> Town of Carrboro 2 10 11 <br /> Town of Hillsborough 15 20 20 <br /> City of Mebane (Orange County) 13 15 15 <br /> Orange County (Outside Municipalities) 5 15 19 <br /> Total 57 90 100 <br /> PROGRAM INFORMATION 2/9/2017 11:59:17 AM Page 15 7' <br />