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DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501D XHIBIT A <br />PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Additional Pro ram Information <br />1) 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 />Page 19 of 26 <br />Actual <br />Estimated <br />Projected <br />2015 -16 <br />2016 -17 <br />2017 -18 <br />Gender <br />Male <br />48 <br />50 <br />52 <br />Female <br />38 <br />42 <br />44 <br />Total <br />86 <br />92 <br />96 <br />African - American <br />25 <br />30 <br />32 <br />American Indian or Alaska Native <br />1 <br />3 <br />4 <br />Asian <br />4 <br />5 <br />5 <br />Caucasian <br />54 <br />50 <br />49 <br />Native Hawaiian or other Pacific Islander <br />0 <br />1 <br />1 <br />Other: specify Latino <br />2 <br />3 <br />5 <br />Total <br />86 <br />92 <br />96 <br />Of the above, how many Hispanic /Latino <br />2 <br />3 <br />7 <br />Of the above, how many non - Hispanic /Latino <br />84 <br />89 <br />89 <br />Total <br />86 <br />92 <br />96 <br />{yJ <br />0 -5 years <br />6 -18 years <br />19 -50 years <br />1 <br />1 <br />3 <br />51+ years <br />85 <br />91 <br />93 <br />Total <br />86 <br />92 <br />96 <br />Alamance County <br />3 <br />4 <br />5 <br />Chatham County <br />1 <br />2 <br />3 <br />Durham County <br />8 <br />7 <br />6 <br />Wake County <br />1 <br />1 <br />1 <br />Page 19 of 26 <br />