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MAIN APPLICATION <br />Program /Project Information <br />j) Complete the Target Population and Program Beneficiary Demographics Chart <br />k) Complete the Schedule of Positions Chart for Program Staff <br />1) Disclosure of Potential Conflicts of Interested must be signed <br />m) Complete the Work Statement Chart to describe the work to be performed, and be sure to <br />attach copies of all data collection tools that will be used to verify achievement of program <br />goals and objectives. Describe who will be responsible for monitoring progress. <br />Information to Complete <br />j.) Target Population <br />Complete the following tables to the best of your ability. Show numbers of participants and <br />percentages, as applicable, in each category. <br />Please indicate whether this project /program will serve: ® Persons ❑ Households ❑ Units <br />Program: Community Education and Civic Engagement_ <br />Program Beneficiary Demographics <br />Actual Estimated Projected <br />2014 -15 2015 -16 2016 -17 <br />Gender <br />Male <br />Female <br />Total 3674 3700 3700 <br />Of the females, how many are single - <br />female Head of Households (Omit for <br />Human Services) <br />Ethnicity <br />African - American <br />American Indian or Alaska Native <br />Asian <br />Caucasian <br />Native Hawaiian or other Pacific <br />Islander <br />Other <br />Unknown <br />Total <br />3700 <br />Of the above, how many <br />Hispanic /Latino <br />Of the above, how many non - <br />Hispanic /Latino <br />Total 3674 3700 3700 <br />Age <br />0 -5 years T <br />6 -18 years 1369 _ 1370 1 1370 <br />Main Application 1/24/2016 2:59:42 PM Page 37 of 58 <br />