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DocuSign Envelope ID: 6818677A -D518- 4750- B391- F6169FB2A4C4 <br />Exhibit A: Provider's Outside Agency Application <br />Additional Pro ram Information <br />nj Target Population <br />Gender <br />Ethnicity <br />Age <br />Program Target Population Demographics <br />Actual Estimated Projected <br />2016 -17 1 2017 -18 2018 -19 <br />Male <br />Female <br />Total <br />African- American <br />American Indian or Alaska Native <br />Asian <br />Caucasian <br />Native Hawaiian or other Pacific Islander <br />Other: specify <br />Total <br />Of the above, how many Hispanic /Latino <br />Of the above, how many non - Hispanic /Latino <br />Total <br />0 -5 years <br />6 -18 years <br />19 -50 years <br />51 + years <br />Total <br />Geographic Location <br />Alamance County <br />Chatham County <br />Durham County <br />Wake County <br />7270 <br />20 <br />75 <br />221 <br />225 <br />250 <br />293 <br />295 <br />325 <br />Aran a County Breakdown <br />V <br />Chapel Hill Public Housing <br />Town of Chapel Hill (Non- Public Housing) <br />Town of Carrboro <br />Town of Hillsborough <br />City of Mebane (Orange County) <br />Orange County (Outside Municipalities) <br />3 <br />20 <br />20 <br />290 <br />275 <br />305 <br />293 <br />295 <br />325 <br />30 <br />35 <br />40 <br />10 <br />8 <br />8 <br />108 <br />115 <br />125 <br />2 <br />2 <br />2 <br />30 <br />35 <br />40 <br />92 <br />90 <br />100 <br />33 <br />35 <br />40 <br />12 <br />10 <br />10 <br />Total 1 293 295 325 <br />PROGRAM INFORMATION 1/2312013 11:40:33 AM P g­ 17 of 21 <br />