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DocuSign Envelope ID: FOFFD659- 4159- 4D4C- 82FD- FF8E51A5A7E4 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Additional Program Information <br />n) 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 />African- American <br />American Indian or Alaska Native <br />Asian <br />Caucasian <br />Native Hawaiian or other Pacific Islander <br />Other: Bi- racial, Latino, Middle- Eastern, Latino <br />(also noted below) <br />Unknown <br />Total <br />Of the above, how many Hispanic /Latino <br />Of the above, how many non-Hispanic/Latino <br />Total <br />Age <br />0 -5 years <br />6 -18 years <br />19 -50 years <br />51 + years <br />Unknown <br />Total <br />Geographic l.�oc tion <br />Alamance County <br />Chatham County <br />Durham County <br />Wake County <br />Orange County Breakdown <br />Chapel Hill Public Housing <br />Town of Chapel Hill (Non - Public Housing) <br />Town of Carrboro <br />Town of Hillsborough <br />Actual Estimated Projected <br />2016 -17 2017 -18 2018 -19 <br />88 <br />90 <br />90 <br />1050 <br />1046 <br />1046 <br />3178 <br />4180 <br />4180 <br />1217 <br />1220 <br />1220 <br />108 <br />115 <br />115 <br />4 <br />4 <br />4 <br />22 <br />25 <br />25 <br />223 <br />225 <br />225 <br />0 <br />0 <br />0 <br />155 <br />124 <br />124 <br />705 <br />727 <br />727 <br />1217 <br />1220 <br />0 <br />146 <br />116 <br />116 <br />1071 <br />1104 <br />1104 <br />1217 <br />1220 <br />1220 <br />2 <br />2 <br />2 <br />23 <br />25 <br />25 <br />248 <br />250 <br />250 <br />37 <br />40 <br />40 <br />907 <br />903 <br />903 <br />1217 <br />1220 <br />1220 <br />21 <br />20 <br />20 <br />27 <br />30 <br />30 <br />93 <br />90 <br />90 <br />53 <br />53 <br />53 <br />Unknown <br />Unknown <br />Unknown <br />357 <br />360 <br />360 <br />68 <br />80 <br />80 <br />118 <br />120 <br />120 <br />PROGRAM INFORMATION 1/22/2018 5:50:18 PM Page 20 of 47 <br />