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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 />Gender <br />Male <br />Female <br />Total <br />Ethnicity <br />African - American <br />American Indian or Alaska Native <br />Asian <br />Caucasian <br />Native Hawaiian or other Pacific Islander <br />Other: Bi- Racial, Thai, Latino (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 />0 -5 years <br />6 -18 years <br />19 -50 years <br />51+ years <br />Unknown <br />Total <br />Geographic Location <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 />City of Mebane (Orange County) <br />Orange County (Outside Municipalities) <br />Actual Estimated Projected <br />2016 -17 I 2017 -18 2018 -19 <br />185 <br />60 <br />100 <br />740 <br />510 <br />570 <br />925 <br />570 <br />670 <br />116 <br />135 <br />160 <br />2 <br />2 <br />4 <br />14 <br />10 <br />15 <br />147 <br />150 <br />175 <br />0 <br />0 <br />0 <br />26 <br />25 <br />35 <br />620 <br />248 <br />281 <br />925 <br />570 <br />670 <br />73 <br />20 <br />35 <br />852 <br />550 <br />635 <br />925 <br />570 <br />670 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />308 <br />320 <br />380 <br />226 <br />125 <br />150 <br />391 <br />125 <br />140 <br />925 <br />570 <br />670 <br />5 <br />2 <br />2 <br />14 <br />10 <br />10 <br />61 <br />40 <br />40 <br />19 <br />10 <br />10 <br />Unknown <br />Unknown <br />Unknown <br />237 <br />170 <br />195 <br />80 <br />40 <br />55 <br />72 <br />60 <br />85 <br />17 <br />12 <br />15 <br />56 <br />25 <br />55 <br />PROGRAM INFORMATION 1/22/2018 5:50:18 PM Page 30 of 47 <br />