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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, Middle- Eastern, Arab, Latinx <br />(also noted below) <br />A1.7""I WE <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 f years <br />Unknown <br />Town of Hillsborough <br />City of Mebane (Orange County) <br />Orange County (Outside Municipalities) <br />Actual Estimated Projected <br />201( 1 2017 -18 2018 -19 <br />1324 <br />1335 <br />1335 <br />3117 <br />3165 <br />3165 <br />4441 <br />4500 <br />4500 <br />208 <br />225 <br />225 <br />0 <br />0 <br />0 <br />232 <br />240 <br />240 <br />910 <br />930 <br />930 <br />0 <br />0 <br />0 <br />331 <br />350 <br />350 <br />2760 <br />2755 <br />2755 <br />4441 <br />4500 1 <br />4500 <br />0 <br />0 <br />280 <br />271 <br />280 <br />1472 <br />1457 <br />1480 <br />4220 <br />4170 <br />4220 <br />800 <br />4441 <br />4500 <br />4500 <br />0 <br />0 <br />0 <br />1472 <br />1472 <br />1472 <br />1457 <br />1480 <br />1480 <br />766 <br />800 <br />800 <br />746 <br />748 <br />748 <br />4441 1 <br />4500 <br />1 4500 <br />11 <br />10 <br />10 <br />25 <br />25 <br />25 <br />82 <br />85 <br />85 <br />50 <br />50 <br />50 <br />Unknown <br />Unknown <br />Unknown <br />2324 <br />2340 <br />2340 <br />1040 <br />1060 <br />1060 <br />301 <br />320 <br />320 <br />14 <br />15 <br />15 <br />254 <br />275 <br />275 <br />PROGRAM INFORMATION 1/22%2098 5:50:18 PM Page 40 of 47 <br />