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DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1 <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 />Program Target Population Demographics <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: specify latino <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 />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 2017 -18 2018 -19 <br />259 <br />236 <br />275 <br />347 <br />414 <br />375 <br />606 <br />640 <br />650 <br />143 <br />152 <br />160 <br />574 <br />616 <br />30 <br />33 <br />22 <br />40 <br />398 <br />442 <br />420 <br />32 <br />24 <br />30 <br />606 <br />640 <br />650 <br />32 <br />24 <br />30 <br />574 <br />616 <br />30 <br />606 <br />640 <br />650 <br />none none <br />606 640 650 <br />41 <br />30 <br />30 <br />33 <br />30 <br />30 <br />12 <br />15 <br />15 <br />35 <br />25 <br />25 <br />unk <br />256 <br />280 <br />285 <br />56 <br />70 <br />75 <br />107 <br />110 <br />110 <br />66 <br />80 <br />80 <br />Total 1 606 640 1 650 <br />PROGRAM INFORMATION 1/22/2018 4:11:17 PM Page 21 of 27 <br />