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DocuSign Envelope ID: 7A9252AF- OE3A- 47EE- A4F6- 2A3D9DF527FF <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 />Nonbinary** <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 />Hispanic /Latino ** <br />Age <br />Geographic Location <br />Other: Multiracial or Unidentified <br />Total <br />0 -5 years <br />6 -18 years <br />19 -50 years <br />51+ years <br />Total <br />Alamance County <br />Chatham County <br />Durham County <br />Wake County <br />Orange County Breakdown <br />Town of Chapel Hill ** <br />Town of Carrboro <br />Town of Hillsborough <br />Orange County** <br />Actual Estimated Projected <br />2016 -17 1 2017 -18 1 2018 -19 <br />658 <br />791 <br />938 <br />750 <br />8 <br />888 <br />1024 <br />1,416 <br />1,679 <br />1,962 <br />307 <br />363 <br />472 <br />7 <br />5 <br />7 <br />120 <br />143 <br />147 <br />705 <br />787 <br />888 <br />3 <br />2 <br />2 <br />181 <br />271 <br />333 <br />95 <br />106 <br />113 <br />1,416 <br />1,679 <br />1,962 <br />3 <br />0 <br />0 <br />740 <br />1,080 <br />1,320 <br />638 <br />552 <br />590 <br />35 <br />47 <br />52 <br />1,4161 <br />1,679 <br />1,962 <br />0 <br />0 <br />0 <br />0 <br />15 <br />15 <br />200 <br />0 <br />200 <br />0 <br />0 <br />0 <br />680 <br />761 <br />794 <br />322 <br />660 <br />670 <br />1,416 <br />243 <br />283 <br />Total 1 1,416 1 1,679 1 1,962 <br />* *Please note: On our demographic surveys we do not separate race from ethnicity, thus we have kept the <br />Hispanic /Latino grouping as its own racial category within the Ethnic Demographic section. We have made <br />slight modifications to the Geographic Location section as well. On our surveys we do do not break up the <br />Town of Chapel Hill on the basis of public and non - public housing nor do we break up Orange County by its <br />municipalities. For this reason, we have provided you with the cumulative total of youth and elders served in <br />both areas. Finally, we have made our student surveys more inclusive which is why a nonbinary option is <br />added to the Gender section. <br />