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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. <br />*Number below includes people receiving wills, home repairs & home repair advocacy, and /or <br />Keeping Your House a Home workshops. Several folks participated across different programs and <br />are not double - counted. Additional households connected to resources are not accounted for. <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 <br />Total <br />Of the above, how many Hispanic /Latino <br />Of the above, how many non - Hispanic /Latino <br />Total <br />Age <br />Geographic Location <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 />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 />22 <br />25 <br />42 <br />57 <br />69 <br />94 <br />79 <br />94 <br />136 <br />73 <br />84 <br />113 <br />N/A <br />N/A <br />128 <br />4 <br />6 <br />8 <br />2 <br />4 <br />15 <br />79 <br />94 <br />136 <br />15 <br />17 <br />39 <br />79 <br />94 <br />136 <br />N/A <br />N/A <br />8 <br />N/A <br />N/A <br />128 <br />0 <br />0 <br />136 <br />Total 1 79 94 1 136 <br />PROGRAM INFORMATION 1/23/2018 2:58:40 PM Page 6 of 10 <br />1 <br />2 <br />4 <br />9 <br />8 <br />12 <br />69 <br />84 <br />120 <br />79 <br />94 <br />136 <br />Total 1 79 94 1 136 <br />PROGRAM INFORMATION 1/23/2018 2:58:40 PM Page 6 of 10 <br />40 <br />51 <br />58 <br />24 <br />26 <br />39 <br />15 <br />17 <br />39 <br />Total 1 79 94 1 136 <br />PROGRAM INFORMATION 1/23/2018 2:58:40 PM Page 6 of 10 <br />