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DocuSign Envelope ID: 1640431D- 872F- 4BC9- ACA1- 2226D9788920 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Additional Prosaram 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 />Actual Estimated Projected <br />2016 -17 2017 -18 1 2018 -19 <br />Gender <br />Male 519 541 541 <br />Female 510 656 656 <br />Total 1,029 1,197 1,197 <br />Ethnicity <br />African- American <br />American Indian or Alaska Native <br />Asian <br />Caucasian <br />Native Hawaiian or other Pacific Islander <br />Other: Biracial <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 />17 <br />11 <br />11 <br />1,000 <br />1,193 <br />1,193 <br />1,164 <br />1,161 <br />18 <br />18 <br />18 <br />133 <br />1,040 1 <br />1,197 <br />5 <br />4 <br />4 <br />1,040 <br />1,197 <br />1,197 <br />7 <br />4 <br />4 <br />1,033 <br />1,193 <br />1,193 <br />1,040 <br />1,197 <br />1,197 <br />148 <br />213 <br />213 <br />423 <br />366 <br />366 <br />366 <br />485 <br />485 <br />103 <br />133 <br />133 <br />1,040 1 <br />1,197 <br />1,197 <br />Alamance County <br />117 <br />117 <br />Chatham County <br />449 <br />353 <br />353 <br />61 <br />Durham County <br />0 <br />18 <br />18 <br />Wake County <br />0 <br />Orange County Breakdown <br />Chapel Hill Public Housing <br />383 <br />383 <br />Town of Chapel Hill (Non - Public Housing) 530 <br />326 <br />326 <br />Town of Carrboro <br />Town of Hillsborough <br />City of Mebane (Orange County) <br />Orange County (Outside Municipalities) <br />PROGRAM INFORMATION 1/22/2018 6:18:22 PM a 9 e <br />449 <br />353 <br />353 <br />61 <br />0 <br />0 <br />18 <br />18 <br />0 <br />0 <br />PROGRAM INFORMATION 1/22/2018 6:18:22 PM a 9 e <br />