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DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />m) Include any other pertinent information. <br />Funding from this grant would go specifically to the program in Chapel Hill. The organizational budget <br />lists both Durham and Orange County programs - many are combined, but funding remains separate <br />when necessary. <br />Additional Program Information <br />n) Target Population <br />Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the <br />best of your ability <br />Program Target Population Demographics <br />Actual Estimated Projected <br />2016 -17 1 2017 -18 2018 -19 <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 _hispanic <br />Total <br />Of the above, how many HispanictLatino <br />Of the above, how many non- Hispanic/Latino <br />Age <br />Geographic Location <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 382 400 <br />Wake County <br />Orange County Breakdown 71 100 <br />Chapel Hill Public Housing 146 50 <br />290 <br />300 <br />200 <br />200 <br />0 <br />490 <br />500 <br />Alamance County <br />Chatham County <br />Durham County 382 400 <br />Wake County <br />Orange County Breakdown 71 100 <br />Chapel Hill Public Housing 146 50 <br />386 <br />440 <br />403 <br />455 <br />0 <br />1 <br />5 <br />6 <br />10 <br />0 <br />453 <br />485 <br />1 <br />30 <br />0 <br />453 <br />485 <br />Alamance County <br />Chatham County <br />Durham County 382 400 <br />Wake County <br />Orange County Breakdown 71 100 <br />Chapel Hill Public Housing 146 50 <br />50 <br />30 <br />403 <br />455 <br />0 <br />453 <br />485 <br />Alamance County <br />Chatham County <br />Durham County 382 400 <br />Wake County <br />Orange County Breakdown 71 100 <br />Chapel Hill Public Housing 146 50 <br />0 <br />453 <br />485 <br />0 <br />0 <br />0 <br />453 <br />485 <br />Alamance County <br />Chatham County <br />Durham County 382 400 <br />Wake County <br />Orange County Breakdown 71 100 <br />Chapel Hill Public Housing 146 50 <br />