Orange County NC Website
Browse       Search
DocuSign Envelope ID: C5305795- 2DF5- 4A04- B090- 9F458AA520CB <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 Hispanic <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 />52 <br />48 <br />55 <br />57 <br />70 <br />65 <br />109 <br />118 <br />120 <br />6 <br />12 <br />12 <br />107 <br />115 <br />117 <br />4 <br />4 <br />5 <br />97 <br />99 <br />100 <br />109 <br />118 <br />120 <br />2 <br />3 <br />3 <br />109 <br />118 <br />120 <br />2 <br />3 <br />3 <br />107 <br />115 <br />117 <br />109 <br />118 <br />120 <br />4 <br />3 <br />4 <br />20 <br />18 <br />20 <br />26 <br />30 <br />25 <br />109 <br />118 <br />120 <br />109 <br />118 <br />120 <br />4 <br />3 <br />4 <br />20 <br />18 <br />20 <br />26 <br />30 <br />25 <br />2 <br />2 <br />2 <br />Total I 109 118 1 120 <br />PROGRAM INFORMATION 1/22/2018 2:17:04 PM P a g e 11 of 15 <br />40 <br />47 <br />50 <br />10 <br />10 <br />12 <br />1 <br />7 <br />7 <br />7 <br />Total I 109 118 1 120 <br />PROGRAM INFORMATION 1/22/2018 2:17:04 PM P a g e 11 of 15 <br />