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DocuSign Envelope ID: 557EOBA8 -OFDF- 4943- B10E- 6AB96D651F4B <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/Latino) <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 />276 <br />284 <br />292 <br />369 <br />392 <br />404 <br />645 1 <br />676 <br />696 <br />415 <br />465 <br />478 <br />1 <br />0 <br />0 <br />4 <br />0 <br />0 <br />126 <br />121 <br />125 <br />8 <br />10 <br />10 <br />91 <br />80 <br />83 <br />645 <br />676 <br />696 <br />91 <br />80 <br />83 <br />554 <br />596 <br />613 <br />645 <br />676 <br />696 <br />130 <br />145 <br />149 <br />214 <br />215 <br />222 <br />232 <br />240 <br />247 <br />69 <br />76 <br />78 <br />645 <br />676 <br />696 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />573 <br />590 <br />606 <br />49 <br />56 <br />58 <br />23 <br />30 <br />32 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />Total L 645 676 696 <br />PROGRAM INFORMATION 1/22/2018 3:33:49 PM Page 17 of 22 <br />