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DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 <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. The following numbers reflect our actual numbers from <br />Jan 1 -Dec 31 of each year.. <br />Program Target Population Demographics <br />Actual Estimated Projected <br />2017 2018 2019 <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 HispanicJLatino <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 />22 <br />28 <br />38 <br />60 <br />72 <br />82 <br />82 <br />100 <br />120 <br />28 <br />37 <br />47 <br />82 <br />90 <br />105 <br />0 <br />0 <br />0 <br />54 <br />63 <br />73 <br />82 <br />1 100 <br />1 120 <br />53 <br />1 70 <br />90 <br />82 <br />100 <br />120 <br />0 <br />10 <br />15 <br />82 <br />90 <br />105 <br />0 <br />0 <br />0 <br />Total 1 82 100 1 120 <br />DO NOT SUBMIT THIS PAGE 1/12/2018 10:05:28 AM Page 20 of 25 <br />82 <br />100 <br />120 <br />82 <br />1 100 <br />1 120 <br />Total 1 82 100 1 120 <br />DO NOT SUBMIT THIS PAGE 1/12/2018 10:05:28 AM Page 20 of 25 <br />28 <br />29 <br />29 <br />1 <br />1 1 <br />1 <br />53 <br />1 70 <br />90 <br />Total 1 82 100 1 120 <br />DO NOT SUBMIT THIS PAGE 1/12/2018 10:05:28 AM Page 20 of 25 <br />