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DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Additional Program Information <br />1) Target Population <br />Complete the following tables, with numbers (not percentages) of individuals served and to be <br />served, to the best of y our 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: Congolese, Syrian <br />Total <br />Of the above, how many Hispanic /Latino <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 />Actual Estimated I Projected <br />2016 -17 2017 -18 1 2018 -19 <br />322 <br />332 <br />336 <br />348 <br />358 <br />364 <br />670 <br />680 <br />700 <br />72 <br />75 <br />80 <br />670 <br />680 <br />700 <br />596 <br />598 <br />601 <br />82 <br />1 82 <br />82 <br />670 <br />1 680 <br />700 <br />74 <br />82 <br />99 <br />670 <br />680 <br />700 <br />72 <br />75 <br />80 <br />670 <br />680 <br />700 <br />670 <br />680 <br />700 <br />72 <br />75 <br />80 <br />80 <br />82 <br />88 <br />436 <br />441 <br />450 <br />82 <br />1 82 <br />82 <br />670 <br />1 680 <br />700 <br />174 <br />180 <br />190 <br />160 <br />160 <br />162 <br />312 <br />309 <br />320 <br />16 <br />21 <br />18 <br />8 <br />10 <br />10 <br />Total 1 670 680 1 700 <br />PROGRAM INFORMATION 1/18/2018 1:56:21 PM Page 22 of 26 <br />