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DocuSign Envelope ID: C47D73DC -CC50- 4723 - 8253- AE01785E7FAA
<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 Latinx
<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 />16,171
<br />16,737
<br />17,323
<br />15,537
<br />16,081
<br />16,664
<br />31,708
<br />32,818
<br />33,967
<br />7,927
<br />8,205
<br />8,492
<br />63
<br />66
<br />68
<br />2,537
<br />2,625
<br />2,717
<br />16,742
<br />17,328
<br />17,935
<br />31,708
<br />32,818
<br />33,967
<br />4,439
<br />4,595
<br />4,755
<br />311708
<br />32,818
<br />33,967
<br />1,459
<br />1,510
<br />4,755
<br />4,439
<br />4,595
<br />32,405
<br />337
<br />328
<br />29,212
<br />27,269
<br />28,223
<br />340
<br />31,708
<br />32,818
<br />33,967
<br />1,459
<br />1,510
<br />1,562
<br />30,249
<br />31,308
<br />32,405
<br />337
<br />328
<br />340
<br />337
<br />320
<br />340
<br />0
<br />0
<br />0
<br />506
<br />492
<br />510
<br />506
<br />492
<br />510
<br />337
<br />328
<br />340
<br />337
<br />320
<br />340
<br />Unknown
<br />Unknown
<br />Unknown
<br />18,391
<br />19,034
<br />19,701
<br />4,439
<br />4,595
<br />4,755
<br />1,902
<br />1,969
<br />2,038
<br />159
<br />164
<br />170
<br />2,220
<br />2,297
<br />2,378
<br />Total 1 31,708 32,818 33,967
<br />PROGRAM INFORMATION 1/23/2018 1:53:53 PM Page 17 of 22
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