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DocuSign Envelope ID: 4B292955- 9A36- 47C6- BDDE- 4E9CDOBA074D <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 />Actual Estimated Projected <br />2016 -17 2017 -18 2018 -19 <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 131- racial <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 5 5 5 <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 />96 <br />95 <br />103 <br />58 <br />65 <br />77 <br />154 <br />160 <br />180 <br />51 <br />55 <br />65 <br />118 <br />121 <br />131 <br />3 <br />4 <br />4 <br />95 <br />96 <br />106 <br />154 <br />160 <br />180 <br />5 <br />5 <br />5 <br />154 <br />160 <br />180 <br />36 <br />39 <br />49 <br />118 <br />121 <br />131 <br />154 <br />160 <br />180 <br />14 <br />18 <br />20 <br />154 <br />160 <br />180 <br />12 <br />14 <br />16 <br />34 <br />34 <br />42 <br />154 <br />160 <br />180 <br />14 <br />18 <br />20 <br />47 <br />47 <br />49 <br />12 <br />14 <br />16 <br />34 <br />34 <br />42 <br />2 <br />2 <br />2 <br />40 <br />40 <br />46 <br />Total 154 160 180 <br />PROGRAM INFORMATION 1/19/2018 2:38:17 PM P a g e 1 9 o f 2 6 <br />