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DocuSign Envelope ID: 3F05AA6E -4F62- 4678- 8F07- 34D6E1679E9A <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Additional Program Information <br />n) Target Population <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 <br />( "Other" includes anyone designated "other" in the <br />reports our partner agencies provide, as well as the <br />Hispanic /Latino population, which agencies typically <br />report as a separate group) <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 <br />2016 -17 2017 -18 <br />Projected <br />2018 -19 <br />3,000 <br />3,500 <br />2,760 <br />5,300 <br />5,500 <br />5,127 <br />8,300 <br />9,000 <br />7,887 <br />3,486 <br />3,780 <br />3,762 <br />224 <br />243 <br />4 <br />249 <br />270 <br />88 <br />1660 <br />1,800 <br />1,665 <br />83 <br />90 <br />2 <br />2598 <br />2,817 <br />2,366 <br />5,893 <br />9,000 <br />7,887 <br />2,407 <br />2,610 <br />1,500 <br />5,893 <br />6,390 <br />6,387 <br />8,300 <br />9,000 <br />7,887 <br />1,006 <br />1,089 <br />947 <br />1,640 <br />1,800 <br />1,577 <br />3,596 <br />3,870 <br />3,391 <br />1,260 <br />2,241 <br />1,972 <br />8,300 <br />9,000 <br />7,887 <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />PROGRAM INFORMATION 2/16/2018 1:09:05 PM Page 17 of 20 <br />