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DocuSign Envelope ID: A899BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 <br />Additional ProgramnNfioBmTai4bnPROVIDER'S OUTSIDE AGENCY APPLICATION <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 />Gender <br />Male <br />Female <br />UnknownlUnreported <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 Hispanic, unknown <br />Age <br />Total <br />Of the above, how many Hispanicll -atino <br />Of the above, how many non - Hispanic /Latino <br />Total <br />0 -5 years <br />6 -18 years <br />19 -50 years <br />51+ years <br />Total <br />Actual Estimated Projected <br />2016 -17 2017 -18 2018 -19 <br />207 <br />250 <br />350 <br />87 <br />75 <br />150 <br />294 <br />5 <br />10 <br />294 <br />325 <br />500 <br />265 <br />50 <br />60 <br />29 <br />0 <br />0 <br />294 <br />5 <br />10 <br />nla <br />20 <br />30 <br />0 <br />0 <br />0 <br />294 <br />250 <br />400 <br />294 <br />325 <br />500 <br />265 <br />275 <br />400 <br />29 <br />50 <br />100 <br />294 <br />325 <br />500 <br />nla <br />nla <br />140 <br />250 <br />nla <br />140 <br />200 <br />nla <br />25 <br />30 <br />0 <br />0 <br />0 <br />Geographic Location <br />Alamance County <br />Chatham County <br />Durham County <br />Wake County <br />Unknownlunreported <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 />Total <br />2 <br />11 <br />25 <br />5 <br />30 <br />PROGRAM INFORMATION 1/2212018 10:14:21 AM Page ? 2' of 3 <br />131 <br />140 <br />250 <br />66 <br />140 <br />200 <br />12 <br />25 <br />30 <br />7 <br />10 <br />10 <br />5 <br />10 <br />10 <br />294 <br />325 <br />500 <br />PROGRAM INFORMATION 1/2212018 10:14:21 AM Page ? 2' of 3 <br />