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DocuSign Envelope ID: A8991BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 <br />Additional PrograrEYjWkWTa&RROVIDER'S OUTSIDE AGENCY APPLICATION <br />q) 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 />Unknown /Unreported <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 />Total <br />Of the above, how many Hispanic /Latino <br />Of the above, how many non- HispaniclLatino /unknown <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 />Actual <br />Estimated <br />Projected <br />2016 -17 <br />2017 -18 <br />2018 -19 <br />1 <br />60 <br />70 <br />28 <br />25 <br />30 <br />115 <br />18 <br />25 <br />144 <br />85 <br />100 <br />Alamance County <br />Chatham County <br />Durham County <br />Wake County <br />Unknown /unreported <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 />11 <br />70 <br />85 <br />133 <br />15 <br />15 <br />16 <br />18 <br />25 <br />1 <br />0 <br />144 <br />1 85 <br />100 <br />127 <br />67 <br />75 <br />144 <br />85 <br />100 <br />Alamance County <br />Chatham County <br />Durham County <br />Wake County <br />Unknown /unreported <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 />11 <br />70 <br />85 <br />133 <br />15 <br />15 <br />144 <br />85 <br />100 <br />30 <br />30 <br />30 <br />75 <br />30 <br />45 <br />36 <br />25 <br />25 <br />3 <br />0 <br />144 <br />1 85 <br />100 <br />PROGRAM INFORMATION 112212018 10:14:21 AM Page a r fl f -?'a <br />0 <br />22 <br />0 <br />1 <br />2 <br />2 <br />0 <br />115 <br />0 <br />PROGRAM INFORMATION 112212018 10:14:21 AM Page a r fl f -?'a <br />0 <br />22 <br />23 <br />61 <br />75 <br />0 <br />1 <br />0 <br />27 <br />0 <br />144 <br />1 85 <br />100 <br />PROGRAM INFORMATION 112212018 10:14:21 AM Page a r fl f -?'a <br />