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DocuSign Envelope ID:3B67A5FD-6776-4322-9152-0531CA4BC4BD XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Additional Program Information <br /> 1) 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 /> 2015-16 2016-17 2017-18 <br /> Gender <br /> Male 42 42 44 <br /> Female 29 33 36 <br /> Total 71 75 80 <br /> Ethnicity <br /> African-American 10 12 15 <br /> American Indian or Alaska Native 1 1 1 <br /> Asian 2 2 3 <br /> Caucasian 58 60 61 <br /> Native Hawaiian or other Pacific Islander 0 0 0 <br /> Other: specify 0 0 0 <br /> Total 71 75 80 <br /> Of the above, how many Hispanic/Latino 6 8 9 <br /> Of the above, how many non-Hispanic/Latino 65 67 71 <br /> Total 71 75 80 <br /> Age <br /> 0-5 years 0 0 0 <br /> 6-18 years 5 6 7 <br /> 19-50 years 40 41 43 <br /> 51+ years 26 28 30 <br /> Total 71 75 80 <br /> Geographic Location <br /> Alamance County 1 0 1 <br /> Chatham County 4 5 6 <br /> Durham County 12 12 12 <br /> Wake County 2 3 3 <br /> Orange County Breakdown <br /> Chapel Hill Public Housing Unknown Unknown Unknown <br /> Town of Chapel Hill (Non-Public Housing) 19 20 20 <br /> Town of Carrboro 23 24 25 <br /> Town of Hillsborough 1 1 1 <br /> City of Mebane (Orange County) 0 0 0 <br /> Orange County(Outside Municipalities) 9 10 12 <br /> Total 71 75 80 <br /> DO NOT SUBMIT THIS PAGE 2/8/2017 9:06:10 AM Page 14 of 18 <br />