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DocuSign Envelope ID: FF2F034D-8ED9-46D3-BB8F-E4DD48CFCF88 <br /> Total 670 5a2 475 J 475 <br /> Of the above,how many Hispanic/Latino 35 35 45 45 <br /> Of the above,how many non-Hispanic/Latino 635 467 425 425 <br /> Total 670 502 475 475 <br /> Age' <br /> 0-5 years 0 0 0 0 <br /> 6-18 years 0 1 0 0 <br /> 19-50 years 380 168 250 250 <br /> 51+years 150 32 75 75 <br /> Unknown 140 301 150 ISO <br /> Total 670 502 475 475 <br /> Geographic Location <br /> Town of Chapel Hill 195 134 150 150 <br /> Town of Carrboro 55 26 50 50 <br /> Orange County{Outside of Chapel Hill/Carrboro) 155 44 100 100 <br /> Outside of Orange County 62 73 70 70 <br /> Unknown 0/203 225 105 105 <br /> Total 670 502 475 475 <br /> Income <br /> Low-income(80%of the Area Median Income and Below) Please see At least At least <br /> income table in the attachments Unknown 377 At least 356 356 <br /> Total 0 502 475 475 <br /> 8. Cost Per Individual <br /> This cost per individual must reflect the total program budget divided by the total number of program <br /> individuals in this application. <br /> Total Cost of Program $115,268 $80,115 $92,985 <br /> Total # of Individuals 502 475 475 <br /> Cost Per Individual $229.61 $168.74 $195.76 <br /> 9. Performance Indicators <br /> For Chapel Hill and Carrboro applicants: <br /> Please complete the following chart with information about the Strategic Objective, Intermediate Result, and <br /> the Agency Performance Indicator for each program for which you are applying for funding. Please see the <br /> Results Framework in the Attachments section as a reference. <br /> Program Name: <br />