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DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E <br /> American Indian or Alaska Native <br /> Asian <br /> White <br /> Native Hawaiian or other Pacific Islander <br /> Two or more races <br /> Some other race <br /> Total 0 0 0 0 <br /> Of the above, how many Hispanic/Latino <br /> Of the above, how many non-Hispanic/Latino <br /> Total 0 0 0 0 <br /> Age <br /> 0-5 years <br /> 6-18 years <br /> 19-50 years <br /> 51+years <br /> Total 0 0 0 0 <br /> Geographic Location <br /> Town of Chapel Hill <br /> Town of Carrboro <br /> Orange County(Outside of Chapel Hill/Carrboro) <br /> Outside of Orange County <br /> Total 0 0 0 0 <br /> Income <br /> Low-income(80%of the Area Median Income and Below) Please see <br /> income table in the attachments <br /> Total 0 0 0 0 <br /> 8. Cost Per Individual <br /> This cost per individual must reflect the total program budget divided by the total number of <br /> program individuals in this application. <br /> Actual 2018-19 Projected 2019-20 Projected 2020-21 <br /> Total Cost of Program $14,000.00 $27,000.00 $15,000.00 <br /> Total # of Individuals 650 780 975 <br /> Cost Per Individual $21.54 $34.62 $15.38 <br /> 9. Performance Indicators <br />