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DocuSign Envelope ID:8C3AC364-20A8-477A-92A7-8FBD4923E2D0 <br /> Age <br /> 0-5 years <br /> 6-18 years 2 2 4 5 <br /> 19-50 years 19 28 30 35 <br /> 51+ years 11 2 6 5 <br /> Total 32 32 40 45 <br /> Geographic Location <br /> Town of Chapel Hill 12 10 15 10 <br /> Town of Carrboro 10 12 15 15 <br /> Orange County (outside of Chapel.Hill/Carrboro) 5 6 5 10 <br /> Outside of Orange County 5 4 5 10 <br /> Total 32 32 40 45 <br /> Income <br /> Low-income (80% of the Area Median Income and 27 27 32 35 <br /> Below) Please see income table in the attachments <br /> Total 27 27 32 35 <br /> 8. Cost Per Individual: This cost per individual must reflect the total program budget <br /> divided by the total number of program individuals in this application. <br /> Actual 2018-19 Projected 2019-20 Projected 2020-21 <br /> Total Cost of Program $10,580.00 $12,500.00 $13,080.00 <br /> Total # of Individuals 32 40 45 <br /> Cost Per Individual $330.63 $312.50 $290.67 <br /> 9. Performance Indicators <br /> For Chapel Hill and Carrboro applicants: <br /> Please complete the following chart with information about the Strategic Objective, <br /> Intermediate Result, and the Agency Performance Indicator for each program for which <br /> you are applying for funding. Please see the Results Framework in the Attachments <br /> section as a reference. <br /> Program Name: NIA <br /> ❑ Children improve their educational outcomes <br /> Strategic <br /> Objective <br /> (please choose ❑ Residents Increase their livelihood security <br /> one from the <br /> Results <br /> Framework) ❑ Residents improve their health outcomes <br /> . � ° <br /> _......... ..........._._............._..__.............._....................................... . ... ..... .................--........_........--._..._.................................................................._.._,..__............__...._....._............................ <br /> Program information Page 11 of 22 <br />