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DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 <br /> ------------ <br /> . i <br /> Of the above,how many non-Hispanic/Latina I ;13 18 24 32 <br /> Total ; 16 28 36 <br /> }' N, � <br /> Icl,l� 111��+.i u!�� <br /> 0-5 years 0 2 2 2 <br /> 6-18 years r_16 <br /> 3 10 10 <br /> 19-50 years 1651+years 1 1 <br /> Total 16 22 28 36 <br /> ,.ii� <br /> a';��e '3'J6� Q �ll+i}',Ll(l��LVii� �IIi�C�W1 u�l:i�l���� I,�il�liflllU�l I S�(I I11� L� ��Gt�, <br /> Town of Chapel.Hill 8 12 19 23 <br /> Town of carrboeo 1 0 <br /> Orange County-(Outside of Chapel Hill/Carrbero) 6 9 8 12 <br /> Outside of Orange County 1 1 1 1 <br /> Total 16 22 28 36 <br /> HIM, <br /> Low-inc6rhe'(8b%'ofthe Area Median Income and Below) Please see 8 12 <br /> income table in the attachments 13 6 <br /> Total F 13 1 6 1 12 1 12 <br /> S. 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 /> plll'1G ' ,r " 'il' <br /> t <br /> Total,Cost.ofProgram $2,000 $1,6,640 $7,572 <br /> Total#of Individuals 22 28 36 <br /> Cost Per Individual ( $90.90 $237.14 $210.33 <br /> 9. Performance Indicators <br /> For Chapel dill 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 /> Strategic ❑ Children improve their educational outcomes <br /> ®bje'ctiVe <br /> 1 (grease choose one from .Residents Increase their livelihood security <br /> 1 the Results Framework) ❑ Residents improve their health outcomes <br /> ,v,t 1 ''`s i t I i I <br /> „ 1 � 'i I��{}4 iC I � i}� •l I ia�fl 1 I <br /> ... �. ( f� ! .,, l � t, , � ,. <br /> Program information P a 4 e 12 of 16 <br />