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DocuSign Envelope ID:29133413CC-1A11-40B3-9EE7-168E6261E415 <br /> Of the above, how many non-Hispanic/Latino 7 <br /> Total 0 0 0 8 <br /> Age <br /> 0-5 years <br /> 6-18 years <br /> 19-50 years 8 <br /> 51+years <br /> Total 0 0 0 8 <br /> Geographic Location <br /> Town of Chapel Hill 2 <br /> Town of Carrboro <br /> Orange County(Outside of Chapel Hill/Carrboro) 3 <br /> Outside of Orange County 3 <br /> Total 0 0 0 8 <br /> Income <br /> Low-income(80%of the Area Median Income and Below).Please see <br /> income table in the attachments *See note below <br /> Total 0 0 0 0 <br /> *Pathways has not requested information related to income,so we have no verifiable data to support any <br /> claims of low-income participants.A request for this information will be added to our intake forms so we <br /> can report accurately in the future. <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 /> Actual 2018-19 Projected 2019-20 Projected 2020-21 <br /> Total Cost of Program N/A N/A $18,469 <br /> Total # of Individuals N/A N/A 8 <br /> Cost Per Individual N/A N/A $2,308.63 <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 information P a g e 14 of 3 7 <br />