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DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 <br /> Of the above, how many Hispanic/Latino 3 8 8 9 <br /> Of the above, how many non-Hispanic/Latino 27 32 56 <br /> 81 <br /> Total 30 40 64 90 <br /> Age <br /> 0-5 years 0 0 0 0 <br /> 6-18 years 5 8 5 6 <br /> 19-50 years 15 30 49 76 <br /> 51+years 10 2 10 8 <br /> Total 30 40 64 90 <br /> Geographic Location <br /> Town of Chapel Hill 10 5 10 14 <br /> Town of Carrboro 5 0 3 2 <br /> Orange County(Outside of Chapel Hill/Carrboro) 10 11 22 22 <br /> Outside of Orange County 5 24 29 52 <br /> Total 30 40 64 90 <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 *See note $25,039 <br /> below <br /> Total # of Individuals 90 <br /> Cost Per Individual $278.21 <br /> *Pathways is working with our accountants to establish our financial records according to GAAP (Generally <br /> Accepted Accounting Principles)for non-profit organizations. Income and expenses were not consistently <br /> entered against programs.We cannot with certainty state actual program income or expenses for <br /> accounting years prior to FY 2020. <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 20 of 3 7 <br />