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DocuSign Envelope ID: F807B28A-EF75-498C-9EC8-5863109A5978 <br /> Some other race 50 37 50 50 <br /> Unknown 123 270 123 123 <br /> Total 475 427 475 475 <br /> Of the above, how many Hispanic/Latino 45 30 45 45 <br /> Of the above, how many non-Hispanic/Latino 425 397 430 430 <br /> Total 475 427 475 475 <br /> Age <br /> 0-5 years 0 0 0 0 <br /> 6-18 years 0 0 0 0 <br /> 19-50 years 250 110 250 250 <br /> 51+years 75 21 75 75 <br /> Unknown 150 296 150 150 <br /> Total 475 427 475 475 <br /> Geographic Location <br /> Town of Chapel Hill 150 117 150 150 <br /> Town of Carrboro 50 19 50 50 <br /> Orange County(Outside of Chapel Hill/Carrboro) 100 32 100 100 <br /> Outside of Orange County 70 54 70 70 <br /> Unknown 105 205 105 105 <br /> Total 475 427 475 475 <br /> Income <br /> Low-income(80%of the Area Median Income and Below) Please see At least At least <br /> income table in the attachments 356 318 At least 356 356 <br /> Total 1 475 1 425 475 475 <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„2019 Z0 , .Projected 2020 21 Pro�jected;202,1-22 ;_, <br /> Total Cost of Program $76,628 $91,152 $96,463 <br /> Total#of Individuals 425 475 475 <br /> Cost Per Individual $180.30 $191.90 $203.08 <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 Name:Self-Sufficiency Services: Financial Education &Career Preparedness, Legal Information <br /> Program information P a g e 1 6 o f 3 4 <br />