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Program information P a g e 9 o f 20 <br />7.Target Population: Please complete the table below with numbers (not percentages) of individuals served <br />and projected to be served. <br />Program Target Population Demographics <br />Projected <br />2019-2020 <br />Actual <br />2019-20 <br />Projected <br />2020-21 <br />Projected <br />2021-22 <br />Gender <br />Men <br />Women <br />Nonbinary/Genderqueer <br />Self-Describe <br />Total 365 547 380 380 <br />Race and Ethnicity <br />Black or African-American <br />American Indian or Alaska Native <br />Asian <br />White <br />Native Hawaiian or other Pacific Islander <br />Two or more races <br /> Some other race <br />Total 365 547 380 380 <br />Of the above, how many Hispanic/Latin o <br />Of the above, how many non-Hispanic/Latino <br />Total 365 547 380 380 <br />Age <br />0-5 years <br />6-18 years <br />19-50 years <br />51+ years <br />Total 365 547 380 380 <br />Geographic Location <br />Town of Chapel Hill <br />Town of Carrboro <br />Orange County ( Outside of Chapel Hill/Carrboro) <br />Outside of Orange County <br />Total 365 547 380 380 <br />Income <br />Low-income (80% of the Area Median Income and Below) Please see <br />income table in the attachments <br />Total **** <br />90 <br />260 <br />15 <br />219 <br />327 <br />1 <br />100 <br />260 <br />20 <br />100 <br />260 <br />20 <br />20 <br />20 <br />15 <br />10 <br />300 <br />12 <br />4 <br />44 <br />487 <br />50 <br />30 <br />270 <br />10 <br />20 <br />50 <br />30 <br />270 <br />10 <br />20 <br />50 <br />315 <br />54 <br />493 <br />50 <br />330 <br />50 <br />330 <br />0 <br />180 <br />180 <br />5 <br />0 <br />386 <br />161 <br />0 <br />0 <br />300 <br />70 <br />10 <br />0 <br />300 <br />70 <br />10 <br />300 <br />25 <br />40 <br />381 <br />136 <br />28 <br />220 <br />70 <br />90 <br />220 <br />70 <br />90 <br />**** <br />*PPSAT does not collect income information for program participants. <br />2 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: 3B9D32F2-BCE5-494E-B2DF-78A17389E8BADocuSign Envelope ID: 01146459-28D7-41C1-ADA0-09401D3877AD