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2021-631-E-Health-Table Ministries-Outside Agency Agreement
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2021-631-E-Health-Table Ministries-Outside Agency Agreement
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Last modified
10/28/2021 8:22:26 AM
Creation date
10/28/2021 8:22:06 AM
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Template:
Contract
Date
10/27/2021
Contract Starting Date
10/27/2021
Contract Ending Date
10/27/2021
Contract Document Type
Contract
Amount
$15,000.00
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<br />Program information P a g e 10 o f 23 <br />7. Target Population: Please complete the table below with numbers (not percentages) of individuals served <br />and projected to be served. <br /> <br />Program Target Population Demographics <br /> <br />Projected <br />2019-2020 <br />Actual <br />2019-20 <br /> Projected <br />2020-21 <br />Projected <br />2021-22 <br />Gender <br />Men 374 346 378 403 <br />Women 361 319 348 372 <br />Nonbinary/Genderqueer N/A N/A N/A N/A <br />Self-Describe N/A N/A N/A N/A <br />Unknown 15 22 24 25 <br />Total 750 686* 750 800 <br />Race and Ethnicity <br />Black or African-American 214 188 206 219 <br />American Indian or Alaska Native 1 0 0 0 <br />Asian 111 94 103 110 <br />White 285 263 288 307 <br />Native Hawaiian or other Pacific Islander 0 0 0 0 <br />Two or more races 57 53 58 62 <br /> Some other race 16 3 3 3 <br />Unknown 66 72 92 99 <br />Total 750 686* 750 800 <br /> <br />Of the above, how many Hispanic/Latino 228 221 242 258 <br />Of the above, how many non-Hispanic/Latino 456 393 430 458 <br />Unknown 66 72 78 84 <br />Total 750 686* 750 800 <br />Age <br />0-5 years 120 118 129 138 <br />6-18 years 548 539 589 629 <br />19-50 years 0 0 0 0 <br />51+ years 0 0 0 0 <br />Unknown 82 29 32 33 <br />Total 750 686* 750 800 <br />Geographic Location <br />Town of Chapel Hill 404 428 468 499 <br />Town of Carrboro 188 178 195 208 <br />Orange County ( Outside of Chapel Hill/Carrboro) 145 75 82 87 <br />Outside of Orange County 4 0 0 0 <br />Unknown 9 5 5 6 <br />Total 750 686* 750 800 <br />Income <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: 6AACAE3D-76C8-46BA-8DCC-C71ED367AD95
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