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<br />Program information P a g e 16 o f 55 <br />7. Target Population: Please complete the table below with numbers (not <br />percentages) of individuals served and projected to be served. <br /> <br />Program Target Population Demographics <br /> <br />Projecte <br />d <br />2019- <br />2020 <br />Actual <br />2019- <br />20 <br /> <br />Projected <br />2020-21 <br />Projecte <br />d <br />2021-22 <br />Gender <br />Men 80 87 80 90 <br />Women 37 37 37 38 <br />Nonbinary/Genderqueer 0 0 0 0 <br />Self-Describe 0 0 0 0 <br />Total 117 124 117 128 <br />Race and Ethnicity <br />Black or African-American 22 23 22 24 <br />American Indian or Alaska Native 0 0 0 0 <br />Asian 2 1 2 1 <br />White 87 94 87 95 <br />Native Hawaiian or other Pacific Islander 0 0 0 0 <br />Two or more races 1 1 1 1 <br /> Some other race 5 5 5 7 <br />Total 117 124 117 128 <br /> <br />Of the above, how many Hispanic/Latino 4 4 4 6 <br />Of the above, how many non-Hispanic/Latino 113 120 113 122 <br />Total 117 124 117 128 <br />Age <br />0-5 years 0 0 0 0 <br />6-18 years 0 0 0 0 <br />19-50 years 53 62 53 66 <br />51+ years 64 62 64 62 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: 11DA72B8-CC83-439E-A25C-F64DE607C614