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Program information P a g e 15 of 32 <br />Black or African-American 1817 1951 1220 1220 <br />American Indian or Alaska Native 92 97 65 65 <br />Asian Indian 1278 1313 1050 1050 <br />White 11796 12566 10650 10650 <br />Native Hawaiian or other Pacific Islander 15 16 15 15 <br />Chinese 400 150 200 <br />Japanese <br />Vietnamese <br />Filipino <br />Korean <br /> Some other race <br />Unknown 0 8644 <br />0 15400 24587 13150 13200 <br />Of the above, how many Hispanic, Latino or Spanish origin 1324 3048 1800 1850 <br />Of the above, how many non-Hispanic, Latino or Spanish origin 14076 21539 11350 11350 <br />Total 15400 24587 13150 13200 <br />Age <br />0-5 years 2000 68 250 1000 <br />6-18 years 11000 5590 7050 7050 <br />19-50 years 2400 18041 3050 3050 <br />51+ years 0 0 150 150 <br />Unknown 888 2650 1950 <br />Total 15400 24587 13150 13200 <br />Geographic Location <br />Town of Chapel Hill 7300 7970 6300 6300 <br />Town of Carrboro 1800 975 1300 1300 <br />Orange County ( Outside of Chapel Hill/Carrboro) 4450 511 3000 3000 <br />Outside of Orange County 1600 3307 1300 1300 <br />Unknown 250 11824 1250 1300 <br />Total 15400 24587 13150 13200 <br />Income <br />Low-income (80% of the Area Median Income and Below) Please see income <br />table in the attachments n/a n/a <br />n/a n/a <br />Total 0 0 0 0 <br />9.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 2020-2021 Projected 2021-2022 Projected 2022-2023 <br />Total Cost of Program 270300 228085 235000 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: D5354C91-47B9-4630-B4CE-FB86A8E9DAB6