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PROPOSER APPLICATION <br />Agency Legal Name <br />Orange County Children's Therapeutic Arts Center <br />Agency DBA <br />N/A <br />Program Name <br />Job Training for Youth with Disabilities, Foster Youth and High School Dropout Youth <br />Program Address <br />2215 N. Broadway, Santa Ana, CA 92706 <br />Corporate Office Address <br />2215 N. Broadway, Santa Ana, CA 92706 <br />Contact Person & Title <br />Dr. Ana Jimenez-Hami <br />Email <br />ana(c@occtac.orz <br />Telephone # <br />714-547-5468 Ext. 107 <br />Fax # <br />714-564-9690 <br />Federal ID Number <br />33-0930891 <br />AGENCYSTATUS <br />Public Non -Profit <br />x <br />Corporation <br />Private Non -Profit <br />Years in O eration? <br />13 <br />Private for Profit <br />I I <br />Government <br />Other <br />PRIMARY FUNDING Sn[IRrFs <br />Funding Source <br />Grants <br />Contracts <br />Tuition <br />Donations <br />Fundraising <br />Amount <br />$2S0,000 <br />$160,000 <br />1 5130,000 <br />$70,000 <br />$50,000 <br />HOURS OF OPERATION AND DAYS <br />Days <br />Monday <br />Tuesday <br />Wednesday <br />Thursday <br />I Friday <br />Saturday <br />Sunday <br />Hours <br />8:30-8:30pm <br />8:30-8:30pm <br />I 8:30-8:30pm <br />I 8:30-8:30pm <br />I 8:30-8:30pm <br />8:30-5700pm <br />Closed <br />TARGET POPULATION <br />Older Youth 17-21 Younger Youth 16-21 Out -of -School 23 In -School 7 <br /># of Youth to be Served in 2013-2014 25 Total WIA Funds Requested $180,000 <br />In compliance with the RFP noted above, and subject to the conditions thereof, the undersigned offers to furnish <br />the services stipulated and certifies he has read, understands, and agrees to all terms, conditions, and <br />requ ents of this RFP and is authorized to contract on behalf of the agency named above. <br />Executive Director <br />Si nature ` Title Date <br />EXHIBIT A <br />