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VA City of Santa Ana <br />Donation Request <br />City Manager's Office — M-31 <br />20 Civic Center Plaza <br />P.O. Box 1986 <br />Santa Ana, CA 9270 <br />(714) 647-5200 <br />(Name: America Bracho mfie: !Chief Executive Officer <br />Address: i450 W. 4th Street, Suite 130 <br />cly, state, zip: ',Santa Ana, CA, 92705 !Phone: 1714-542-7792 <br />Emall: Iamerica@latiiiohealthaccess,org IFax: 1714-542-4853 <br />Name: <br />Bracho <br />Tex - Exempt Status: Is your organization a non-profit or public tax-exempt organization as iselect one: I Yes ❑ No <br />defined under Sector 501 (c)(3) of the internal Revenue Code? I <br />IfAto, you will only qualify fora credit for City-related costs foryourrequest (i.e. permlt less, <br />staff time, rental rates tar facilities or equipment, etc.). Costs for City services vary and if I If Yes, 133-0562943 <br />;approved, credit may or may not cover full cost of requested City services. Tax ID <br />ICity Services Credit <br />Arnownt Requested: <br />0 <br />Data Needed: N/A <br />Imayoricaunclimernber: ;Martinez <br />Direct Payment Amount <br />.. ......... ­ ...... <br />$1,000 Event Date !Every Wed. Evantlhme. Apirn-5:30pim <br />Requested! <br />Event Location: <br />Latino Health Access' Green Hearts Families Park, 602 E. 4th Street, Santa Ana, CA, 92701 <br />Addrass, Cily, State, Zip <br />This request is for the "Leyendo an Familia" (Family Literacy Program), a weekly reading program with the goal of <br />oeacriptionot <br />increasing literay among low-income Latina children in Santa Ana. The program engages parents and children in reading <br />Event I Purpose: <br />lessons designed to increase reading frequency. As pal of the program, families also have access to a lending library <br />!with books for child ran from Pre-K to young adults. Attached, you will find more detailed information about this program. <br />The an o oil Fami ies" program engages parents to take an active role In helping their children to increase their <br />Community Benefit: <br />reading frequency and employ key reading strategies. The program is offered to low-income families in Santa Ana, many <br />of whom live in surrounding apartment complexes that average 10 people in a 1.2 bedroom apartment. Parent participants <br />cannot afford to purchase books for ther children. Our program provides access to books. Please see attached. <br />Applicant Signature: <br />I <br />Date: <br />October 28, 2015 <br />Return completed form via: <br />ErI donationrequest@santo•ana.org <br />20 Civic Center Plaza Fax: (714) 047-6954 <br />P.O, Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request #: on - <br />Council Meeting Date: <br />Eligibility Met: YES NO Approved Amount: <br />City Manager Signature: 1 Date: <br />Revised 8/2612 01 5 <br />