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City of Santa Ana <br />Donation Request <br />Name: Jenny Rios Title: CEO <br />Address: 505 E. Central Ave <br />City Manager's Office— 11141 <br />20 Civic Center Plaza <br />P.O. Box 1986 <br />Santa Ana, CA 92702 <br />(714) 647 -5200 <br />city, state, zip: Santa Ana, CA 92707 Phone: 714- 481 -9601 <br />Email: jennyrios @delhicenter.org Fax: 714- 481 -9698 <br />• .. <br />Im am <br />Name: Delhi Center <br />Tax - Exempt Status: Is your organization a nonprofit or public tax - exempt organization as Select One: <br />defined under Section 501(c)(3) of the Internal Revenue Code? 7 Yes ❑ No <br />If No, you will only qualify fora credit for City - related costs for your request (i.e. permit fees, If Yes, <br />staff time, rental rates for facilities or equipment, etc), Costs for City services vary and if 95262 ®952 <br />approved, credit may or may not cover full cost of requested City services. Tax ID 0: <br />•s a -a <br />City Services Credit $ Date Needed: June 30, 2016 Mayor /Councitmembor. Sarmiento <br />Amount Requested: <br />Direct Payment Amount $ 2 500 Event Date: <br />Requested: 6 -20 to 8 -19 Event Time: M -F 7:30 ann -5:30 pm <br />Event Location: 505 E. Central Ave. Santa Ana, CA 92707 <br />Address, City, State, Zip <br />Summer Enrichment Camp Junior Leader Training', A comprehensive 9,week mortaring and job skills trebling program, where professional insbucim's will train <br />Description of and guide Junior Leaders in are areas of teaching, recreation, visual and pererming arts. fashion and madaling, costume and set design. and media arts. <br />Training will also include Business Etiquette, Life Skills, Guest Speakers, Financial EducatioNeudgeting, horses Techniques, and Career Exploretien. <br />Event / Purpose: participants will learn interviewing and storytelling techniques and will explore the arts, culture, and the use of mixed media to create a film to showcase the <br />rich history of their lives and their community. <br />Junior Leaders (ages 14 -19) will gain job training and experience by assisting professional inatruchera with the implementation of the <br />Community Benefit: Summer Enrichment Camp for children ages &Q. Junior Leaders will be Instrumental in developing a mufti-media production to highlight the <br />accomplishments of program participants that wfll be presented to the control at a variety of events to emphasize the posNive <br />contributions of young people in in Ommunily.` .I <br />Applicant Signature:/' Date: May 11, 2016 <br />Mail: City Manager's Office — M -31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Email: donatlonrequest@santa- ana.org <br />Fax: )714)647 -6954 <br />i)onnton RequeSt R OR- <br />Coum:d Nieclmg Daie- <br />Ehgibrlity Mob `r ES / NO Apprmrod Amount' <br />:J2Y Manager Signature. Date. <br />Revised 11/16/2015 <br />s9 <br />