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City of Santa Ana <br />Donation Request <br />City Manager's Office — M -31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 6474208 <br />Contact' a s <br />Name: (Jenny Rios "Title: CEO <br />Address: 505 E. Central Ave <br />City, state, zip: !. Santa Ana, CA 92707 (Phone: 1714 -481 -9601 <br />jEmail: jennyrios @delhicenter.org Fax: 1714- 481 -9698 <br />Ornanization Informatic <br />Name: JDelhi Center <br />i Tax - Exempt Status: Is your organization a non - profit or public lax - exempt organization as Select One: <br />;defined under Section 501(c)(3) of the Internal Revenue Code? F Yes ❑ No <br />l No, you will only qualify fora credit for City - related costs for your request (i.e. permit fees, I - - - -- f <br />(staff time, rental rates for facilities or equipment, etc.). Costs for City services vary and if Yes, 952620952 <br />approved, credit may or may not cover full cost of requested City services. <br />Donation; <br />City' __._— _— ______,_ -Ir _.. <br />lA Services Credit iS (Date Needed: June 30, 2016 IMayoricounciimember. IAmezcua <br />(Amount Requested: I <br />(Direct Payment Amount <br />Requested: $11,000 IEventDate: 6 -20 to 8 -19 Event rime: M -F 7:30 am -5:30 pm <br />i Event Location: 1505 E. Central Ave. Santa Ana, CA 92707 <br />IlAddrase, City, State, Zip <br />I Summer Enrichment Camp: A comprehensive menu of age abridgment activities for youth bass 01013, and ages 14 to 19. The dual goals of the program are to provide <br />Description of I chalahchtgemichor l activities using avidm.c bnaed Prevention ovoidales for both age groups, while providing older pedioipante Wo, 21 at Cealury skills to help them <br />p Ibecome wllagoand career ready. Activities will Include physical ninths, visual and padonning Otte, video pmdualbn, and other opportunities that will help them develop <br />I Event i Purpose: I healthy Iifeeryles, develop dllllrod thinking skills, and cam respect Participants will learn interviewing and storytelling techniques and will Media a film producllon to showcase <br />the rich history of their lives and their dannin lly. Older padlclpant vil ad es Junior Leedere and will engage in a training component for leadership development. <br />I nofunding will cover the cost of 2 Santa Ana youths from Ward 3 for the full 9 week ramp where they will be engaged in challenging, educational, and healthy acgvilas <br />I which will lead to an end dof -s miner indeci Lion that will serve as to vehicle to aimwcaae their accomplishments and their community, Junior Leaders will gain job minion} and <br />I Community Benefit: erpanena whla bev,gm.ntoratl by college ctutlentsand wdl pol.ntielly 6erva ae g. pool Orqualiged mwre Inatmctpra br ekpandetl pmgnmming. Therummercamprvi <br />eery.... p Ot program In order IO mont to Its Wri On Itla youth served and t0 nab it,. .suite As the bass for a filly deeralepatl program for which mall Carter tall seek <br />grant kniningn order t. condl to p.,,do quality, ve pewhimn programs for at Oak youth. <br />�Appucantsignature: _ (Date: May 18, 2016 <br />• •. <br />Mail: City Manager's Office — M -31 Email: donationrequest@santa-ana.org <br />20 Civic Center Plaza Fax: (714) 947.6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request #: OR <br />ftefareace 4 on arl,alaled » °V:: Council Meeting Date' <br />Lilginility feet YES I NO <br />City Manager Signature, <br />Apptavud Amount <br />� <br />5�T � <br />Date. <br />Revised 11/1612015 <br />