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a t`. City of Santa Ana <br />Donation Request <br />!Name: Jenny Rios <br />Address: 1505 E. Central Ave <br />city, state, zip: 1 Santa Ana, CA 92707 <br />;Email: jennyrios @dethicenter.org <br />Name: Delhi Center <br />City Manager's Office - M -31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 647.6200 <br />CEO <br />jPhone: :714- 481 -9601 <br />!Fax: 714- 481.9698 <br />Tax- Exempt Status: Is your organization a non - profit or public lax - exempt organization as <br />defined under Section 501(.)(3) of the Internal Revenue Code? <br />Select One: <br />Yes ❑ No <br />IIfell you willonlyqualdy fors credit for City- related costs foryourrequest il.e, permit fees, <br />If Yes <br />staff time, rental rates forfacilittas orequipment,etc.).Costs for Cityservices vary andif <br />!g52620952 <br />approved, credit may or may not cover full cost of requested City services. <br />ax ID #: <br />!City Services Credit <br />(A Date Needed: !June 30, 2016 Mayor /Councgmembgr: Martinez <br />Amount Requested: j <br />!Direct Payment Amount <br />!Requeste: '$2,500 Event Date: 16 -20 to 8 -19 (Event Time: Ili 7:30 am -5:30 pm <br />IEvent Location: E. Central Ave. Santa Ana, CA 92707 <br />[Address. City. State, Lp 1 1 <br />Summer Endchmenl Camp: A comprehensive maT ofag. appropdale edlvitles foryouth eAea Sfo13, and ages 14 to 18. The dual goal¢ Wtheprogremare to Vav,dn <br />IDesad doll al chepenong antlomedno activities main ®eyidnnae bond prevenlim strategies for both age groupa,whlle pmvad'mg order pe,lltlpable with 21.1 Century skills to help them <br />p become College and Career ready. Aahvllles will Include physedel htnes;, now and performing ode, video FmduGlion, end other opportunities that well help them develop <br />�.. Event l Purpose: healthy Restless, develop original Mlnang s kills, and Cam respond, paradpanls vell team Mlevi.vang and Storytelling sachneci and lest drugs a film pmtluctlon to showcase <br />the net third, of their ave , and than community. Older peounpanl3 Yell ail as Junior Leaders and vve engage In a framing component for IoaderehaF die8lepnewl <br />The funding will Cover the cost of 2 1 Ana youths lam Want 2 for the Nil g weak Camp eased they Will be engaged in Challanging, educational, and healthy adivaes <br />i which swill lead to an anLL.l- summer produmMn Mat wall sewn as a vohado to showcase grab aaCnmpliebmente and Near..Co ity. Junior Leader.. 11 gain job training antl <br />Community Benefit: I f.porl.r. while being mentmed by collage Masora; and will pslenlaaty s¢,a as the pool of qualified future inaimptor. Ihr expanded programming. The summer camp will <br />hmv. am a pilot pmgmm In order to evaluate Its Impact on the youth moved and to use the houlls as the basis fin fully developed Wagr.m for eliM Debt Center Coal eeaA <br />Igrant fdndleg In order to carcae to provdDqooewe prevention programs for at risk youth <br />Approant Signature: 10ate: . May 18, 2016 <br />(Mail: City Manager's Office -M -31 Email: donationrequest@santa- ana.org <br />20 Civic Center Plaza Fax: (714) 647.6964 <br />P.O. Box 1968 <br />Santa Ana, CA 92702 <br />Donation Requi ri CSR <br />ez.P ,a�ee a an m Coune II Mooting Dater <br />Eligibility Mct: YES I NO Approved Antonin'_ <br />City Manager Signature. Date: <br />Revised 11/16/2015 <br />SW <br />