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City of Santa Ana <br />Donation Request <br />Name: M. Nellie Kaniski Title: <br />Address: 1614 W. 9th Street <br />City, State, ZIP: Santa Ana, CA 92703 Phone: <br />Email: nelliel<c@roadrunner.eom Fax: <br />City Manager's Office -. M -31 <br />20 Civic Center Plaza <br />P.O. Box 1989 <br />Santa Ana, CA 92702 <br />(714) 647 -9200 <br />Executive Director, MANIA <br />714 - 914 -6502 <br />Name: Mexican- American 'Wornens 'National Association of Change County <br />Tax - Exempt Status: Is your organization a non - profit or public tax- exempt organization as Select One: <br />defined under Section 501(c)(3) of the Internal Revenue Code? ® Yes No <br />If No, you will only qualify for a credit for City - related costs for your request (i. a, permit fees, if Yee, <br />staff time, rental rates for' facilities or equipment, etc.). Costs for City services vary and if 68- 0552012 <br />approved, credit may or may not cover full cost of requested City servicea Tax ID 0: , <br />City Services Credit $ Date Needed: Mayor /Counclimember: Martinez <br />Amount Requested: <br />Direct tAmount <br />Requested; ted: $1,000 Event Date: April 22 2017 Event Time: 8 am - 4 pm <br />Event Location: Santa Ana College, 1530 W. 17th <br />address, city, state, zip Santa Ana, CA 92706 <br />Description of The 26th Annual Adelante Young Women's Educational Leadership Conference, <br />Event /Purpose: High school student outreach, to promote higher education, <br />By supporting self confidence, encouraging higher education, sharing career opportunities in STEM <br />Community Bonefit: fields along with financial aid and scholarship information, a community of learners -- students will thrive; <br />our community will thrive -it can became a elf sufficient, educated and aware society. <br />Applicant signature: ;(_ Date; December 6, 2016 <br />Mail: City Manager's Office —M -$1 Email: donationrequest@santa- ana,org <br />20 Civic Center Plaza Fax: (714) 6478954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />�J r -1 "Cr Ftr _st'd- rk <' <br />IW IA,• 'lEtt :'ai °QL ki. ° -1 .- __ -�.. <br />EXHIBIT 1 <br />Revised 11/16/2015 <br />