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City ®f Santa Ana <br />City Manager's Office - M-31 <br />20 Civic Center Plaza <br />Donation Request <br />(9) <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 647-5200 <br />Contact <br />Name: ( Dr. Ana Jimenez-HamiTitle: <br />[Executive Director <br />Aadress: 2215 North Broadway <br />Icity, state, zip: Santa AnaPhone: <br />( 714-296-2191 <br />rEmali: Kana@occtac.org Pax: <br />(714-564 9690 <br />rName: ---[Orange County Children-'s Therapeutic Arts Center <br />Tax-Exempt Status: Is your organization a non-profit or public tax-exempt organization as <br />defined under Section 501(c)(3) of the Internal Revenue Code? <br />Select One: <br />Fv/1 Yes ❑ No <br />If No, you will only qualify for a credit for City-related costs for your request (i. e. permit fees, <br />If Yes, <br />staff time, rental rates for facilities or equipment, etc.). Costs for City services vary and if <br />3 3-0 9 303 91 <br />approved, credit may or may not cover full cost of requested City services. <br />ax ID #: <br />®a <br />— <br />City Services Credit $ Date Needed: 06-09-2017 Mayoricouncilmember: <br />Sarmiento <br />Amount Requested: <br />;D:mot Payment Amount $ 500_[, ent Date: <br />Requested:06-16-2017 Event Time: <br />�+ <br />6.00-8.00 ply <br />Event Location: Heritage Museum of Orange County <br />Address, city, state, Zip 310 West Harvard street, Santa Ana CA 92704 <br />The End of the School Year Art Show will showcase selected works <br />from elementary and middle <br />Description of <br />Event I Purpose: school students who participated in the After School Arts enrichment <br />program at OCCTAC and <br />the Arts program taught at SAUSD extended learning program, Engage 360. <br />This free community event and Art Exhibition will feature Art created by students from Santa Ana <br />that learned the works of great Latin <br />American Masters they studied during the year. This is an excellent educational opportunity for <br />Community Benefit: <br />the parents of the students and the <br />community to learn more about these great Latino masters and feel proud of their Cultural Heritage. <br />Also, this event will benefit the <br />community by bringing more awareness of Artistic activities that help youth express their talents and engage in positive life experiences) <br />— <br />Applicant Signature; j DR ANA JIMENEZ-HAMI Date; <br />i6--017 <br />----- <br />Mall. City Manager's Office- M-31 Email: donationrequest@santa-ana.org <br />[Pax. <br />20 Civic Center Plaza (714) 647.6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request #: DR;. _, I :• ., <br />ercnce on enret,re,au uw Council Meeting Date: <br />_ _. <br />JUNE 20, 2017 <br />l; Eligibility Met: YES I NO YES Approved Amount: <br />$500 <br />City Manager Signature =' Data: <br />X IBITA A <br />LVP%— 14 <br />