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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 92762 <br />(794) 547.5200 <br />e c a <br />Name: Debbie Wells 'Title: - Executive Director <br />Address: ',1621 Bullard Lane -._..._ <br />city, state, zip: , Santa Ana <br />Phone: 7143362061 <br />Email: idewelis(_w-pacbell.net Fax: _... ._... <br />Name: Achievement Institute of Scientific Studies <br />ITax-ExemptStatus: Is your organization a non-profit or public tax-exempt organization as - --- <br />select One: <br />defined under Section 501(c)(3) of the Internal Revenue Code? ❑/ Yes ❑ No <br />Y <br />If No, you will only qualify fora credit for City -related costs for your request (i.e. pannit tees, f Yes, <br />:staff time, rental rates for Facilities or equipment etc.). Costs for City services vary and if '330734877 <br />'approved, credit may ormay not cover full cost ofrequested Cityservices. Tax ID #: <br />i <br />Services Credit <br />,City <br />jAmount Requested: <br />��' ate Needed: 106/23/17 MayorlCouncilmember: Solarie <br />Direct <br />Requested: ont Amount <br />Event Data: 06/23/17 Event Time: 8.30-A.M........ <br />$1,200— <br />IEventLocation: <br />'.Address, <br />',Chapman University, One University Drive, Orange, CA 92866 <br />City, state, zip <br />Chapman INSPIRES 4 -Day Weekend Kick -Off with STEM activities and workshops, joint <br />DesAISS <br />iEventI Purtion of <br />,Event/ Purpose: <br />business mixer with OC Hispanic Chamber and STEM Panel Dinner! Expose new AISS Class <br />p P <br />of 2019 student scholars to Chapman University, business community and STEM professional, <br />AISS is providing services to youth in Santa Ana for its AISS College to Career Readiness STEM <br />(!Community Benefit: <br />Program. AISS' program will benefit 48 youth in Santa Ana. AISS is 100% successful with guiding '. <br />students in getting into a quality university, with a 99% success rate for college completion. <br />Applicant Signature: <br />Date: 619/17 <br />_.. _... _.. <br />mail: City managers office -M-31 Email: dauationrequost@sama-ana.org <br />29 Civic Center Plaza Fax: (714) 647.8954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 '.. <br />Ct. maTou, <br />r)p- <br />YE81iHo YES <br />29AIT'�5 <br />JUNE 20, 2017 <br />$1,200 <br />Revised 01/0512017 <br />