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City of Santa Ana <br />° Donation Request <br />�iNamo: Jenny Rios _. ....... <br />l <br />Acidraes; 505 E. Central Ave. <br />;city, state, zip: I Santa Ana,CA 82707 <br />�Emau: ijennyrios@delhlcenter.org <br />_ <br />Narna: Delhi Center <br />City Manager's Office — M41 <br />20 Civic Center Plaza <br />P.O. Box 1900 <br />Santa Ana, CA 92702 <br />(714) 647.5200 <br />�ftde: CEO <br />jP ho ne: 1714-481-9601 <br />Fax: 714-481-9698 <br />._ ... __.. _. .._ _ __.. _. . e I _ __.. <br />Exempt Status: is your argenizailon a non•pro6t or public tax•exempi organization as elect One: ' <br />Id under Seollon 661(c)(3) of the Internal Revenue Code? 1 ® yes ❑ No <br />You will only quality for a credit for Ci related costs for our request l e. permit fees,-��''r`r (—'�ryry— <br />Y yq h'- Y ic L n X952620952 <br />Ime, rental rates for facilities orequipment etc.).Costs for City services vary and N <br />wed, credit may or may not cover full cast of requested City services, ax ID #; <br />CServideacratit <br />tuntRequested: <br />I <br />�(6 <br />fDale Needed: <br />I Fax: (714) 647.6964 <br />(Mayor/Councilmember: •`J (�Y115'1l�Vl)i-c) <br />Direct Payment Amount <br />Requested. <br />I$ ®QQ <br />' <br />(Event Date: <br />I11 <br />(.lune 26-30 2� (Evont Time: I M -F 7:30 el1'i - 5:30 p111 <br />+ <br />Event Location: <br />Delhi Center 505 E, Central Ave. Santa Ana CA 92707 <br />(Address, City, Stara, Zip <br />ISummar <br />I <br />Day Camp: Funds will cover the cost of one week of Summer Day Camp offering challenging enrichment and cultural <br />{Description of <br />an lessons for children ages 6.15 including classes in singing, acting, musical theater, hip hop, breakdance, popping, ballet <br />I <br />Event I purpose: <br />t,Ikiorico. and art, and preparation for an end-of�summer extravaganza, which will Include a musical theater rendition of a <br />� <br />popular movie, an art gallery, a math and science fair, and a video presentation. <br />(lura' <br />Summer Day Camp will enrich the Santa Ana community by engaging young people in the arts and STEM activihea by providing them Vill a <br />Community Benefit: <br />variety of classes to give them maximum exposure to math and science as well as to different visual and performing artistic genres to help <br />them develop a longterm passlon and commitment to the ane and to math and science. The project will also serve as a vehicle to celebrate <br />I�mmenily. <br />an Share le accomplishments of the students with their families and the co <br />Applicant Signature: <br />` 4 <br />n..w ;Date: i� �r���41ITr <br />Mail: City Manager's off- lcu—M•31 <br />(Email: donatimlroquaat(Qeanta-ano.org <br />20 Civic Center Plaza <br />I Fax: (714) 647.6964 <br />Ro, Dox 1906 <br />I Santa Ana, CA 92702 <br />i <br />cE <br />l Donation requom DR - <br />6FaJoeenA�l'on ea ralataR Dr'J• <br />:oufi AeflYgDate, <br />2-0-3_ <br />Eiiginilly Vat; TC51 _l \\�"l% <br />ApP ntluti imwnll <br />� <br />Cily 0.lanagsr sig,wtum <br />(lura' <br />Revised 0110512017 <br />2 AT8 <br />