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ti ?. <br />City of Santa Ana <br />Donation Request <br />,contact Information'(Y --- <br />City Manager's Office- M-31 <br />20 Civic Center -Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 647-5200 <br />Name: Jenny Rios itle: CEO <br />� ddras� s: <br />505 E. Central Ave. <br />city, state, zip.- <br />Santa Ana,CA 82707 IPhoi a: <br />714-481-9601 <br />Email: <br />jennyrios@delhicenter.org IFa� x: <br />714481-9698 <br />Nama: Delhi Center <br />Tax -Exempt Status: Is your organization a non-profit or <br />lefined under Section 501(c)(3) of the Internal Revenue I <br />as IS elect One: I ❑ 11Yes No <br />will only qualify fora credit for City -related costs for yourrequest (i.e. permit tees,ItU Yes <br />ID #: <br />rental rates for facf7ities or equipment,etc.).Costs for City services vary and if I 852620952 <br />credit may ormay not cover full cost of requested City services. IT <br />©onatlon R:rcj <br />IC'rty Services asested: Date Needed: 11-30-17 7llayorlCou <br />Requested: <br />Sarmiento <br />oSer <br />Council rAeeting Date: <br />Direct Payment Amount 1,000 I Event Date: 8Even <br />/1/17-6/30/18 t Time: M -F 2:30-8:30 pm <br />Requested: Y <br />YES 1 NO YES <br />Approved Amount: <br />Event Location: <br />Central Ave. <br />Address, City, State, Zip <br />F505 <br />Ana, CA 92707 <br />in Learning andLeadership is a gang prevention program that uses leadership development, internships, and <br />Description of <br />Feemngaged <br />ity service to train teens to overcome risk factors for gang Involvement and to develop skills to help them succeed. <br />Event i Purpose: <br />nts will complete 30 hours of classroom training, 80 hours of internship work, and 100 hours of volunteer service and <br />ve a $500 scholarship for completing all requirements. <br />Community Benefit: <br />Participants, ages 1419 will gain job training and experience by assisting with the implementation of programs and services offered at Delhi <br />Center. Teens will be exposed to a variety of work-related tasks and skills and will make a meaningful contribution to the community through <br />their service, A total o/ 22 teens will be served from throughout Santa Ana and $2,500 will cover the cost of a scholarship for 5 or the 13 <br />teens who live in Ward 1. <br />Applicant Slgnature: <br />Date:/qU <br />—J <br />USt 7, 2017 <br />Mail: City Manager's Office -M-31 Email: donationrequest@santaana.org <br />20 Civic Center Plaza Fax: (714) 647.6964 <br />P.O. Box 1986 <br />Santa Ana, CA 92702 <br />Revised 01/05/2017 <br />EXHIBIT 5 <br />29A-13 <br />Donation P.11rt#: <br />Reference q on all related DPVs <br />DR • <br />Council rAeeting Date: <br />NOVEMBER 7, 2017 <br />Eligibility Mot: <br />YES 1 NO YES <br />Approved Amount: <br />$1,000 <br />City Manager Signature: <br />Dale: <br />Revised 01/05/2017 <br />EXHIBIT 5 <br />29A-13 <br />