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City of Santa Ana <br />i <br />Donation Request <br />City Manager's Office- M-31 <br />20 Civic Center Plaza <br />P.O. Box 9988 <br />Santa Ana, CA 92702 <br />(794) 8475200 <br />Name: Jenny Rios <br />�ddross: 505 E. Central Ave. - - <br />(city, state, zip: Santa Arl 82707 Phone: 1714-481-9601 <br />Email: jjennyrios@delhicenter.org Tax: 714-481-9698 <br />Name: (Delhi Center <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as mlect One: <br />lefined under Section 501(c)(3) of the Internal Revenue Code? <br />If No, you will only qualify for a credit for City -related costs for your request (i.e. permit fees, f Yes, <br />mail time, rental rates for facilities or equipment, etc.). Costs for City services vary and if ff Yos <br />tpproved, credit may or may not cover full cost of requested City services. If <br />to #: <br />City Services Credit <br />mount Requested: <br />Direot payment Amount B 1,000 <br />Requested: --.---- ----- <br />Needed: 111-30-17 <br />Date: 18/1/17-6/30/18 (Eventrime: <br />® Yes ❑ No <br />952620952 <br />Event !notation: <br />i 505 E. Central Ave. <br />Address, City, State, Zip <br />Santa Ana, CA 92707 <br />Teens Engaged in Leaming and Leadership is a gang prevention program that uses leadership development, internships, and <br />Description of <br />community service to train teens to overcome risk factors for gang Involvement and to develop skills to help them succeed. <br />Event I Purpose: <br />Participants will complete 30 hours of classroom training, 80 hours of internship work, and 100 hours of volunteer service and <br />will receive a $500 scholarship for completing all requirements. <br />Pe4icipants ages _t -4._.__a -wl..ga.i.n.l.a_b— tra_n.—g a_nd —expe—ctanc_e..by asis-ttingg-w_ih _the- i_m_pla—a-n_ta_tlon of programs and services oHared et Delhi <br />Community Bmnmfit: <br />Center. Teens will be exposed to a variety of work-reirsed tasks and skills and will make a meaningful contribution to the community through <br />their service. A total of 22 teens will he served from throughout Santa Ana and $2,500 will cover the cost of a scholarship for 5 of the 13 <br />teens who live in Ward 1. <br />cant Slgnatare:,� �x ��_ Date: �p141(,�USt 7, 2017 <br />Mail: City Manager's Office -M-31 (Email: donationroquest@santa-ana.org <br />20 Civic Center Plaza Fax: (714) 647.8954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request 9: DR INOVEMBER 7 2017 <br />1 Council Meeting Date: , <br />RvYnrence # r,r, 4+i rela¢ed LJPVs � ' 1 <br />_ -.. .. r.. ..... _. _.. .._ .. ... _.. .. _. .. __... <br />Eligibility Mat; YES t NO YES Approved Amount: <br />$1,000 <br />City Manager Signature- - Dante: <br />Revised 0110512017 <br />EXHIBIT 5 <br />