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.' City Of Santa Ana City Manager's20Civic Center <br />20 Civic Center Plaza <br />'••~• <br />Donation Request - P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 647-5200 <br />Nama: <br />Roman Reyna/ Mario Rodriguez <br />Fills: Lead Advisor <br />ddrass: <br />PO Box 194 <br />mount Requested: <br />Ree <br />ity, state, zip: <br />San Clemente, CA 92674 <br />Phone: (714) 865-9118 <br />man: <br />mrod262@yahoo.com or roman _reyna@hotmail.com <br />q Event Date: <br />500— Fort going <br />Fax: <br />— <br />IName: I Hispanic 100 Foundation <br />iptStatus: Is your organization a non-profit or public tax-exempt organization as <br />der Section 501(c)(3) of the Internal Revenue Code? <br />will only qualify for a credit for City -related costs for your request (i.e. permit fees,, <br />rental rates for facilities or equipment, etc.). Costs for Cily services vary and if <br />credit may or may not cover full cost of requested City services. <br />One: I F7 Yes ❑ No <br />Yes, <br />rx ID #: 46-1962620 <br />DonafiontRbquesY <br />Credit <br />Ity Sermount <br />F <br />Date Needed: <br />ASAP <br />ayorlCouncilmember. S � <br />mount Requested: <br />Ree <br />YES! NO YES <br />Approved Amount: <br />$500 <br />W1KXijV <br />Direct Payment Amount <br />q Event Date: <br />500— Fort going <br />f -----� <br />Event Time: <br />— <br />Requested: <br />Event Location: <br />will help cover on-going cost for the youth program, but will specifically cover <br />Fthecost <br />Address, City, State, Zip <br />of conferences to prepyouth for legislation training in Nov., Jan., and Febr. <br />Many Santa Ana youth will participate in the Youth & Government Program and <br />Description of <br />activities that include training on how to create a bill and help it pass. There are three <br />Event I Purpose: <br />upcoming conferences that will train youth and hlep them launch the bills. <br />Santa Ana youth will become empowered by the education, leadership skills, that t ey <br />community Benefit: <br />will learn from the YOuth & Government Program. This will also provide insight on <br />networking, self-esteem, and public speaking skills. <br />FPca Signature, ,, <br />tttle�gi��sl�atio <br />., � <br />ate--..._ <br />11/6(17 <br />/� <br />I <br />Mall: City Manager's Office—M-31 Email: donationrequest@santa-ana.org <br />20 Civic Center Plaza Fax: (714) 647.6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Revised 01/05/2017 <br />Donation Request M <br />Reference 4 on all related DPYs <br />DR. <br />Council Meeting Date: <br />December 19, 2017 <br />Eligibility Met: <br />YES! NO YES <br />Approved Amount: <br />$500 <br />City Manager Signature: <br />_ <br />Dale: <br />Revised 01/05/2017 <br />