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City Manager's OtTce—M-31 <br />City of Santa Ana 20 Civic Center Plaza <br />Donation Request P.O. Box 1988 <br />Santa Ana, CA 92762 <br />(714) 547.5200 <br />0 o e <br />ama: Roman Reyna/ Mario Rodriguez (CEO) tie: Lead Advisor <br />Fp0ess: <br />Box 194 <br />(City, State, San Clemente, CA 92674 none: (714) 865-9118 <br />or <br />Name: Hispanic 100 Foundation <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as oleo One: <br />defined under Section 501(c)(3) of the Internal Revenue Code? Z Yes ❑ No <br />If No, you will only qualify fora credit for City -related costs for yourrequest (i.e. permit fees, raylls <br />etaNtime, rental rate's for facilities of -equipment, etc.).Costs for City services vary and i(pproved, credit may" or may not cover full cost ofmquesfed City services. s#: 46-1962620 <br />.. <br />Dortafion Reque"s't m r. `r«"; t to S m ':$.�e tJ ` , -a _-"A-'" : e a ax7z•a l <br />Services <br />ICmIty Services Credit }� <br />Requested: <br />Date Needed: <br />I ayorlCouncilmember. <br />ASAPi k �Q <br />" Yt� 11aS <br />Direct Payment Amount �F200 `.Event Date: OIl-going Event Time: <br />on-going <br />$ <br />Requested: <br />g <br />Event Location: <br />Funds will help cover on-going cost for the youth program, but will specifically cover <br />Address, Ci(y, State, Zip <br />the cost of conferencesto prep youth for legislation training in Nov., Jan., and Fehr. <br />ny Santa Ana youth will participate in the Youth &Government Program and <br />Description o1 <br />ivities that including training on how to create a bill and help pass it. There are <br />ra <br />Event t Purpose: <br />ee upcoming conferences that will train youth and help them launch bills. <br />Santa Ana youth will become empowered by the education, training, and leadership <br />Community Benefit: <br />skills, that they will earn from the Youth & Government Program. This will also <br />providel insight on legislation, networking, self-esteem, and publick speaking skills. <br />ApplicantSignature: <br />r-- <br />I r7 Datl e: <br />F1 1/6/17 <br />,-.,m. -•wee 4`"--„v r»w-r a vsx. <br />`heturn;;cornpleteclforrn: yia, s:9�" �..�.�`t.°s"€3a �v. •. <br />Mall: City Managers Office—M41 Email: donationrequest@santa-ans.org <br />20 Civic Center Plaza Fax: (714) 647-6964 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />1 <br />Revised 01/05/2017 <br />Donation Request M <br />Rarerenca eon a0 reh:eC DPVs <br />DR. <br />Council Poiastipg Data: <br />December 19, 2017 <br />Eligibility Met: <br />YES! NO YES I Approved Amount: <br />$200 <br />City Manager Signature: <br />1 <br />Revised 01/05/2017 <br />