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Roman Reyna / Mario Rodriguez (CEO)Itis: ( Lead Advisor
<br />asa: _ PO Box 194
<br />Stara, zip: FSan Clemente, CA 9".-___....___-,.____.._-._.._.-._..__._._-
<br />2674 phone: (714) 865-9118
<br />aho_._..m__r..e Y a.@__o
<br />ro_62@yotm__ai._l.
<br />._._...._._.�_. ....___
<br />Name: Hispanic 100 Foundation ,
<br />Tax•Exeri Status: Is your organization a non-profit or public tax-exempt organization as I
<br />defined under Section 501(c)(3) of the Internet Revenue Code? r elect One: Yes ❑ No
<br />If Na, you will only qualify for a credit for City -related costs for your request (t.e, parrntt fees,
<br />staff time, rental rates for faollities orequipment, etc.).Costs for City services vary and if Yes,
<br />`approved, credit may or may not cover full cost of requested City services, ax to #: 46-1962620
<br />DOs r
<br />___....__l___V....___......................�.._ _ _ _ .__.__-_-___...
<br />City Services CredVt �-
<br />,Amount Requested: aro Needed: ASAP Imayor/Counoiimember: ,e¢�
<br />Re pasted: � �.��__ ��_.__�
<br />._.._...._.._..._.�......._._.___ ._.__._...,._._.r ... .I ..__...__..,.__.._..„....._ _
<br />Direct payment Amount vont Date: !Event Time:
<br />q 1 On -Going On -Going
<br />Event Location: Funds will help cover on-going cost for the youth program, but will specifically cover
<br />adress, city, scale, Zip the cost of conferences to prep youth for legislation training in Nov., Jan, and Fehr.
<br />Many Santa Ana youth will participate in the Youth & Government program/activites
<br />Description of
<br />Event/ Purpose; that include training on how to create a bill and help it pass. There are three
<br />upcoming conferences that will train youth and help them launch the bills.
<br />�._.w_. ........_._.,_,._. - ._..--_.._..... _ _ ...__..._._._ ,
<br />Santa Ana youth will become empowered by the education, training, ani leadership skit
<br />Community Benefit that they will learn from the Youth & Government Program. This will also provide
<br />insight o g station, networking, self-esteem and public speaking skills
<br />Applicant Signature: ✓ .. _. ,�".. -. _ Data ... - 11/6/17
<br />...... .. ..
<br />'Matt: Cifij t9anagor'a Ofilea-flA-B9��_ W �.. µ.--�� �_ y .Email: donaloonrequsstt-santa-anaorg
<br />20 Civic Center Plaza Fax: (714) 647.6964
<br />13.0. Box 1956
<br />Santa Ana, CA 92702
<br />Donatlon Request DR ,.. _. -: .. _. .... . ........
<br />i Councl? 6298t3ng oats December 19, 2017
<br />VNib902y Olaf YESi No YES Approved Amount: $1,500
<br />i_g
<br />Ci pAariaeY S naturo. i
<br />Darte
<br />Revised 01/05/2017
<br />-•,.. Cit of Santa A
<br />,� anAna
<br />city Managers OPflce-M-31
<br />20 Civic Center Plaza
<br />7 .. T. Donation Request
<br />P.O Box 1990
<br />Santa Ana,
<br />CA 92702
<br />--
<br />(714) 647.3200
<br />Roman Reyna / Mario Rodriguez (CEO)Itis: ( Lead Advisor
<br />asa: _ PO Box 194
<br />Stara, zip: FSan Clemente, CA 9".-___....___-,.____.._-._.._.-._..__._._-
<br />2674 phone: (714) 865-9118
<br />aho_._..m__r..e Y a.@__o
<br />ro_62@yotm__ai._l.
<br />._._...._._.�_. ....___
<br />Name: Hispanic 100 Foundation ,
<br />Tax•Exeri Status: Is your organization a non-profit or public tax-exempt organization as I
<br />defined under Section 501(c)(3) of the Internet Revenue Code? r elect One: Yes ❑ No
<br />If Na, you will only qualify for a credit for City -related costs for your request (t.e, parrntt fees,
<br />staff time, rental rates for faollities orequipment, etc.).Costs for City services vary and if Yes,
<br />`approved, credit may or may not cover full cost of requested City services, ax to #: 46-1962620
<br />DOs r
<br />___....__l___V....___......................�.._ _ _ _ .__.__-_-___...
<br />City Services CredVt �-
<br />,Amount Requested: aro Needed: ASAP Imayor/Counoiimember: ,e¢�
<br />Re pasted: � �.��__ ��_.__�
<br />._.._...._.._..._.�......._._.___ ._.__._...,._._.r ... .I ..__...__..,.__.._..„....._ _
<br />Direct payment Amount vont Date: !Event Time:
<br />q 1 On -Going On -Going
<br />Event Location: Funds will help cover on-going cost for the youth program, but will specifically cover
<br />adress, city, scale, Zip the cost of conferences to prep youth for legislation training in Nov., Jan, and Fehr.
<br />Many Santa Ana youth will participate in the Youth & Government program/activites
<br />Description of
<br />Event/ Purpose; that include training on how to create a bill and help it pass. There are three
<br />upcoming conferences that will train youth and help them launch the bills.
<br />�._.w_. ........_._.,_,._. - ._..--_.._..... _ _ ...__..._._._ ,
<br />Santa Ana youth will become empowered by the education, training, ani leadership skit
<br />Community Benefit that they will learn from the Youth & Government Program. This will also provide
<br />insight o g station, networking, self-esteem and public speaking skills
<br />Applicant Signature: ✓ .. _. ,�".. -. _ Data ... - 11/6/17
<br />...... .. ..
<br />'Matt: Cifij t9anagor'a Ofilea-flA-B9��_ W �.. µ.--�� �_ y .Email: donaloonrequsstt-santa-anaorg
<br />20 Civic Center Plaza Fax: (714) 647.6964
<br />13.0. Box 1956
<br />Santa Ana, CA 92702
<br />Donatlon Request DR ,.. _. -: .. _. .... . ........
<br />i Councl? 6298t3ng oats December 19, 2017
<br />VNib902y Olaf YESi No YES Approved Amount: $1,500
<br />i_g
<br />Ci pAariaeY S naturo. i
<br />Darte
<br />Revised 01/05/2017
<br />
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