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PROPOSER APPLICATION <br />Agency Legal Name <br />Orange County Children's Therapeutic Arts Center <br />Agency DBA <br />N/A <br />Program Name <br />Job Training for Youth with Disabilities, Foster Youth and High School Dropout Youth <br />Program Address <br />2215 N. Broadway, Santa Ana, CA 92706 <br />Corporate Office Address <br />2215 N. Broadway, Santa Ana, CA 92706 <br />Contact Person & Title <br />Dr. Ana Jimenez -Ham! <br />Email <br />ana @occtac.org <br />Telephone # <br />714 - 547 -5468 Ext. 107 <br />Fax # <br />714- 564 -9690 <br />Federal ID Number <br />33- 0930891 <br />Public Non -Profit <br />Private for Profit <br />X <br />AGENCY STATUS <br />Corporation I Private Non -Profit <br />Government I Other <br />Years in <br />13 <br />PRIMARY FUNDING SOURCES <br />Funding Source Grants Contracts I Donations Fundraising <br />Amount $250,000 <br />000 $130,000 1 $70,000 $50,000 <br />HOURS OF OPERATION AND nAYS <br />Days <br />Monday <br />I Tuesday <br />Wednesday <br />I Thursday. <br />Friday <br />I Saturday <br />Sunday <br />Hours <br />I 8:30- 8:30pm I <br />8:30- 8 :30pm <br />8:30- 8:30pm <br />8:30- 8:30pm <br />8:30- 8:30pm <br />I 8:30- 5:00pm <br />Closed <br />TARGET POPULATION <br />Older Youth 17 -21 1 Younger Youth 1 16 -21 1 Out -of- School 1 23 1 In- School 7 <br /># of Youth to be Served in 2013 -2014 25 1 Total WIA Funds Requested $180,000 <br />In compliance with the RFP noted above, and subject to the conditions thereof, the undersigned offers to furnish <br />the services stipulated and certifies he has read, understands, and agrees to all terms, conditions, and <br />requirements of this RFP and is authorized to contract on behalf of the agency named above. <br />Signature <br />_ Executive Director <br />Title <br />EXHIBIT A <br />25D -347 <br />Date <br />