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City of Santa Ana <br />Donation Request <br />Name: _ Roman Reynal Mario Rodi <br />Address: pp Fox 194 <br />City, sesta, ztp: I San Clemente, CA 92674 <br />inrod262@yahoo.com or <br />Name: , Hispanic 100 Foundation <br />City Manager's Office— U-31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 9,2702 <br />(714) 647.6200 <br />Lead <br />(714)865-9118 <br />Sax-Exompt 9W#ua: Is your organtzatlon a norE-praftt or public tax-exempt organ/ _fF0n as efact Ona: f �� ❑ <br />9efined under Sectlon 501(c)(3) o1 the Internal Revenue Code? , Yea [f <br />No <br />No, you will only qualify for a credit for City -related costs for yourrequest (f. e. permit fees, } Yom"""""'""" <br />;tall time, rental rates forfactlities or equipment, eto.).Costs for City services vary and if <br />approved, credit may or may not cover full cost of requested C@y services. �faxl1 46-1962620 <br />9s • a <br />City Services Credit <br />Date Needed-'- <br />1SAp,MayorlGounuilmembar., S <br />rNmount Requested: I r ( , <br />Requested: 200 Event Date: on-going vantTime: on-going <br />I <br />vent Locaticm Funds will help cover on-going cost for the youth program, but will epeeiftcally c&ver <br />Address, City, ware,the cost of conferencesto prep youth for legislation training in Nov., Jan., and Fehr. <br />Many Santa Ana youth will participate in the Youth & Government Program and <br />Event/ of <br />Event/ Puractivities that including training on how to create a bill and help pass it. There are <br />I <br />three upcoming conferences that will train youth and help them launch bills. <br />Santa Ana youth will become empowered by the education, trailing, and leadersnlp <br />Community Benefit: skills, that they will earn from the Youth & Government Program. 'Phis will also <br />provide,insight on legislation, networking, self-esteem, and publick speaking skills. <br />[AppnaantSignaturd iDafa 1116117, ._ <br />• • s <br />city Manager's office — M-31 <br />20 Civic Center Plaza <br />P.O. Box 1989 <br />Santa Ana, CA 92702 <br />Email: donationreques%santa-ana.org <br />Fax: (714) 647-6964 <br />Donation Request r;R: OR • ._ . _.. December 19, 2017 <br />,. .., .._. I council Meeting Date I <br />Owbilityi clot _ _...., Yes r NO YES Approved Amount: <br />—.. _ <br />I <br />LKy lWanagar Signature: � Cats <br />Ge__ _. ___ ...__. _ _ILD <br />;200 <br />Revised 01/05/2017 <br />