City of Los Angeles, Department of Neighborhood Empowerment
Neighborhood Council Funding Program
APPLICATION for Neighborhood Purposes Grant (NPG)
This form is to be completed by the applicant seeking the Neighborhood Purposes Grant and submitted to the
Neighborhood Council from whom the grant is being sought. All applications for grants must be reviewed and approved in
a public meeting.The Neighborhood Council, upon approval of the application, shall submit the approved application along
with all required documentation to the Department of Neighborhood Empowerment.
Name of Neighborhood Council you are seeking the grant from:
Palms
Neighborhood Council Name
SECTION I- APPLICANT VERIFICATION INFORMATION
Community Partners/Wildwoods Foundation 95–4302067
1A) Organization Name
1B)
1C)
1D)
Federal I.D. # (EIN#)
1000 N. Alameda St., Suite 240 Los Angeles
1995
CA
Date of 501(c)(3)
Status (if applicable)
90012
Organization Mailing Address
City
State
Zip Code
Business Address (If different)
City
State
Zip Code
Address of Affiliated Organization (If applicable)
City
State
Zip Code
Name and address of person designated to receive official/legal notices:
2)
CA
State of Incorporation
1000 N. Alameda St., Suite 240 Los Angeles
Street
City
Name:
Paul Vandeventer
CA
State
90012
Zip Code
3) Type of Organization- Please select one: (Organizations must be located within the City of Los
X 501(c)(3) Non-profits (other than religious institutions)
Public School (not to include private schools)
or
Attach Letterhead
Attach IRS Determination Letter
SECTION II - PROJECT DESCRIPTION
Angeles)
4) Please describe the Neighborhood Improvement Project for which the grant is intended.
Oakgrove is a student-led human relations retreat originally founded in 1972 by a teacher at
Venice High School to address race relations on campus. In the years since, Oakgrove has
continually evolved to reflect issues faced by today’s students. Held at the end of each
semester, the off-campus weekend retreat at a camp in the mountains provides students a forum
and peer support to address those issues. Entirely volunteer driven, the Oakgrove retreat is
organized and conducted by a Council of 12 – 15 students with help from program alumni. We
expect between 50 – 80 students will participate in the retreat. A Neighborhood Purpose Grant
will allow us to increase campus outreach and build diversity of program participants by
providing 10 full scholarships to economically challenged students.
5) How will this grant be used to primarily support or serve a non-discriminatory, public purpose and benefit the
public at-large.
The Oakgrove retreat is open to any student at Marshall High School. The initial benefits of
the Oakgrove program are the improved social environment and student relations realized on
the campus as a sense of community is developed among the diverse population of the student
body. The retreat activities serve to develop stronger communication, teamwork and
leadership skills. The ripple effect of these benefits is felt in the community at-large as
students become more civically engaged. Often, Oakgrove students launch community service
projects as a result of their participation in the program. Several alumni have made social
work and human relations their careers.
City of Los Angeles, Department of Neighborhood Empowerment
NPG APPLICATION Page 2
SECTION III - PROJECT BUDGET OUTLINE- Please outline the project budget below.
6A) Personnel Related Expenses
Program Coordinator
6B)
T
e Expenses
Non-Personnel Related
xt
Camp Rental
Transportation
Administrative Fee
Requested of NC
$
$
$
$
Total Projected Cost
$
2,500
$
$
$
Requested of NC
Total Projected Cost
$
$
$
$
$
$
1000
750
$
$
17,000
4,000
3,998
7) Is the implementation of this specific program or purpose described in box 4 above contingent on any other
factors or sources or funding?
✓
Yes, please describe below
Source of Funding
No
Amount
$
17,500
$
$
$
Participant Fees
8) What is the TOTAL amount of the grant funding requested with this application:
Total Projected Cost
$
$
$
$
$ 1750
6 /10 / 2016 (mm/dd/yyyy) (required)
Te
SECTION IV - PROJECT PRIMARY AND SECONDARY
CONTACT INFORMATION
Teaddress (if applicable) of the person(s) responsible for
Provide the name, telephone number, fax xt
and e-mail
the funds and program(s) listed in Section II of thisxt
application.
9) What is the expected completion date?
Dwain
Wilson
10A) First Name
213–989–1955
Telephone Number
Last Name
213–947–1956
Fax Number
10B) First Name
Telephone Number
MI
[email protected]
E-mail
Last Name
Fax Number
MI
E-mail
SECTION VI - AFFILIATIONS
11) Does anyone in your organization have a former or existing relationship with any of the NC board members?
Name of Organization
Status
Example: XYZ Non-profit Corporation
Executive Director