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
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