HomeMy WebLinkAboutSelf IdentificationThis form must he
turned in as a trrrt of
the approval process.
Data Collected for August 2009 Reporting
Zn
Self Identificafion
Please fill in the information requested below and return this form to your
program representative. The SFSP fax dumber is (850) 245-9276.
Shaded areas are text boxes
Sponsor # 04-0899
Sponsor Full Legal Name* city of Miami Department of Parks and Recreation
Sponsor City Miami, Florida 33130
* Provide the full legal name. Do not use abbrevia*cons or acronyms.
OriZa>lniizatiioanal TyjDe (check oue below)
❑ SEC- Non -Profit Organization (Se-cular)
❑ FBO- Non -Profit Organization (Faith -Based)
❑ EDU- Educational institution
❑ GOV- State or Local Government
❑ OTH- Other
Program Representative (check one below)
❑ Donna Salyers Region 1
❑ Wendy Rude Region 2
❑ Lisbeth Rytlewslci Region 3
❑ Lori Ciszak Region 4
❑ Awilda Font Region 5
❑ Craig Clemmer Region 6
❑ Lisa Rodriguez Region 7
❑ Brenda Delde Region 8