HomeMy WebLinkAboutBack-Up DocumentsCity of Miami
Anti -Poverty Initiative Program
Funding Request Form
CONTACT INFORMATION:
Contact Person: IA- r 7 /- v� -(0.
Title: V i t e. �;!� �i .'l��ii✓`
Phone number: 7� � 4 �7 - /7 0Z
Email Address:
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Name of Person completing this form:
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Legal Name of Organization: / a f'� //c) / // 'A`cca A ' -.7 i/c) ",C c. 4 Get e.--
Address (Street, City, State, Zip Code):
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Executive Director of Organization: Lc t 11; yv 7--e
Executive Director email: L 4 - et -lt- h e � D-e e&e>cc 7L�i •
Executive Director Contact Phone Number: ,C2 � — (� `y — / 7 2
The organization is a registered and active State of Florida Corporation (select one):
For -profit organization
INot-for profit organization {501(3)(c)}
Local governmental unit
State governmental unit
riEducational and academic institution
nCity of Miami department, agency and board
Page 1 of 5
Return this form to: mtrevino@miamigov.com
Last revised June 6, 2019
City of Miami
Anti -Poverty Initiative Program
Funding Request Form
ORGANIZATION AND PROGRAM/PROJECT INFORMATION
Organization History and Background Information:
We have been in existence since 1980s, and we have helped our community
and political prisoners since then. We also shelter elderly residents that would
otherwise be homeless.
Is your program/project providing direct services to residents of the City of Miami? Yes❑✓ No❑
Number of residents your entity will serve:
Frequency of Service:
Age Group Served:
5
year around
70 and up
Is your program/project impacting one of Miami's disadvantaged communities? Yes ✓❑No n
Geographic Area Served (specific to this project/program)
District Served (1, 2, 3, 4, 5, Citywide) 3
Neighborhood/Community being served:
Program/Project Priority area (Select one):
nE• ducational Programs for children, youth and adults
nC• rime Prevention
nE• lderly meals, transportation, recreational and health/wellness related activities
nA• t -risk youth or youth summer job programs
nT• ransportation services and programs
nJob development, retention and training programs
nH• omeless Services
Page 2 of 5
Return this form to: mtrevino@miamigov.com
Last revised August 28, 2019
City of Miami
Anti -Poverty Initiative Program - Funding Request Form
Program/Project Title: Housing repair/upgrade for elderly
We own a property that provides housing facility to the elderly that would otherwise be homeless.
Project/Program Description:
We need to upkeep the property, and we need help with expenses related to the housing facility to ensure comfortable and safe living conditions for the residents.
We have to perform a number of maintenance related activities (paint, A/C, and repair of fixtures).
We also need to repair the physical structure to allow for a safe housing facility (roof and painting of common areas).
Program Start Date: 10/1/19 Program End Date: 10/1/20
Please describe how this program/project and funding will alleviate poverty within the City of
Miami?
We need the support from the City to help our elderly residents that live in our housing facility that would otherwise be homeless.
We also assist members to ensure that they have a healthy environmental by providing safe shelter.
IMPACT AND PERFORMANCE:
Describe overall expected outcomes and performance measures for this project/program:
The facility that elderly residents live will be upgrade and will continue to provide safe shelter to the elderly residents.
Please attach additional pages to the back of this packet, if the space above is not sufficient.
Return this form to: mtrevino@miamigov.com
Last revised June 6, 2019
City of Miami
Anti -Poverty Initiative Program - Funding Request Form
FUNDING REQUEST INFORMATION:
Amount Requested: $ $10,000.00
Explain how the City of Miami Anti -Poverty funding will be utilized:
We will use the funds to improve our physical location and member services we provide.
Itemize API funding related to expenditures below:
Personnel Salaries & Wages: $
Personnel Benefits $
Space: $
Utilities (Electricity, Phone, Internet): $
Supplies: $
Marketing: $
Transportation (Participants): $
Meals (Participants): $
Professional Services (List each):
Other (please describe): 10,000.00
Other (please describe):
Other (please describe):
housing repair/upgrade such
as AC and painting
Return this form to: mtrevino@miamigov.com
Last revised June 6, 2019
City of Miami
Anti -Poverty Initiative Program
Funding Request Form
To be completed by the Entity/Recipient
By signing below you agree to the guidelines and stipulate that the information provided on this form is
accurate and complete.
Completed by (Print & Sign): t(446
Date: / / / /
Additional Comments:,/,
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To be completed by District Commissioner/Mayor's Office
Recommended for funding: YesP Non
Funding Recommendation:
Commission Meeting Date:
Additional Comments:
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Completed b
Date:
(Print & Sign):
To be completed by the Department
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Received by (Print & Sign): } 7 (,' j (�1 =4/11i
Date:
Additional Comments:
Page 5 of 5
Return this form to: mtrevino@miamigov.com
Last revised June 6, 2019