HomeMy WebLinkAboutExhibit ACity of Miami
Anti -Poverty Initiative Program
Funding Request Form
CONTACT INFORMATION:
Contact Person: Nathaniel J. Wilcox
Title: Executive Director
Phone number: (786) 488-2979
Email Address: nwilcox2@gmail.com
Name of Person completing this form: Nathaniel J. Wilcox
Legal Name of Organization: People United To Lead the Struggle for Equality
Address (Street, City, State, Zip Code):
150 N.E. 19th Street
Miami, Florida 33132
Executive Director of Organization: Nathaniel J. Wilcox
Executive Director email: NWIIcox2@gmail.corn
Executive Director Contact Phone Number: (786) 488-2979
The organization is a registered and active State of Florida Corporation (select one):
For -profit organization
Not -for profit organization {501(3)(c)}
Local governmental unit
State governmental unit
Educational and academic institution
City of Miami department, agency and board
Return this form to: mtrevino@miamigov.com
Last revised: September 16, 2019
City of Miami
Anti -Poverty Initiative Program
Funding Request Form
ORGANIZATION AND PROGRAM/PROJECT INFORMATION
Organization History and Background Information:
City of Miami Mayor, Francis Suarez came together with leaders of
PULSE to help to address the leadership crisis in the Black community.
Pastors, teachers and community leaders worked together to identify
25 young people that would be taught leadership skills.
Is your program/project providing direct services to residents of the City of Miami? Yes0Nofl
Number of residents your entity will serve:
Frequency of Service:
Age Group Served:
25
2 per month
13-18
Is your program/project impacting one of Miami's disadvantaged communities? Yes fNo n
Geographic Area Served (specific to this project/program)
District Served (1, 2, 3, 4, 5, Citywide) District 5
Neighborhood/Community being served: Liberty City
Program/Project Priority area (Select one):
✓ Educational Programs for children, youth and adults
Crime Prevention
Elderly meals, transportation, recreational and health/wellness related activities
At -risk youth or youth summer job programs
nTransportation services and programs
Job development, retention and training programs
Homeless Services
Return this form to: mtrevino@miamigov.com
Last revised: September 16, 2019
City of Miami
Anti -Poverty Initiative Program - Funding Request Form
Program/Project Title: P.U.L.S.E. Youth Leadership Academy
Project/Program Description:
Teach young people effective leadership principles necessary to
enable them to take proactive roles In improving their community
via learning the political process and engaging in it.
Program Start Date: January 25
Program End Date: April 25
Please describe how this program/project and funding will alleviate poverty within the City of
Miami?
The program will alleviate poverty by addressing issues related to teen violence, delinquency, youth apathy and
employment issues, by working toward solutions that can only be
addressed by teaching young people leadership skills.
IMPACT AND PERFORMANCE:
Describe overall expected outcomes and performance measures for this project/program:
The expectation is that the youth will continue to involve themselves
with community issues and become mentors to other youth. This will be
measured by how many volunteer their services to future academies
using our participant roster list.
Please attach additional pages to the back ()Phis packet, if the space above is not sufficient.
Return this form to: mtrevino@miamigov.com
Last revised: September 16, 2019
City of Miami
Anti -Poverty Initiative Program - Funding Request Form
FUNDING REQUEST INFORMATION:
Amount Requested: $ 15,000
Explain how the City of Miami Anti -Poverty funding will be utilized:
The funding will be used primarily to benefit the youth. They will
receive a stipend for each date they attend and fulfill the requirements
for participation. Supplies and salaries are also included.
Itemize API funding related to expenditures below:
Personnel Salaries & Wages: $ 4,000
Personnel Benefits $
Space Rental: $Donated
Utilities (Electricity, Phone, Internet): $
Supplies: $1,400
Marketing: $ 150
Transportation (Participants): $ 300
Meals (Participants): $ 2,000
Professional Services (List each):
Other (please describe):
Other (please describe):
Other (please describe):
Speakers $1,000
Stipends $6,150
Return this form to: mtrevino@miamigov.com
Last revised: September 16, 2019
City of Miami
Anti -Poverty Initiative Program
Funding Request Form
To be completed by the Entity/Recipient
ay signing below you agree to the guidelines and stipulate that the information provided on this form is
accurate and complete.
Completed by (Print & Sign): Nathaniel Wilcox
Date: Nov. 27, 2020
Additional Comments:
The program has been operational for three years and we are looking for-
ward to continued growth and transforming youth in the community.
7o be completed by District Commissioner/Mayor's Office
Recommended for funding: Yes4No❑
Funding Recommendation: IS f 000
Commission Meeting Date: u Co r� 2-0 W
Additional Comments:
co(Mw�NsiOvn viiveefk�r,�
Completed by (Pri t& Sign).
Date: �2! 4- L l
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(}dswt4�
To be completed by the Department
Caf
deceived by (Print&Sign): fl y '� 3�7 T 1,.-1-1c aAJLi
Date: f 17;
Additional Comments:
Return this form to: mtrevino@miamigov.corr
Last revised: September 16, 2019
Page 5 of 5
P.U.L.S.E. YOUTH LEADERSHIP ACADEMY
"PREPARING FUTURE LEADERS"
THE P.U.L.S.E. ORGANIZATION WOULD LIKE TO
THANK MAYOR FRANCIS SUAREZ FOR HIS SUP-
PORT AND HELP TO THE P.U.L.S.E. YOUTH
LEADERSHIP ACADEMY 2017-201 S.