YOUTH EMPOWERMENT SERVICE GRANT

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Project Name: COVERSHEET Group Name: 1

Project Information Required Your Contact Information (Please List One Main Contact Person) Your Name: Age: Email Contact: Phone Number: Address: Sponsoring Organization Information Non-profit, School, Faith-Based Organization, Neighborhood Associations or Government Program (must be located within Pasadena city limits and/or PUSD-District) Project Checklist Use this checklist as you complete tasks. Please make sure all of the boxes are checked before you submit your grant application. Thanks! YOUR CHECKLIST Have your coversheet completed with all of the needed information. The Project Information section (left side of this paper) is completely filled out. All 6 Application Questions are answered. I have reviewed my Budget Worksheet and everything I talked about in my project is included in the budget. Name of Organization: Federal Tax ID Number (if applicable): Adult Partner at Sponsoring Organization: Phone: Email: Address: Please list the names, ages, and schools** of ALL the youth who are involved in planning your project and/or writing the grant: **School eligibility: Within your team, one team member is required to attend a Pasadena public school and one member is required to attend Pasadena private school. One team member has attended the Mandatory Information Meeting. (see page 5; under Dates to Remember) School Requirement: Within your team, one team member attends a Pasadena public school and one team member attends a Pasadena private school. SPONSORING ORGANIZATION CHECKLIST I have included a letter of support from my sponsoring organization. TURN IT IN Online Only Via Email at youthcouncil@cityofpasadena.net To be eligible submit completed Application by the deadline: December 5, 2017 2

Application Questions (See page 5 for eligible projects, maximum funding, and dates to remember) 1. Tell us about the organizers of your project. How do you know each other (friends, school, neighborhood, youth group, organization)? We want to know what makes your group unique and how that will help make your project a success. 2. What other youth, youth groups, or organizations do you plan to involve and why? 3. What is the goal of your project? What are you hoping to accomplish? 4. How will you make your project happen? What are the specific action steps you will take to accomplish your project? 5. Where will the project happen? When will it happen (include a timeline)? Please note: Your project must take place in the City of Pasadena and/or PUSD district. 6. How will you know if your project was a success? Is there a way of showing how your project has changed Pasadena for the better? Tell us how you will prove youth got something out of your project. Some ideas might include a survey, evaluation, video, audio, pictures, etc. 3

BUDGET WORKSHEET Please do the math on this budget worksheet so that we know how much your project will cost and what you are asking to pay for with this grant. Also include any donations you hope to get. This could include donations of money, food or other materials. Make sure everything that you are proposing to do is accounted for in your budget. Please remember the grant does not pay for labor. Thank you! What Will You Need How Much Will it Cost Other Places That Will Donate for This Team Amount You Want from The Grant for This item Example: Balloons $10 Will get coupons for $3 off $7 Totals Add this column and put the total here. Add this column and put the total here. Add this column and put the total here. 4

Eligible Projects Grant Amount Capital projects (i.e., physical projects) Create a mural Start a community garden Clean up and landscape a vacant lot Other capital projects Maximum grant amount of $1000 will be awarded to cover; Materials and/or supplies Labor is not included Non-Eligible Projects Dates to Remember Advocacy Events Fundraising Application open: November 6 December 5, 2017 Application deadline: December 5, 2017 o Submit online at youthcouncil@cityofpasadena.net Award Announcement: December 7, 2017 o Via email Project Completion Deadline: March 30, 2018 5

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