2015 AK-CHIN APPLICATION COVER SHEET - MCESA.PDF

Ak-Chin Indian Community Grant Application Cover Sheet
Date of Application: July 7, 2015
Name of City/Town/County/Non-Profit (circle one):
Mayor/Supervisor/Chairman/President: Chairman Steve Chucri
Contact Person and Title: Kristine Morris, Chief Deputy Superintendent
Applicant Address (administrative office): 4041 N. Central Ave, Suite 1200
City: Phoenix Zip Code: 85012
Applicant Mailing Address (if different):
City: Zip Code:
Phone Number: 602-506-3929 Fax Number: 602-506-3753
E-mail Address: kristine.morris@mcesa.maricopa.gov
If Non-Profit, Name of City/Town/County
With Which You Will Associate:
Contact Person: Amanda Nash
City/Town/County Mailing Address: 301 W. Jefferson, 10th Floor
City: Phoenix Zip Code: 85003
Phone Number: 602-506-4885 Fax Number:
E-mail Address: nasha001@mail.maricopa.gov
Program or Project Name: Opportunity Youth Initiative
Purpose of Grant (brief statement): Through this iniative we will harness the power of
cross-sector collaboration to create a comprehensive system of opportunity that re-engages
our Valley's disconnected youth, indiviudals 16-24 who are neither working nor attending
school.
Beginning and Ending Date of
Program or Project: November 2015 - October 2016
Amount Requested: $141,746 Total Cost: $141,746
Geographic Area Served: Maricopa County
By the execution of this Grant Application the undersigned agrees that the information contained
in this Application is true, to the best of the Applicant’s knowledge. The Applicant shall notify
the Community if any information in this Application changes
Signature:
For the Applicant: __________________________________________ Date:______________
Typed/Printed Name and Title: __________________________________________
For the City/Town County: ____________________________________ Date:______________
(If different than applicant)
Typed/Printed Name and Title: __________________________________________