COUNTY OF RIVERSIDE
FIFTH DISTRICT
Fiscal Year 2014-15
COMMUNITY IMPROVEMENT DESIGNATION FUND APPLICATION
District Representative:
Name of Organization:
Is this for:
An event, Date:
Amount Requested from 5th District:
Project
Other:
Total Project Budget:
Are you requesting from another Supervisor’s office or department? If so, who & how much?
Project/Event Name:
/
Project/Event date:
End Date (if applicable):
Project/Event location:
ORGANIZATION DATA:
Contact Name:
Phone number:
Title/Position:
Email address: [
@
/
Select One ]
Mailing address:
Number of paid staff:
Number of Volunteers:
Year Organization Founded:
Geographic Area(s) served:
Indicate the specific address you will provide the service from:
Is your organization:
Non-Profit (Attach IRS Form 990 or Schedule A)
Community Organization
Government Agency
Other, please explain:
If your organization is a For Profit entity:
Federal identification number:
/
Please provide the following information:
1.
Mission statement: Describe the goals and objects of your organization? Where the services are provided?
How does your organization benefit the Fifth District?
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Fifth District
2. Project Description: How will your organization use the funding awarded? Describe the project objectives, who
and how many are expected to be served, area serviced, and number of volunteers involved. Be specific. Include
equipment or services that would be purchased and why. Include a detailed budget and schedule of significant
activities related to this project. You may attach a maximum of one double-spaced typed page of information.
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Fifth District
3. Has your organization received Community Improvement Designation funds in the past? From which districts?
Amount? Please indicate below, specific project name, start/finish dates, break down of how funds were spent.
4. Explain how funding/project benefits the constituents of the Fifth District
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Fifth District
Signature Page
We hereby certify the information contained in this application is true to the best of our knowledge and belief.
Prepared by:
Name and Title (Please print or type)
Signature
President or Authorized Officer:
Name and Title (Please print or type)
Signature
Organization:
Organization Name
Mailing Address of Organization
Telephone number
Date
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Fifth District
NOTE:
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Every CID application is considered individually and on its own merit.
Preference will be given to organizations and activities that directly benefit the residents of the Fifth District.
The awarding of CID funds does not constitute an automatic annual allocation.
CID applications must be submitted to the Supervisor’s office within 4 weeks for consideration and processing.
For approved applications, please allow 10 working days to receive funding check.
CID recipients are not permitted to use the Supervisor’s name or likeness in promotion of their events or
activities unless otherwise specifically authorized by this office (e.g. if he is speaking at the event and needs to be
listed on the agenda).
CID funds must be spent as specified on the application and records may be requested by the Board of
Supervisors, the County Auditor, or other appropriate agencies to ensure they were used appropriately.
Our office will not award or announce CID grants sixty (60) days leading up to election for the Fifth
District Supervisor.
Submit applications to:
Supervisor Marion Ashley
Riverside County, Fifth District
Attn: Jaime Hurtado/Katrina Cline
4080 Lemon Street, 5th floor
P.O. Box 1645
Riverside, CA 92502
Phone: 951-955-1050
Fax: 951-955-9030
Email: District5@rcbos.org
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Fifth District