April 2016 filing period Conference & event sponsorship PAPER APPLICATION
Organization Information
Organization Name
Organization Address
Organization City
Organization State
Zip Code
Office Phone Number
Office Fax Number
Organization E-mail Address
Organization Website
Organization Type
Is organization a current or past First 5 LA grantee? If current or past First 5 LA grantee, please provide the following information: Grant received, project title and year of funding. All Required Documents along with this Paper Application must be received by First 5 LA via US Postal Service or hand-delivered at the Address below no later than Close of Business April 30, 2016 by 5:00pm PT to: Judith Gómez Program Officer, Grants Management Department First 5 LA 750 N. Alameda Street Los Angeles, CA 90012
All applicants will receive a notice of application received within 10 business days of submission. Final funding notices will be sent by June 30, 2016.
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Primary Contact Organization Contact Information Prefix First Name Middle Name Last Name Title E-mail Phone Number Request Primary Contact Same as Organization Primary Contact If yes, leave remaining section fields blank Prefix First Name Middle Name Last Name
Title E-mail
Phone
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Conference Information Conference/Event Name
Type of Conference/Event (e.g. professional development, parent education/empowerment, workshop, classes, other) Confirmed Date of Conference/Event (including times)
Confirmed location of conference/event
Please add address of conference/event location including city, state and zip code Goal of Conference/Event
What do you hope to achieve by the end of this Conference/Event? Will conference offer programming/content specific to parents of/or children 5 and under?
Will First 5 LA's Outcome Areas be covered by event programming/content?
1.Families: Increased Family Protective Factors; 2.Communities: Increased community capacity to support and promote the safety, healthy development, and well-being of children prenatal to age 5 and their families; 3.Early Care and Education Systems: Increased access to high-quality early care and education; 4.Health-Related Systems: Improved capacity of health, mental health, and substance abuse services systems to meet the needs of children prenatal to age 5 and their families.
Target Audience
(service providers, professionals, parents, children, other)
Estimate number of attendees
Number of attendees from LA County:
How will you promote the event so that you have good attendance?
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Required Documents Please ensure you include the following with this completed application form:
1. Conference Agenda 2. Short Biographies of all Presenters/Speakers 3. Conference Budget (Appendix C) 4. Conference Programs (if available)
Contact Us For additional information or further questions, please contact Judith Gómez, Program Officer, Grants Management Department at [email protected].
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