<p> April 2016 filing period Conference & event sponsorship PAPER APPLICATION</p><p>Organization Information </p><p>Organization Name </p><p>Organization Address </p><p>Organization City </p><p>Organization State </p><p>Zip Code</p><p>Office Phone Number</p><p>Office Fax Number</p><p>Organization E-mail Address</p><p>Organization Website</p><p>Organization Type</p><p>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</p><p>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.</p><p>1 of 4 Pages April 2016 filing period Conference & event sponsorship PAPER APPLICATION</p><p>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</p><p>Title E-mail</p><p>Phone</p><p>2 of 4 Pages April 2016 filing period Conference & event sponsorship PAPER APPLICATION</p><p>3 of 4 Pages April 2016 filing period Conference & event sponsorship PAPER APPLICATION</p><p>Conference Information Conference/Event Name</p><p>Type of Conference/Event (e.g. professional development, parent education/empowerment, workshop, classes, other) Confirmed Date of Conference/Event (including times) </p><p>Confirmed location of conference/event</p><p>Please add address of conference/event location including city, state and zip code Goal of Conference/Event</p><p>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?</p><p>Will First 5 LA's Outcome Areas be covered by event programming/content?</p><p>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.</p><p>Target Audience</p><p>(service providers, professionals, parents, children, other) </p><p>Estimate number of attendees</p><p>Number of attendees from LA County:</p><p>How will you promote the event so that you have good attendance?</p><p>4 of 4 Pages April 2016 filing period Conference & event sponsorship PAPER APPLICATION</p><p>Required Documents Please ensure you include the following with this completed application form:</p><p>1. Conference Agenda 2. Short Biographies of all Presenters/Speakers 3. Conference Budget (Appendix C) 4. Conference Programs (if available)</p><p>Contact Us For additional information or further questions, please contact Judith Gómez, Program Officer, Grants Management Department at [email protected].</p><p>5 of 4 Pages</p>