Midtown District Santa Fe - Public Engagement Request

City of Santa Fe Midtown Community Planning Stipend Request

Please complete the form below to request funds. Funds can be used to support the development, printing, posting and distribution of outreach or research materials, including electronic media ($1,500.00 max.); a single outreach event or activity ($3,000.00 max.); or a combination of events, activities, and materials ($5,000.00 max.).

1. AMOUNT REQUESTED:(Required)

2. NAME OF ORGANIZATION TO WHOM THE SPONSORSHIP IS PAYABLE:(Required)

Provide Name of Organization

3. CONTACT NAME AND INFO (phone, email)(Required)

Provide Contact Name, Contact Phone # and email address

First Last

Phone(Required)

Email(Required)

4. PROJECT TITLE/NAME/FOCUS:(Required)

Provide project name/title and/or focus of activity

5. DATE(S), TIME(S), LOCATION(S) OF PROPOSED EVENT(S) OR PROGRAM(S):(Required)

Describe date, time, location, and other details that connect your proposed activity to Midtown

6. DESCRIPTION OF THE PROPOSED EVENT(S), PUBLICATION(S) OR PROGRAM(S):(Required)

Describe in detail the proposed event(s), publication(s), program(s). Include description of how participants will be reached or how materials will be distributed to ensure involvement of targeted participants. Include staffing/management details to ensure organizational capacity to complete proposed activity.

7. ANTICIPATED OUTCOMES:(Required)

Describe in detail the anticipated outcomes of your proposed activity (#s reached, materials developed, expanded capacity, etc.)

8. DESCRIBE IN DETAIL THE BENEFITS OF SPONSORSHIP:(Required)

Identify opportunities for the participation of City officials, public acknowledgement of the City’s support, and any other benefits provided through the sponsorship, such as event admission, use of City logo, etc.

By signing below, I agree to the terms described above if a stipend is awarded to my organization.

Signed(Required)

Print Name(Required)

First Last

Date(Required)

APPROVED (for staff only):

City of Santa Fe Midtown Redevelopment Staff

DATE:

APPROVED (for staff only):

Director, Office of Economic Development OED Funding Source – 2122800.510340

DATE:

CAPTCHA

Midtown Community Planning Stipend Request

Midtown Community Planning Stipend Request

City of Santa Fe Midtown Community Planning Stipend Request

By signing below, I agree to the terms described above if a stipend is awarded to my organization.

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