Conference & Event Sponsorship

October 2016 Filing Period

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 Applicationmust be received by First 5 LA via US Postal Service or hand-delivered at the Address below no later than October 31, 2016 by 5:00pm PT to:

Judith Gómez

Program Officer, Grants Management Department
First 5 LA
750 N. Alameda Street, Suite 300
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 December 31, 2016.

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
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?
Fee to attend Conference/Event
Will there be fee waivers or scholarships available for low-income attendees (if parent or child audience)?
Amount Requested
(A maximum of $15,000 or 50 percent of total Conference/Event budget, whichever is lower)
How does this conference/event relate to First 5 LA's goal of "Increasing community and/or professional capacity, Disseminating best and promising practices, or Sharing new research findings? (500 Words Max).
What is the result the conference hopes to achieve? Will there be a measurement of success? If so, please describe measurement.

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. Any Previous Conference Programs (if available)

For additional information or further questions, please contact Judith Gómez, Program Officer, Grants Management Department at .

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