City of San Diego FY11 Creative Communities San Diego Program Intent to Apply

Please complete and submit this Intent to Apply Survey by September 30, 2009. Organizations using a fiscal agent to apply for funding must have the fiscal agent complete and submit this Intent to Apply Survey.

If you have any questions, please contact Gary Margolis at gmargolis@sandiego.gov or 619-236-6788.

Thank you. Gary Margolis

* Requires a response.

1. Contact Information:

Contact Information: Name of Organization
Name of Contact Person
Title
Organizaiton Address
City
State
Zip
Council District
Phone
Fax
Email
Website

2. Eligibility Criteria.
You must check "yes" for every one of the items below to be eligible to apply:

	Yes	No
1) Nonprofit Status: We are able to demonstrate proof of tax exempt nonprofit status under section 501(c)(3) or 501(c)(6) of the Internal Revenue Code or Section 23701d of the California Revenue and Taxation Code at the time of application.	Eligibility Criteria. You must check "yes" for every one of the items below to be eligible to apply: 1) Nonprofit Status: We are able to demonstrate proof of tax exempt nonprofit status under section 501(c)(3) or 501(c)(6) of the Internal Revenue Code or Section 23701d of the California Revenue and Taxation Code at the time of application. Yes	No
2) Location: Our project will take place within San Diego City limits.	2) Location: Our project will take place within San Diego City limits. Yes	No
3) Track Record: Our organization has a three (3) year history of ongoing programming within the City of San Diego prior to the deadline. (The proposed project, however, may be a new one.)	3) Track Record: Our organization has a three (3) year history of ongoing programming within the City of San Diego prior to the deadline. (The proposed project, however, may be a new one.) Yes	No
4) Compliance: Our organization is in compliance with all existing contracts (if applicable).	4) Compliance: Our organization is in compliance with all existing contracts (if applicable). Yes	No
5) Matching Funds: Our organization is able to meet the City’s required match of 3:1 (budgets greater than $30,000) or 2:1 (budgets of $30,000 or less).	5) Matching Funds: Our organization is able to meet the City’s required match of 3:1 (budgets greater than $30,000) or 2:1 (budgets of $30,000 or less). Yes	No

3. If you are a fiscal agent, please provide the name of the implementing organization:

If you are a fiscal agent, please provide the name of the implementing organization:

4. Where will the project take place (complete address or addresses with City Council Districts)?

Where will the project take place (complete address or addresses with City Council Districts)?

5. Are you the implementing organization or the fiscal agent?

Are you the implementing organization or the fiscal agent? Implementing Organization

Fiscal Agent

6. Please answer the following regarding your project:

Please answer the following regarding your project: 1) What is the name of the project?
2) What are the dates (must be between July 1, 2010 and June 30, 2011)?

7. Which application Form does your organization plan to submit?

Which application Form does your organization plan to submit? Long

Short

8. You must check "yes" to all of the following if you indicated above that you plan to apply using the Short Form. All organizations, however, should complete this question so that in addition to knowing which organizations plan to submit short forms, staff may also understand why an organization is not planning to apply using the short form.

	Yes	No
1) Our organization has satisfactorily completed City contracts for three (3) or more consecutive years.	You must check "yes" to all of the following if you indicated above that you plan to apply using the Short Form. All organizations, however, should complete this question so that in addition to knowing which organizations plan to submit short forms, staff may also understand why an organization is not planning to apply using the short form. 1) Our organization has satisfactorily completed City contracts for three (3) or more consecutive years. Yes	No
2) Our organization holds a rank of 3+ or higher.	2) Our organization holds a rank of 3+ or higher. Yes	No
3) Our organization has presented the same project or event for three consecutive years, at the same site(s), with the same key staff.	3) Our organization has presented the same project or event for three consecutive years, at the same site(s), with the same key staff. Yes	No
4) Our organization has NOT submitted short form applications for all three of the three previous years (FY08, FY09, and FY10).	4) Our organization has NOT submitted short form applications for all three of the three previous years (FY08, FY09, and FY10). Yes	No

9. Compliance or Intent to Comply with Current Contract(s):

Compliance or Intent to Comply with Current Contract(s): Date FY10 Contract Components were or will be submitted (must be before August 31, 2009)... Enter Date:
Date FY09 Final Report was or will be submitted (must be before September 30, 2009)... Enter Date:

10. Certification:

With the submittal of this Intent to Apply Form to the Commission, the organization acknowledges that the deadline for the CCSD Application is Friday, November 20, 2009. The organization also acknowledges that Commision staff will verify elements of this Form, for example, compliance with current contract deadlines and that the Commission reserves the right to require any organization not in compliance with all of the requirements for Short Form eligibility to apply using the Long Form.

	I accept these terms.	I do not accept these terms.
By checking "I accept these terms," the organization certifies that the content of this Form is true and accurate, that the content has been reviewed and approved by the organization's chief executive staff member, and that the organization understands and agrees to the above terms.	Certification: With the submittal of this Intent to Apply Form to the Commission, the organization acknowledges that the deadline for the CCSD Application is Friday, November 20, 2009. The organization also acknowledges that Commision staff will verify elements of this Form, for example, compliance with current contract deadlines and that the Commission reserves the right to require any organization not in compliance with all of the requirements for Short Form eligibility to apply using the Long Form. By checking "I accept these terms," the organization certifies that the content of this Form is true and accurate, that the content has been reviewed and approved by the organization's chief executive staff member, and that the organization understands and agrees to the above terms. I accept these terms.	I do not accept these terms.

1. Due by September 30, 2009