City of Milpitas City Council Non-Profit Donation/Fee Waiver Request Program Application Form

The City recognizes the value of partnership with other agencies and organizations in providing services that benefit the community and its residents. The City may provide a donation or grant a reduction and/or waiver of fees to intergovernmental agencies or non-profit organizations that provide Milpitas community benefit. Application requests will be reviewed by the Director of Recreation and Community Services, and if eligible, will be scheduled for a future City Council meeting for review and approval or denial.

Name of Organization
Is there a Milpitas Branch or Affiliation?

Is there a Milpitas Branch or Affiliation? Yes No
Organization Address (as listed on your 501 (c) 3) Organization Address (as listed on your 501 (c) 3)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Organization Web Site
Organization Contact Name Organization Contact Name First Last
Organization Contact Phone Organization Contact Phone - ### - ### ####
Organization Contact Email
Request Type

Request Type Donation (up to $500) Fee Waiver (up to $1,500)
Requested Amount (request types cannot be combined or exceed maximum listed amounts)
Description of Use of Funds/Fees to be Waived
Event Name
Event Date(s) Event Date(s) / MM / DD YYYY
Event Location (Facility Name and Address)
Is your Event Open to the Public
What is you anticipated Event attendance?
What is the purpose of the Event?
Is your event a Fundraiser
What percentage of your event fundraising proceeds will benefit the Milpitas Community?

What percentage of your event fundraising proceeds will benefit the Milpitas Community? None, this is not a fundraiser Less than 60% 60% or more
How will the Milpitas Community Benefit from this Event?
How will the City's contribution (if approved) be recognized in event media and publicity?
Upload your Entity Status Letter (Entity Name listed on this application must match the Entity Status Letter Name)

Attach Files
Within 60 days after completion of the event for which a donation was received or a fee waiver was granted by the City of Milpitas, your organization will provide a report to the Director of Recreation and Community Services to include at minimum: number of participants, copies of all publicity of the event, any benefit to the community, amount of funds raised and an accounting of how the proceeds of the event will be dispersed.

Failure to abide by the rules and procedures set forth in the City Council Donation/Fee Waiver Policy will result in the organization being denied for funding and/or fee waiver in the future.
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