Logout Confirmation of Application Receipt: * indicates required field Your request was successfully submitted. No further action on your part is required and you can expect to receive notice of your request's status within the next 30 days. To print a copy of this completed application go to 'File', then 'Print' on your browser toolbar. Thank you for completing this process. Please visit www.disneyoutreach.com to learn more about our charitable outreach efforts. Charity Information - Basic * Legal Name Laurelglen Elementary * Primary Phone Number 661-831-4444 * Fax 661-831-6689 * E-mail Address laurelglenpc@yahoo.com * Website Address www.pbvusd.k12.ca.us/schools/laurelglen * Name of Executive Director, CEO, Principal or Other Lead Executive * Email address of Executive Director, CEO, Principal or Other Lead Executive * Are there any Board Members of The Walt Disney Company affiliated with your organization? If, please type "None" in the text box and click the "Add to List" button. * Are there any members of The Jennifer Irvin jirvin@pbvusd.net Walt Disney Company Executive Management Team affiliated with your organization? If, please type "None" in the Page 1 of 5
, please type "None" in the text box and click the "Add to List" button. Charity Information - Mission * Organization Type Education: K-12 * Mission Statement and Goals To teach lifelong learning in all students by building a foundation of basic skills, high self-esteem, and positive behavior patterns while encouraging creativity and divergent thinking. To have all students meet or exceed all grade level expectations based on the California state standards. To base the instruction of all students on the results of a variety of assessment strategies. To develop literate citizens who can meet the challenges of the twenty-first century and who have a knowledge, understanding, and mutual respect of multicultural values and ideals. * Services Provided Public education of students grades Pre-K thru 6th grade. * Geographic Region/Area Bakersfield, Kern County, CA * Ethnic Groups 9% African American 2% American Indian 2% Asian 51% Caucasian 33% Hispanic 1% Pacific Islander 2% Other * Population/Demographic Children Students (K-12) * Gender Female Male * Age Group Children (Age 4-12) * Income Range of Population * How many recipients are served in the average year? If this is a membership organization, how many members? Name other charities or other organizations to which you provide support All 600 n/a * Salutation Mrs. * First Name Beth Charity Information - Contacts * Last Name Nahama Page 2 of 5
* Last Name Nahama * Contact Type Volunteer * Title or Position Parent Volunteer Occupation Engineer * Relationship to Organization Parent * Address 2601 EL PORTAL DR. * City BAKERSFIELD * State California * Zip 93309 5333 * Country United States * Telephone 661-835-7370 * Fax 661-831-6689 * E-mail Address bethnahama@yahoo.com Charity Information - Board Organization * If you have a Board, please list their names here. If, please type "None" in the text box and click the "Add to List" button. Cheryl Palla Linda Brenner Keith Wolaridge Dean Haddock Dolores Whitley * If you have an Advisory Board, please list their names here. If, please type "None" in the text box and click the "Add to List" button. * Please list names of any Disney, ABC, or ESPN employees currently serving your organization as board members, executive officers or with any significant affiliation. If, please type "None" in the text box and click the "Add to List" button. * Please describe their involvement These are the members of the local Board of Trustees for this school * Employee Benefit No * If a current or past employee will benefit, please provide the employee's name and explain benefit below. If, please type "None" in the text box. Page 3 of 5
Annual Budget Audited Financial Statement Anti-Discrimination Statement IRS 501(c)3 Determination Letter Annual Report Charity Information - Documentation Organization * Request Date 01/22/2013 Request Information - Standard * Project Title End of Year Open House * Project Start Date 04/27/2013 * Purpose of Request This final event of the year allows parents and students review the year's work and progress. It is a social gathering, community building, and fundraising event as well. A meal is served. Raffle tickets are sold for the opportunity to win a prize. * Delivery Organization Name LAURELGLEN ELEMENTARY * Delivery Organization Address 1 2601 EL PORTAL DR. Delivery Organization Address 2 * Delivery Organization City BAKERSFIELD * Delivery Organization State/Province California * Delivery Organization Zip 93309 5333 * Delivery Organization Country United States * Delivery Contact First Name Beth * Delivery Contact Last Name Nahama * Delivery Contact Email Address * Delivery Organization Phone Number * Delivery Organization Email Address bethnahama@yahoo.com 661-831-4444 laurelglenpc@yahoo.com * What type of address is this? School Address * If delivery address provided is different from that of the registered 501(c)(3) charitable organization making the request, please indicate the Address is the same Page 4 of 5
request, please indicate the reason why: * Other reason for alternative delivery address n/a Request Information - Specific * Event Summary The theme of the evening is - End of Year Open House. The activities inlcude a family meal, visit to the classroom, visit with teacher and classmates, and a raffle opportunity drawing. * Event Budget $350.00 * Anticipated Event Revenue $3,000.00 Number of Event Volunteers 10 * Number of Charity Volunteers/Staff * How will contribution be used? 5 Opportunity Auction Need Support? Disney Page 5 of 5