Attachment_C-Application_Form_4_2025.pdf
PDF 135 KB Posted
- Attached to
- Office of Community Affairs Chinese and Spanish Outreach and Education for Regions 1 and 2
- Solicitation number
- 2025-RFP-00495
- Issued by
- San Mateo County, San Bernardino City, California
About this file
Attachment C is an Application Form for the County of San Mateo's Office of Community Affairs Chinese and Spanish Outreach and Education program, designed for potential community partners seeking to provide outreach services in Regions 1 and 2. The form allows applicants to indicate their language capacity (Chinese and/or Spanish), target regions (Daly City, Broadmoor, Colma, Brisbane, South San Francisco, San Bruno, and unincorporated areas; or Millbrae, Burlingame, Hillsborough, San Mateo, Foster City, Belmont, and unincorporated areas), and specific populations they will serve.
The application captures essential organizational details such as contact information, Federal EIN, year of incorporation, annual operating budget, and the amount of funding being requested. Applicants can select from a comprehensive list of target populations including African Americans, Asian/Pacific Islanders, children, disabled individuals, homeless populations, immigrants, LGBTQ+ communities, low-income residents, seniors, veterans, and young adults. The form also includes a detailed language capacity section where applicants can specify their speaking, reading, and writing proficiencies in Chinese (Cantonese/Mandarin) and Spanish.
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Text version
ATTACHMENT C:
APPLICATION FORM
Date:
Applicant: Phone:
Address: Email:
Web:
Project
Contact:
Title:
Fed EIN:
IRS Code:
Year
Incorporated:
Annual
Operating
Budget: $
Amount
Being
Requested: $
REGIONS TO BE COVERED
(Check all that apply)
POPULATIONS TARGETED (Check all that apply) Applicants should indicate which regions of the County they will be conducting outreach in.
*See Attachment D: Community Outreach Regions Map
☐ Daly City, Broadmoor, Colma, Brisbane, SSF, San Bruno +
Unincorp.
☐ Millbrae, Burlingame, Hillsborough, San Mateo, Foster
City, Belmont + Unincorp.
☐ African American
☐ Asian/Pacific Islander
☐ Children (0-5)
☐ Disabled
☐ Hispanic/Latinx
☐ Homeless
☐ Immigrants/ Refugees
☐ LGBTQ+
☐ Limited English Proficient
☐ Limited/No Internet Access
☐ Low Income
☐ Native American
☐ Public Benefits Recipients
☐ Public Housing Residents
☐ Renters
☐ SRO Residents
☐ Seniors (65+)
☐ Immigrants
☐ Veterans
☐ Young Adults (17-25)
☐ Other_________________
LANGUAGE CAPACITY (Check all that apply)
Chinese (Cantonese or Mandarin):
☐ Speak
Chinese (Simplified or Traditional):
☐ Read ☐ Write
Spanish:
☐ Speak ☐ Read ☐ Write
Tagalog:
☐ Speak ☐ Read ☐ Write
File details come from the government source that posted it. Updated .