Attachment_C-Application_Form.pdf
PDF 138 KB Posted
- Solicitation number
- 2025-RFP-00418
- Issued by
- San Mateo County, San Bernardino City, California
About this file
This document is an Application Form (Attachment C) from the County of San Mateo's Office of Community Affairs for an Outreach and Education opportunity. The form is designed for potential community partners to apply for funding and support in connecting hard-to-reach populations with county resources and services. Applicants can select from multiple geographic regions within San Mateo County, including areas like Daly City, Redwood City, Half Moon Bay, and others, with the goal of conducting targeted community outreach.
The application allows organizations to specify their language capabilities (including Chinese, Spanish, Tagalog, Samoan, and Tongan) and identify the specific populations they will target, such as African Americans, children, disabled individuals, immigrants, low-income residents, seniors, veterans, and young adults. The form requires applicants to provide organizational details like federal EIN, annual operating budget, and the specific funding amount being requested. The comprehensive nature of the form suggests the County is seeking robust, culturally competent community partners who can effectively bridge communication and service access gaps for diverse and underserved populations.
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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.
☐ San Carlos, Redwood City, North Fair Oaks
☐ Woodside, Portola Valley, Ladera, Atherton, West Menlo
Park, Menlo Park, East Palo Alto
☐ Half Moon Bay, San Gregorio, La Honda, Loma Mar, Pescadero
☐ Pacifica, Montara, Moss Beach, El Granada
☐ 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
Samoan:
☐ Speak ☐ Read ☐ Write
Spanish:
☐ Speak ☐ Read ☐ Write
Tagalog:
☐ Speak ☐ Read ☐ Write
Tongan:
☐ Speak ☐ Read ☐ Write
File details come from the government source that posted it. Updated .