A - Community Funding Applications and Preliminary Eligibility Evaluations

Eligibility YES NO Notes:

Be made or sponsored by a 501(c)(3) non‐profit organization with experienced members capable of implementing and managing the program/project/event
x
Identify how the funds will be used to benefit the Cupertino community x
Be awarded only once per projec
t x
For specific needs, not on going, operational costs x
Have more than 75% of the requested funds allocated for direct service costs versus administrative costs x
Be complete and submitted by the application deadline x Restrictions/Guidelines YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
NA
Omniware Networks (NEW) Eligibility Checklist (staff use only)

January 27, 2022

Leaders of the Cupertino Community,
It is with great pleasure that I submit the enclosed proposal for support of the Palisadoes Foundation’s 2022 Calico Challenge. The Calico Challenge provides software engineering students in underserved communities a mentored internship developing open-source software. We aim to provide the tools they need to be global contributors and entrepreneurs.

Life started for us in 2016 when a group of expatriate Jamaicans wanted to assist development of new and existing information technologies for the island’s social good. We knew academic and student leadership wanted greater practical exposure to the latest technology. In response, our pilot program for Jamaican universities was created with the goal of addressing the issues graduates would face when employed. After five years of success, members of the Jamaican diaspora suggested we expand our service area to include North America. They saw similar needs in their underserved communities. Here BIPOC minorities experience similar disadvantages after receiving a STEM education.

We are actively planning for this expansion this coming summer.

Like many non-profits, the 2020 pandemic challenged us and our students. We scaled back efforts, strategized, and developed a recovery plan to support our international growth and current program. In 2021, we took exploratory steps towards this goal by becoming a mentoring organization in the Google Summer of Code and the India-based GitHub Externship. Thanks to these opportunities and the hard work of past Calico participants, our Talawa app, a community management software, is in its final stages of development.

The ultimate mission of our foundation is to provide equitable access to life opportunities for STEM students. The Calico Challenge gives students exposure to large scale, unique, and collaborative projects that will allow them to compete in the global marketplace. We believe our program supports all of Cupertino's values. It utilizes community members to mentor the next generation, supporting their growth and volunteering their time.

We ask that you support the 2022 Calico Challenge with a generous donation of $3,750 US dollars. This will provide a Cupertino student with this mentored internship opportunity. These internships bridge the learning gap in open-source software and professional experiences. The Palisadoes Foundation is fully volunteer effort with minimal overhead expenses, ensuring funds are efficiently used for the students.

The accompanying proposal provides more information on the Palisadoes Foundation and the 2022 Calico Challenge.

Please do not hesitate to contact us should you need additional information. Thank you for your consideration.

Best Regards,

Peter Harrison
President, The Palisadoes Foundation
www.palisadoes.org
[email protected]
www.palisadoes.org
P.O. Box 518
Cupertino, CA, 95015

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Table of Contents
Executive Summary ............................................................................................................................................... 3 What We Do.......................................................................................................................................................... 4 The Calico Challenge ......................................................................................................................................... 4 Calico Expands to the USA in 2022 ............................................................................................................... 4 Expansion Preparation Activities in 2021 ..................................................................................................... 5 What We Can Do Together ............................................................................................................................... 6 Statement of Need ................................................................................................................................................ 7 Calico in Detail ...................................................................................................................................................... 9 2022 Calico Challenge ...................................................................................................................................... 9 2022 Timeline for the Calico Challenge ...................................................................................................... 10 Progress Evaluations for the Calico Challenge ............................................................................................ 11 Tangible Results for the Calico Challenge ................................................................................................... 11 Our Software Projects’ Highlight: The Talawa Mobile App ................................................................................ 12 Organizational Information................................................................................................................................. 13 Palisadoes Foundation Beginnings ................................................................................................................. 14 Meet Our Volunteers ...................................................................................................................................... 15 Peter Harrison, President ............................................................................................................................ 15 KG Charles-Harris, Secretary ....................................................................................................................... 15 Tennyson Williams, Treasurer .................................................................................................................... 16 The Palisadoes Foundation Team ............................................................................................................... 16 Conclusion ........................................................................................................................................................... 16 Palisadoes Foundation Budget ........................................................................................................................... 17 Calico Challenge .............................................................................................................................................. 17 General Expenses ............................................................................................................................................ 18

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Executive Summary
The Palisadoes Foundation provides equitable access to life opportunities for STEM students. We focus on offering software engineering education internships to university students in under-served communities. This prepares them for the competitive realities of the working world.

After five years of success, members of the Jamaican diaspora suggested we expand our service area to include North America. They saw similar needs in their under-served communities. Here BIPOC minorities of race experience similar disadvantages after receiving a STEM education.

We are based in the San Francisco metropolitan area, where the digital divide in education is very visible. We feel that our experience in the developing world will be useful in aiding this community too. This is where we will start the next stage of our evolution.

Figure 1: Jamaica Public Service Student Tour, 2016

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What We Do
The Information and Communication Technology (ICT) sector is a dynamic, growing, and critical international industry. It can provide significant financial, developmental, and social opportunities. Our internship programs provide equitable access to critical experiences for local ICT students in under-served communities. We make them globally competitive.

The Calico Challenge
Our existing program is the annual Calico Challenge. It provides mentored, paid internships for underserved university students to work on open-source code projects. Stipends are paid upon achieving predefined goals.

These stipends ensure students work full time on one of our ongoing coding projects. We also provide a small gratuity for our quality mentors. In 2022, the Calico Challenge will become an international program, supporting both US and Jamaican students. The success of this expanded program depends upon both the support of local companies and organizations, and international cooperation.

Calico Expands to the USA in 2022
For the past 6 years, we have been consistently sponsored by Jamaican IT companies, who believe in the need and value of Calico. Over 30 internships have been provided to Jamaica software engineering students. These students have gone on to join local Jamaican IT companies, global companies such as Apple and WordPress, and postgraduate studies in North America and Europe. As we expand the 2022 Calico Challenge, we hope to continue this momentum and bring it to under-served US students.

Figure 2: RealDecoy Donation, 2017

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Expansion Preparation Activities in 2021
Like many non-profits, the 2020 pandemic hit us hard due to a lack of funding. We scaled back our efforts in Jamaica. We also began a strategy review to determine how to recover, learn, and plan our growth for international expansion.

We decided to take exploratory steps towards this goal by becoming a mentoring organization in the 2021 Google Summer of Code and the India based GitHub Externship. We are growing our processes, volunteers, and software projects to meet the international standards we must consistently attain in future. This will help us create a robust Calico Challenge program to specifically meet the needs of US-based students in 2022.

Figure 3: University of Technology Students, 2018

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What We Can Do Together

Figure 4: Palisadoes Silicon Valley Supporters, 2019
We believe our program aligns with the city of Cupertino’s mission to utilize the strengths of the community to grow and support its future generations through innovation.

We have experience with students from around the world. We began with a specialization in cultivating software engineering talent from developing countries. This makes us uniquely positioned to successfully support under-served university communities in the United States. Together we can expose BIPOC students to the professional growth opportunities we often take for granted. This expands the American worker talent pool and will improve the communities where they live, work, and play.

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Statement of Need

Figure 5: Students Learning about Internship Opportunities through a Palisadoes Foundation Video Conference The Palisadoes Foundation works to bridge well-known opportunity and representation gaps. To understand how we could help IT students, we spoke with them, their professors, and IT businesses both in Jamaica and beyond. We found that exposure to collaborative, open-source coding was missing. It was felt this could be a bridge between university education and professional performance.

Contributing effectively to open-source projects requires the programmer to structure their code in a way that allows multinational teams to use it and add to it easily. This skill set is taught in many university coursework programs, but often to a limited degree. We feel that it is best learned from real world, practical opportunities.

In 2020, when we began exploring expansion opportunities, we decided to evaluate how our program could help underserved students in the US.

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We started by looking at US STEM and race related data in the National Science Foundation’s database. The NSF defines underrepresented minorities as Black American, African American, Hispanic, Latino, American Indian, or Alaska Native. The gaps we found are summarized in Figure 6.

The numbers demonstrate that equal representation diminishes as the minorities advance in the education and career process. Clearly, this group faces other, less tangible obstacles to entering the workforce. We believe these obstacles include a lack of experience and exposure, not by choice, but rather by factors related to race and/or socio-economic position. Our foundation works to ensure that these underserved students receive internship opportunities often unknown or denied to them. We believe in the value of exposure to new coding experiences and opportunities to form community and professional connection. Our talented students complete our internships feeling more confident and connected with an IT community and professionals who look like them. We hope our efforts increase the number of under-served minority Americans entering and remaining in the STEM workforce. It is essential that their creativity, perspective, and experience be represented in STEM products. Only then will these same products fully serve the needs of users who look like this part of the American community.

Figure 6: Underrepresented Minorities in STEM

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Calico in Detail

Figure 7: Student Visit, National Commercial Bank
2022 Calico Challenge
The Calico Challenge is the Palisadoes Foundation’s
primary program. It offers underserved student-
developers stipends to write software code for various
open-source software projects.

This program cultivates globally competitive skills
through its combination of 3 key aspects with the
student’s own talent and education. Collaborative open- source coding techniques; professional requirements;
and a quality mentor combine to strengthen the
student’s preparation for the workforce.

This concept is closely modeled on the Google Summer of Code (GSoC) initiative, a program that has proven to be a successful method of developing open-source code and
young programmers. Google is aware of the Calico
Challenge program and has actively expressed support.

These simple, relatively inexpensive internships will
create international opportunities for these students.

This concept bridges a gap in experience that will bring new, creative minds into a global vocation. A vocation
Figure 7: How Calico Challenge Supports Student Growth

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Progress Evaluations for the Calico Challenge
The Palisadoes Foundation monitors progress through 2 evaluations. Students and mentors are asked to complete Phase 1 (due mid-July 2022) and Final (due end of August 2022) evaluation forms. After each passed evaluation, students receive a specified stipend amount, as documented in Figure 11. The Palisadoes Foundation has a thorough method for arbitrating any disputes, and clear expectations of both the student and mentor are agreed upon ahead of initiation of the project.

Tangible Results for the Calico Challenge
The final results of the 2022 Calico Challenge will be:
 The completion of one or more project tasks for their selected open-source program.
 Mentor-approved open-source code which is easily usable and modifiable by other programmers.
 An increased skill level in his/her coding skills and an enhanced his/her reputation on an international level for the student.
 An increased understanding of professional aspects of collaboration and presentation
 A new, positive relationship between the mentoring
organization and student developers.

The combination of these goals will help the 2022 Calico Challenge participants establish themselves globally as the budding innovative, talented professionals they are.

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Our Software Projects’ Highlight: The Talawa Mobile App Since 2015 we have been developing open-source software code in many areas. For the past three years we have been focusing on ways to help community organizations.

Talawa was created to help community-based organizations collaborate with their membership. These organizations
would include religious groups, non-profit charities, social groups, sports clubs and in limited cases, businesses.

Though software applications exist for these types of
organizations (eg. Breeze ChMS, The Realm) they assume
their memberships are fully literate and have access to email.

We wanted to create a system that would work for countries and communities with similar technology access and
education challenges as Jamaica.

Talawa has three main components. A mobile application
with social media features, a web-based portal to be used by the organization’s administrative team, and finally an API providing access to data and features.

The Palisadoes Foundation wants to eventually host Talawa as a cloud service to help finance its education outreach.

Talawa’s main features include:

1. A user news feed

2. Event calendars with lightweight project management

3. Group chats

4. Member notifications

5. Donation and subscription acceptance

6. Service provider level multi-organization capability

7. Plugin support for administration services such as billing Talawa has over 60 software developers actively updating its code. The projects have been cloned 250 times by curious software developers trying to understand how the nuts and bolts work.

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Organizational Information
Since 2016, the Palisadoes Foundation has been promoting equitable access to life opportunities for STEM education recipients. Our annual internship programs match university students with Information and Communications Technology (ICT) professionals as they collaborate on Open-Source software projects.

We are a registered 501(c)(3) non-profit organization registered in California.

Figure 10: Student testing our Talawa Mobile App

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Palisadoes Foundation Beginnings
Our story begins in 2016, when a group of Jamaican technology professionals came together with a desire to assist underserved university students on STEM education paths. We began in Jamaica, where we spoke with academic and student leadership in ICT education to ask what gaps we could fill. With their responses in mind, we focused our mission on promoting equitable access to life opportunities for STEM education recipients.

Our first program, the Calico Challenge, began in 2016, supporting the Jamaican ICT student community. In 2020, we realized that a similar gap existed for underserved students in our local San Francisco Bay area community. This realization inspired us to expand to the USA. Using the successful Calico Challenge as a model, we hope to do our part to fill opportunity gaps for underserved students in this area.

Figure 11: President Peter Harrison from the Palisadoes Foundation speaks to Jamaican students about the Calico Challenge program Figure 12: Calico Challenge History

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Meet Our Volunteers
The Palisadoes Foundation’s staff of volunteers includes the board president, treasurer, secretary, and several additional volunteers.

Peter Harrison, President
Peter is currently the Chief Technology Officer and a Co-Founder of Colovore. Colovore is a provider of high-density colocation solutions for companies operating high-performance IT hardware.

Peter has built the core web infrastructure for several of Silicon Valley’s internet titans. Most recently, Peter worked at Google where he helped manage global data center demand and capacity planning; the Google Fiber program and its initial data center infrastructure rollout. Peter previously lead the network team that was responsible for the initial design and deployment of Netflix’s Internet video service.

Peter obtained his Computer Engineering undergraduate and postgraduate diplomas from the University of West Indies in Jamaica. By chance, Peter was recruited to support Y2K issues in the US, and found himself on a unique path to success. He is proof that the quality of Jamaican college education is strong, but it took chance opportunities to help him establish his place in Silicon Valley. He wants to ensure that Jamaican programmers who share his work ethic don’t have to wait for luck to develop their reputation in the growing world of Information Technology.

KG Charles-Harris, Secretary
KG is currently the Chief Executive Officer of Quarrio Corporation.

Quarrio Corp. is a software company that uses artificial intelligence (AI) to make it easy for average business users to do advanced reporting and analytics. KG has founded, built, and sold three companies in the software, biotech and services and investment banking industries. He was named Global Entrepreneur of the Year by the United Nations and is a board member and advisor to several companies.

KG grew up experiencing a variety of different cultures. When he moved to Jamaica from Sweden during his teenage years, it changed his life and he fell in love with the country. One of his goals is to provide college students in disadvantaged countries the ability to keep pace with cutting edge technologies. The Calico Project brings Jamaican computer science students the opportunity to experience real world open-source coding and collaboration on an international level. KG helps Palisadoes provide great students great opportunities, and teach them how to align themselves for future ones.

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Tennyson Williams, Treasurer
Tennyson is a Senior Technical Project Manager at Comcast. He has worked on projects for Google, PayPal, Cisco, and has also worked for Hewlett-Packard. He is passionate about the Palisadoes Foundation, and in particular the Calico Challenge, because it's one of the few programs that has a direct impact on the students. His forte is working on next generation technologies and products, which gives him great insight into what is required to stay current. He knows they are getting exposure to real world technology and will have the opportunity for their contribution to have direct impact to solve real world issues. He believes these are the things needed to raise the knowledge base of the Jamaican next generation of software developers such that they can compete with the rest of the world.

The Palisadoes Foundation Team
Palisadoes Foundation is also supported by a few
volunteers and its Advisory Board. Each year we work
together with our target communities to expand the
program and aid the fundraising effort. The Palisadoes
Foundation team is passionate about their mission to
bridge gaps in STEM barriers for underserved youth. We
are particularly excited about the potential of our current sustainable programs. We believe in exposing capable,
underserved university students to modern engineering
collaboration techniques. We are confident this will enable these new technology graduates to thrive in well-deserved roles and create increasingly diverse and creative
technologies.

Conclusion
The Palisadoes Foundation is committed to creating access to critical educational and professional experiences for underserved software engineering students. We are
continually learning from the community. We will continue to seek opportunities to remove racially-related barriers to success in the STEM industry. Our current efforts focus on removing the barrier to real-world experience during the student’s university pursuits. We do this by providing real- world, collaborative, and paid coding internships.

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Palisadoes Foundation Budget
Calico Challenge
The standard yearly Calico Challenge budget is $28,620 (US). The breakdown of these numbers is presented below.

Item Item Explanation Cost
(US Dollars)
Number
of Item
Student Stipend This stipend will provide each Jamaican student with the resources they need to focus their time
on their Open-Source project and learning from
their mentor, rather than finding an irrelevant
summer job.
$1500 (JA)
$3000(SF)
10 (JA)
3 (SF)
Mentor Thank You When possible, the Calico Challenge prefers to provide the volunteer mentors with a token thank
you as they manage several students and provide
a great deal of coaching and written feedback.
$375(JA)
$750(US)
6 3
Wire Transfers The Palisadoes Foundation will need to transfer stipend funds to the Jamaica Computer Society
for them to disburse the funds to the students.

These transfers cost $30 each.
$60 2
Total Cost: $28,620

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General Expenses
General expenses for the Palisadoes Foundation cost about $200 each year. While it varies, our current overhead expenses focus on paying for email and social media services, and legal costs related to expansion.

Item Item Explanation Cost
(US Dollars)
Number
of Item
MailChimp Subscription The Calico Challenge uses this service to communicate updates to sponsors, participants,
volunteers, and supporters. MailChimp provides
additional email capabilities which greatly
increases Calico’s efficiencies.
$200 1
Legal Costs As we look to expand in to the US, we will require legal advice to ensure a successful expansion.

Total Cost: $200
Eligibility YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
NA
Palisadoes Foundation (NEW) Eligibility Checklist (staff use only)

Form W-9
(Rev. October 2018)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
a Go to www.irs.gov/FormW9 for instructions and the latest information.

Give Form to the
requester. Do not
send to the IRS.

Print or type.

See Specific Instructions on page 3.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. 2 Business name/disregarded entity name, if different from above 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes.

Individual/sole proprietor or
single-member LLC
C Corporation S Corporation Partnership Trust/estate
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) a Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner.

Other (see instructions) a
4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):

Exempt payee code (if any)
Exemption from FATCA reporting
code (if any)
(Applies to accounts maintained outside the U.S.)
5 Address (number, street, and apt. or suite no.) See instructions. 6 City, state, and ZIP code
Requester’s name and address (optional)
7 List account number(s) here (optional)
Part I Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.

Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter.

Social security number
––
or
Employer identification number
–
Part II Certification
Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and

2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.

Sign
Here
Signature of
U.S. person a Date a
General Instructions
Section references are to the Internal Revenue Code unless otherwise noted.

Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9.

Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
• Form 1099-B (stock or mutual fund sales and certain other transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.

If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later.

Cat. No. 10231X Form W-9 (Rev. 10-2018)
American Cancer Society, Inc.
✔ Non-Profit, IRS 501(c)(3)
1 A
PO Box 111417
Campbell, CA 95011
13 178849 1
7/6/21

Form W-9 (Rev. 10-2018) Page 2
By signing the filled-out form, you:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),

2. Certify that you are not subject to backup withholding, or

3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and

4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting, later, for further information.

Note: If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.

Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien; • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States; • An estate (other than a foreign estate); or
• A domestic trust (as defined in Regulations section 301.7701-7).

Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners’ share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income.

In the cases below, the following person must give Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States.
• In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity;
• In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and
• In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust.

Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities).

Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a “saving clause.” Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes.

If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items.

1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien.

2. The treaty article addressing the income.

3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions.

4. The type and amount of income that qualifies for the exemption from tax.

5. Sufficient facts to justify the exemption from tax under the terms of the treaty article.

Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption.

If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form 8233.

Backup Withholding
What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 24% of such payments. This is called “backup withholding.” Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding.

You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return.

Payments you receive will be subject to backup withholding if:

1. You do not furnish your TIN to the requester,

2. You do not certify your TIN when required (see the instructions for Part II for details),

3. The IRS tells the requester that you furnished an incorrect TIN,

4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or

5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only).

Certain payees and payments are exempt from backup withholding.

See Exempt payee code, later, and the separate Instructions for the Requester of Form W-9 for more information.

Also see Special rules for partnerships, earlier.

What is FATCA Reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code, later, and the Instructions for the Requester of Form W-9 for more information.

Updating Your Information
You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account; for example, if the grantor of a grantor trust dies.

Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.

Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.

Form W-9 (Rev. 10-2018) Page 3
Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.

Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties.

Specific Instructions
Line 1
You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return.

If this Form W-9 is for a joint account (other than an account maintained by a foreign financial institution (FFI)), list first, and then circle, the name of the person or entity whose number you entered in Part I of Form W-9. If you are providing Form W-9 to an FFI to document a joint account, each holder of the account that is a U.S. person must provide a Form W-9.
a. Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name.

Note: ITIN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1a. This should also be the same as the name you entered on the Form 1040/1040A/1040EZ you filed with your application.
b. Sole proprietor or single-member LLC. Enter your individual name as shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade, or “doing business as” (DBA) name on line 2. c. Partnership, LLC that is not a single-member LLC, C corporation, or S corporation. Enter the entity's name as shown on the entity's tax return on line 1 and any business, trade, or DBA name on line 2.
d. Other entities. Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on line 2.
e. Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a “disregarded entity.” See Regulations section 301.7701-2(c)(2)(iii). Enter the owner's name on line 1. The name of the entity entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on line 2, “Business name/disregarded entity name.” If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9.

This is the case even if the foreign person has a U.S. TIN.

Line 2
If you have a business name, trade name, DBA name, or disregarded entity name, you may enter it on line 2.

Line 3
Check the appropriate box on line 3 for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box on line 3.

IF the entity/person on line 1 is
a(n) . . .

THEN check the box for . . .
• Corporation Corporation
• Individual
• Sole proprietorship, or
• Single-member limited liability
company (LLC) owned by an
individual and disregarded for U.S.
federal tax purposes.

Individual/sole proprietor or single-
member LLC
• LLC treated as a partnership for
U.S. federal tax purposes,
• LLC that has filed Form 8832 or
2553 to be taxed as a corporation,
or
• LLC that is disregarded as an
entity separate from its owner but
the owner is another LLC that is
not disregarded for U.S. federal tax
purposes.

Limited liability company and enter
the appropriate tax classification.
(P= Partnership; C= C corporation;
or S= S corporation)
• Partnership Partnership
• Trust/estate Trust/estate
Line 4, Exemptions
If you are exempt from backup withholding and/or FATCA reporting, enter in the appropriate space on line 4 any code(s) that may apply to you.

Exempt payee code.
• Generally, individuals (including sole proprietors) are not exempt from backup withholding.
• Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends. • Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions. • Corporations are not exempt from backup withholding with respect to attorneys’ fees or gross proceeds paid to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form 1099-MISC.

The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space in line 4. 1—An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2)
2—The United States or any of its agencies or instrumentalities 3—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities 4—A foreign government or any of its political subdivisions, agencies, or instrumentalities
5—A corporation
6—A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or possession
7—A futures commission merchant registered with the Commodity Futures Trading Commission
8—A real estate investment trust
9—An entity registered at all times during the tax year under the Investment Company Act of 1940
10—A common trust fund operated by a bank under section 584(a) 11—A financial institution
12—A middleman known in the investment community as a nominee or custodian
13—A trust exempt from tax under section 664 or described in section 4947
Form W-9 (Rev. 10-2018) Page 4
The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 13.

IF the payment is for . . . THEN the payment is exempt
for . . .

Interest and dividend payments All exempt payees except for 7
Broker transactions Exempt payees 1 through 4 and 6
through 11 and all C corporations.

S corporations must not enter an
exempt payee code because they
are exempt only for sales of
noncovered securities acquired
prior to 2012.

Barter exchange transactions and
patronage dividends
Exempt payees 1 through 4
Payments over $600 required to be
reported and direct sales over
$5,000
1 Generally, exempt payees
1 through 5
2 Payments made in settlement of
payment card or third party network
transactions
Exempt payees 1 through 4
1 See Form 1099-MISC, Miscellaneous Income, and its instructions. 2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys’ fees, gross proceeds paid to an attorney reportable under section 6045(f), and payments for services paid by a federal executive agency.

Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements. A requester may indicate that a code is not required by providing you with a Form W-9 with “Not Applicable” (or any similar indication) written or printed on the line for a FATCA exemption code.

A—An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37) B—The United States or any of its agencies or instrumentalities C—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities D—A corporation the stock of which is regularly traded on one or more established securities markets, as described in Regulations section 1.1472-1(c)(1)(i)
E—A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section 1.1472-1(c)(1)(i) F—A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state
G—A real estate investment trust
H—A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940
I—A common trust fund as defined in section 584(a)
J—A bank as defined in section 581
K—A broker
L—A trust exempt from tax under section 664 or described in section 4947(a)(1)
M—A tax exempt trust under a section 403(b) plan or section 457(g) plan
Note: You may wish to consult with the financial institution requesting this form to determine whether the FATCA code and/or exempt payee code should be completed.

Line 5
Enter your address (number, street, and apartment or suite number).

This is where the requester of this Form W-9 will mail your information returns. If this address differs from the one the requester already has on file, write NEW at the top. If a new address is provided, there is still a chance the old address will be used until the payor changes your address in their records.

Line 6
Enter your city, state, and ZIP code.

Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below.

If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN.

If you are a single-member LLC that is disregarded as an entity separate from its owner, enter the owner’s SSN (or EIN, if the owner has one). Do not enter the disregarded entity’s EIN. If the LLC is classified as a corporation or partnership, enter the entity’s EIN.

Note: See What Name and Number To Give the Requester, later, for further clarification of name and TIN combinations.

How to get a TIN. If you do not have a TIN, apply for one immediately.

To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local SSA office or get this form online at www.SSA.gov. You may also get this form by calling 1-800-772-1213.

Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/Businesses and clicking on Employer Identification Number (EIN) under Starting a Business. Go to www.irs.gov/Forms to view, download, or print Form W-7 and/or Form SS-4. Or, you can go to www.irs.gov/OrderForms to place an order and have Form W-7 and/or SS-4 mailed to you within 10 business days.

If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and write “Applied For” in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments.

You will be subject to backup withholding on all such payments until you provide your TIN to the requester.

Note: Entering “Applied For” means that you have already applied for a TIN or that you intend to apply for one soon.

Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W-8.

Part II. Certification
To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, 4, or 5 below indicates otherwise.

For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on line 1 must sign. Exempt payees, see Exempt payee
code, earlier.

Signature requirements. Complete the certification as indicated in items 1 through 5 below.

Form W-9 (Rev. 10-2018) Page 5

1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983.

You must give your correct TIN, but you do not have to sign the certification.

2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form.

3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification.

4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. “Other payments” include payments made in the course of the requester’s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations).

5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), ABLE accounts (under section 529A), IRA, Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification.

What Name and Number To Give the Requester
For this type of account: Give name and SSN of:

1. Individual The individual

2. Two or more individuals (joint
account) other than an account
maintained by an FFI
The actual owner of the account or, if
combined funds, the first individual on
the account
1 3. Two or more U.S. persons
(joint account maintained by an FFI)
Each holder of the account

4. Custodial account of a minor
(Uniform Gift to Minors Act)
The minor2

5. a. The usual revocable savings trust
(grantor is also trustee)
b. So-called trust account that is not
a legal or valid trust under state law
The grantor-trustee1
The actual owner
1 6. Sole proprietorship or disregarded
entity owned by an individual
The owner
3 7. Grantor trust filing under Optional
Form 1099 Filing Method 1 (see
Regulations section 1.671-4(b)(2)(i)
(A))
The grantor*
For this type of account: Give name and EIN of:

8. Disregarded entity not owned by an
individual
The owner

9. A valid trust, estate, or pension trust Legal entity4

10. Corporation or LLC electing
corporate status on Form 8832 or
Form 2553
The corporation

11. Association, club, religious,
charitable, educational, or other tax-
exempt organization
The organization

12. Partnership or multi-member LLC The partnership

13. A broker or registered nominee The broker or nominee For this type of account: Give name and EIN of:

14. Account with the Department of
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
The public entity

15. Grantor trust filing under the Form
1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
Regulations section 1.671-4(b)(2)(i)(B))
The trust
1 List first and circle the name of the person whose number you furnish.

If only one person on a joint account has an SSN, that person’s number must be furnished.
2 Circle the minor’s name and furnish the minor’s SSN.
3 You must show your individual name and you may also enter your business or DBA name on the “Business name/disregarded entity” name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN.
4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for partnerships, earlier.
*Note: The grantor also must provide a Form W-9 to trustee of trust.

Note: If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed.

Secure Your Tax Records From Identity Theft
Identity theft occurs when someone uses your personal information such as your name, SSN, or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund.

To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax preparer.

If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter.

If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039.

For more information, see Pub. 5027, Identity Theft Information for Taxpayers.

Victims of identity theft who are experiencing economic harm or a systemic problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059.

Protect yourself from suspicious emails or phishing schemes.

Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft.

Form W-9 (Rev. 10-2018) Page 6
The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts.

If you receive an unsolicited email claiming to be from the IRS, forward this message to [email protected]. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration (TIGTA) at 1-800-366-4484. You can forward suspicious emails to the Federal Trade Commission at [email protected] or report them at www.ftc.gov/complaint. You can contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338).

If you have been the victim of identity theft, see www.IdentityTheft.gov and Pub. 5027.

Visit www.irs.gov/IdentityTheft to learn more about identity theft and how to reduce your risk.

Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information.

Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer.

Certain penalties may also apply for providing false or fraudulent information.

Eligibility YES NO Notes:

Be made or sponsored by a 501(c)(3) non‐profit organization with experienced members capable of implementing and managing the program/project/event
X
Identify how the funds will be used to benefit the Cupertino community X
Be awarded only once per projec
t X
For specific needs, not on going, operational costs X
Have more than 75% of the requested funds allocated for direct service costs versus administrative costs X
Be complete and submitted by the application deadline X Restrictions/Guidelines YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
NA
American Cancer Society Relay for Life (NEW) Eligibility Checklist (staff use only)

Eligibility YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
x Registration Fee (amount not
specified) for workshop.

STEMBoost Corporation (NEW) Eligibility Checklist (staff use only)

Deepa Gopalakrishnan
Founder, Youngzine
10386 Avenida Ln
Cupertino, CA 95014

Dear Cupertino Grant Committee Members,

Thank you for considering Youngzine for the grant opportunity from Parks and Rec, Cupertino.

I wanted to clarify that the IRS letter for 501c3 certification was granted when the organization was incorporated in San Jose. In 2015, the organization address was moved to Cupertino and since then, that is the official address on IRS records. I have tried many times to amend the original letter but was informed that is not possible. Hence, I am including additional images from the IRS website that show the location of the organization as well as the 990N.

I hope this helps clarify the address. Thank you.

Eligibility YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
12e. Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
x Registration Fee (amount not
specified) for program.

Youngzine (New) Eligibility Checklist (staff use only)

DEPARTMENT OF THE TREASURY

INTERNAL REVENUE SERVICE
CINCINNATI OH 45999-0023
Date of this notice: 05-20-2016
Employer Identification Number:
81-2697003
Form: SS-4
Number of this notice: CP 575 A
ABLE 2 SHINE FOUNDATION

For assistance you may call us at:
1-800-829-4933

IF YOU WRITE, ATTACH THE
STUB AT THE END OF THIS NOTICE.

WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER
Thank you for applying for an Employer Identification Number (EIN). We assigned you EIN 81-2697003. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records.

When filing tax documents, payments, and related correspondence, it is very important that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. If the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us.

Based on the information received from you or your representative, you must file the following form(s) by the date(s) shown.

Form 1120 03/15/2017
If you have questions about the form(s) or the due date(s) shown, you can call us at the phone number or write to us at the address shown at the top of this notice. If you need help in determining your annual accounting period (tax year), see Publication 538, Accounting Periods and Methods.

We assigned you a tax classification based on information obtained from you or your representative. It is not a legal determination of your tax classification, and is not binding on the IRS. If you want a legal determination of your tax classification, you may request a private letter ruling from the IRS under the guidelines in Revenue Procedure 2004-1, 2004-1 I.R.B. 1 (or superseding Revenue Procedure for the year at issue). Note:

Certain tax classification elections can be requested by filing Form 8832, Entity Classification Election. See Form 8832 and its instructions for additional information.

IMPORTANT INFORMATION FOR S CORPORATION ELECTION:

If you intend to elect to file your return as a small business corporation, an election to file a Form 1120-S must be made within certain timeframes and the corporation must meet certain tests. All of this information is included in the instructions for Form 2553, Election by a Small Business Corporation.

(IRS USE ONLY) 575A 05-20-2016 ABLE B 9999999999 SS-4 If you are required to deposit for employment taxes (Forms 941, 943, 940, 944, 945, CT-1, or 1042), excise taxes (Form 720), or income taxes (Form 1120), you will receive a Welcome Package shortly, which includes instructions for making your deposits electronically through the Electronic Federal Tax Payment System (EFTPS). A Personal Identification Number (PIN) for EFTPS will also be sent to you under separate cover.

Please activate the PIN once you receive it, even if you have requested the services of a tax professional or representative. For more information about EFTPS, refer to Publication 966, Electronic Choices to Pay All Your Federal Taxes. If you need to make a deposit immediately, you will need to make arrangements with your Financial Institution to complete a wire transfer.

The IRS is committed to helping all taxpayers comply with their tax filing obligations. If you need help completing your returns or meeting your tax obligations, Authorized e-file Providers, such as Reporting Agents (payroll service providers) are available to assist you. Visit the IRS Web site at www.irs.gov for a list of companies that offer IRS e-file for business products and services. The list provides addresses, telephone numbers, and links to their Web sites.

To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1-800-829-3676 (TTY/TDD 1-800-829-4059) or visit your local IRS office.

IMPORTANT REMINDERS:
* Keep a copy of this notice in your permanent records. This notice is issued only one time and the IRS will not be able to generate a duplicate copy for you. You may give a copy of this document to anyone asking for proof of your EIN. * Use this EIN and your name exactly as they appear at the top of this notice on all your federal tax forms.
* Refer to this EIN on your tax-related correspondence and documents.

If you have questions about your EIN, you can call us at the phone number or write to us at the address shown at the top of this notice. If you write, please tear off the stub at the bottom of this notice and send it along with your letter. If you do not need to write us, do not complete and return the stub.

Your name control associated with this EIN is ABLE. You will need to provide this information, along with your EIN, if you file your returns electronically.

Thank you for your cooperation.
(IRS USE ONLY) 575A 05-20-2016 ABLE B 9999999999 SS-4 Keep this part for your records. CP 575 A (Rev. 7-2007) ---------------------------------------------------------------------------------------------- Return this part with any correspondence
so we may identify your account. Please CP 575 A correct any errors in your name or address.
9999999999
Your Telephone Number Best Time to Call DATE OF THIS NOTICE: 05-20-2016 ( ) - EMPLOYER IDENTIFICATION NUMBER: 81-2697003 _____________________ _________________ FORM: SS-4 NOBOD INTERNAL REVENUE SERVICE ABLE 2 SHINE FOUNDATION CINCINNATI OH 45999-0023

Eligibility YES NO Notes:

Be made or sponsored by a 501(c)(3) non‐profit organization with experienced members capable of implementing and managing the program/project/event
x
Identify how the funds will be used to benefit the Cupertino community x
Be awarded only once per projec
t x
For specific needs, not on going, operational costs x $9,000 Staffing/$11,000 non‐operational Have more than 75% of the requested funds allocated for direct service costs versus administrative costs x $9,000 Staffing/$11,000 non‐operational Be complete and submitted by the application deadline x Restrictions/Guidelines YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
NA
Able 2 Shine (NEW) Eligibility Checklist (staff use only)

Eligibility YES NO Notes:

Be made or sponsored by a 501(c)(3) non‐profit organization with experienced members capable of implementing and managing the program/project/event x
Identify how the funds will be used to benefit the Cupertino community x Be awarded only once per project x
For specific needs, not on going, operational costs x
Have more than 75% of the requested funds allocated for direct service costs versus administrative costs x
Be complete and submitted by the application deadline x Restrictions/Guidelines YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA Proceeds generated from the funded activity may only be used for the conducted activity NA admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission NA Cupertino Educational Endowment Foundation (NEW) Eligibility Checklist (staff use only)

Eligibility YES NO Notes:

Be made or sponsored by a 501(c)(3) non‐profit organization with experienced members capable of implementing and managing the program/project/event
x Public Schools are considered non‐profit organizations by the IRS and 501(c)(3) status is not required.

Identify how the funds will be used to benefit the Cupertino community x Be awarded only once per project x
For specific needs, not on going, operational costs x
Have more than 75% of the requested funds allocated for direct service costs versus administrative costs x
Be complete and submitted by the application deadline x Restrictions/Guidelines YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
NA
Cupertino Union School District Summer Bridge (NEW) Eligibility Checklist (staff use only)

Over the last several
decades, the FUHS Foun-
dation has supported
supplemental opportuni-
ties for the students of
FUHSD, enhancing the
exemplary educational
experience that is
offered at all five of our
comprehensive high
schools. These addition-
al opportunities have
allowed students to
more fully explore their
passions in a variety of
interest areas. The en-
thusiasm and dedication
displayed by the Foun-
dation Board is truly re-
markable, and we are
especially appreciative
of their tireless work,
which has not dimin-
ished over the past year
and a half of the pan-
demic. The Foundation
has continued to raise
critical funds for our stu-
dents and programs,
particularly in the areas
of Student Support, Aca-
demic Enrichment, and
College and Career
Readiness. As an all-
volunteer organization,
the Foundation has
worked diligently to en-
sure that more dollars
are flowing directly to
students in our music,
theater, athletics, jour-
nalism, FBLA, robotics
and STEM programs,
while also supporting
critical student services
like our partnership with
Care Solace, an online
resource that assists stu-
dents and families in lo-
cating mental health and
counseling services. The
services provided by
Care Solace have been
critical to our families as
they have navigated the
effects of the pandemic,
and the support of the
Foundation has allowed
us to continue providing
this valuable resource to
our school community.

On behalf of the entire
district, I want to thank
the Foundation for their
continued efforts to sup-
port our teachers and
staff and ensure that
every student has the
best possible foundation
for success in the future.

We work closely with the District to allocate funds for services and programs. We’re proud to support these programs and more.

ACADEMIC ENRICHMENT
• Science, Technology, Engineering and Math (STEM) classes at all five schools • Direct Grants to Teachers for equipment and innovative programs • Robotics equipment and competition entry fees
• Journalism Support for school newspapers
• District-Wide Art Show to showcase our students’ talents in the visual arts • Choral Festival to showcase our students’ talents in the performing arts • AVID—a college readiness system for Advancement Via Individual Determination • Teacher Summer Work Teams – curriculum collaboration
What We Fund
A Message from Superintendent Polly Bove
Fremont Union High Schools Foundation
2020—2021 Annual Report

Page 2 ends

Every year, the Foundation awards $1,000 scholarships to students at each school. These students are selected by school staff based on having overcome significant obstacles with courage and grace. This 2020-2021 awardees were:

Anushka Kelkar - Lynbrook
Evelyn Solis Cabrera - Homestead
Winter Bloom - Monta Vista
Audrey Su - Fremont
Heather Kuhl - Cupertino
Zelli Duke - Educational Options (not pictured)
Foundation Scholars

Page 4 ends

We received a very generous bequest from the estate of Jane French, a 1953 Fremont High gradu- ate. Jane and Dick French, became high school sweethearts and went on to get married and reside in Sunnyvale until they both passed away. Substantial donations also came in honoring Captain Pat- rick Klokow, a Homestead High alumnus and proud marine, and Harry Bettencourt, a teacher, princi- pal, and long-time supporter of the Foundation. These donations kicked off our Legacy Giving pro- gram and propelled our Endowment to a $1-million milestone, which allows us to disburse money each year to further the Foundation’s mission, helping students today and for years to come.

If you’d like more information about Legacy Giving, please contact us at [email protected].

Legacy Giving
Fremont Union High Schools Foundation
2020—2021 Annual Report
Fremont Union High Schools Foundation
2020—2021 Annual Report

Page 5 ends

For 2020 - 2021 school year, our total income was $927,349, as beneficiary of a legacy gift.

Total expenses were $404,876, which includes our legacy giving, endowment, and managed scholarship programs. Our standard Operating Income and Expenses are shown below.

Financials

The Foundation is honored to serve this wonderful community. We strive to make a difference in the educational experience of all students. Stay informed with our monthly newsletter by signing up on the home page of our website.

We appreciate your support.

Expanding Opportunities to Explore, Discover, and Learn 589 West Fremont Avenue
Sunnyvale, CA 94087
(408) 773-1218
[email protected]
fuhsfoundation.org
Tax ID: 94-2907804

Page 8 ends

Eligibility YES NO Notes:

Be made or sponsored by a 501(c)(3) non‐profit organization with experienced members capable of implementing and managing the program/project/event x
Identify how the funds will be used to benefit the Cupertino community x Be awarded only once per project x
For specific needs, not on going, operational costs x
Have more than 75% of the requested funds allocated for direct service costs versus administrative costs x
Be complete and submitted by the application deadline x Restrictions/Guidelines YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
NA
Fremont Union School District High School Foundation (NEW) Eligibility Checklist (staff use only)

WomenSV
Links to Articles

WomenSV was featured on the front page of the San Jose Mercury News on 12/31/20 as part of their Wish Book series
https://wishbook.mercurynews.com/2020/women

WomenSV Founder & Executive Director Ruth Darlene wrote a 7 part series on domestic violence and coercive control for the Los Altos Town Crier. Links to the series (which ran between 11/11/20 – 12/23/20) are below:

Part 1
https://www.losaltosonline.com/news/sections/community/177-features/63517-invisible-abuse-coercive- control-violates-right-to-live-in-peace

Part 2
https://www.losaltosonline.com/news/sections/community/177-features/63553-confronting-domestic- violence-new-state-legislation-addresses-coercive-control

Part 3
https://www.losaltosonline.com/news/sections/community/177-features/63580-confronting-domestic- violence-the-tactics-of-covert-abusers

Part 4
https://www.losaltosonline.com/news/sections/community/177-features/63636-confronting-domestic- violence-the-impacts-of-coercive-control

Part 5
https://www.losaltosonline.com/news/sections/community/177-features/63677-confronting-domestic- violence-subtle-forms-of-abuse-wear-victims-down

Part 6
https://www.losaltosonline.com/news/sections/community/177-features/63710-confronting-domestic- violence-education-proves-best-form-of-protection

Part 7
https://www.losaltosonline.com/news/sections/community/177-features/63731-recognizing-the-warning- signs-of-coercive-control

Eligibility YES NO Notes:

Be made or sponsored by a 501(c)(3) non‐profit organization with experienced members capable o implementing and managing the program/project/event x
Identify how the funds will be used to benefit the Cupertino community x Be awarded only once per project x
For specific needs, not on going, operational costs x
Have more than 75% of the requested funds allocated for direct service costs versus administrativ costs x
Be complete and submitted by the application deadlin x
Restrictions/Guidelines YES NO Notes:

An organization that is applying for multiple grants shall only submit one applicatio NA Proceeds generated from the funded activity may only be used for the conducted activi NA admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unles stated in the application and approved by Parks and Recreation Commission NA Women SV (NEW) Eligibility Checklist (staff use only

Breathe California of the Bay Area report for July 1, 2020 through December 31, 2021 (Extension)

a. Please provide a line-item breakdown of how the Community Funding Grant was used last year in the categories below. If a category is not applicable, put $0:

a. Admin Staff $____250
b. Materials/Equipment $____781_______
c. Environment $____ 30
d. Room/Venue Rental $___ 120
e. Other professional Services $__ 2,761
i. Please specify
f. Other expenses $___ 58 ______
i. Please specify: travel $ 4,000 TOTAL

b. Who was served by the grant last year?
g. Number of individuals total 1,894______
h. Number of Cupertino Residents ____1,894______

i. Particular Community Groups
i. Please specify: focus on seniors, but most were general Cupertino residents this year.

j. Was the program/project/event available to the entire community/public or was their eligibility criteria? Yes

k. Was there a charge or fee for the program/project/event? No

b. Was the program/project/event successful? More successful than we thought considering the pandemic. We did not meet our goal for number of people reached, reaching 1,874 of the 3,000 we had hoped to serve, but we worked harder than ever to let people know we were still there to serve. We spent a lot less on travel to deliver services but needed to spend much more on staffing than usual, as it was staff and not volunteers handling phone and website duties as we sheltered. While most of our Cupertino partners were closed to the public, we worked with long-time partners to reach their senior clients (Chateau Cupertino, Cupertino Healthcare and Wellness Center, Villa Sienna). Please indicate how success was measured. We measured success by how we were able to connect with Cupertino residents during this difficult time and how we were able to serve their lung health needs despite most of our community partners being closed for most of the time. Cupertino residents participated in our on-line presentations and the 2-hour World COPD Day webinar event that included yoga breathing, COPD jeopardy game, and practical instruction on using inhalers and spacers, along with a talk from one of the COPD experts at the National Heart, Lung, and Blood Institute. They picked up health education materials at senior centers that they visited one-at-a-time when they reopened, and they were able to connect with us by phone and email to arrange other services such as getting respiratory therapy equipment or asking about air pollution. We sent much more by old-fashioned snail mail this year, including information on getting COVID vaccinations, and fliers to physicians and clinics in Cupertino to promote our curbside and on- line health education offerings for their patients. Finally, there was the Silicon Valley Fall Festival, our first big in-person health fair in Cupertino since the pandemic, a very busy event that reminded us of life before COVID. We are set to provide services with or without COVID now and into the future. Seniors are the most vulnerable population for COVID, and we will do all that we can to reach them.

c. Please indicate any addition funding received last year from other sources and provide your financial statement if available. : $50,000 from National Heart, Lung, and Blood Institute; $25,000 from El Camino Hospital District.

Eligibility YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
NA
Breathe California of the Bay Area (Returning) Eligibility Checklist (staff use only)

Eligibility YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
NA
Tian Hong Foundation (Returning) Eligibility Checklist (staff use only)

Eligibility YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
NA
Buddhist Tzu Chi Medical Foundation (Returning) Eligibility Checklist (staff use only)

Heart of the Valley - COVID Car Kit materials table
PPE Price Quantity Cost
KN95 Masks – for close contact, ie transportation & in-Home Services $149.98 2,000 $149.98 3 Ply Masks – for outside services, ie yardwork/handyman/HHW/5D $155.55 2,000 $155.55 Disposable gloves – various sizes – 1,000/pack $49.99 2,000 $350.00 Disposable Antiseptic Towelettes – 1,000/pack – 20 towelettes per service $25.47 40 $1,018.80 Lysol Disinfectant Spray – 12 pack $69.99 400 $2,379.66 Paper Towels – 16 rolls/case - 128 sheets/roll $31.79 25 $47.69 Kleenex – 18 boxes/case $26.49 400 $588.67
Jumbo Zip Lock Bags – 10/box $14.98 400 $599.20
1 Gallon Zip Lock Bags – 200/box $21.99 2,000 $219.90
Printed Cards $0.33 400 $132,00
Tax 9.20% $519.01
COVID Car Kits 400 $6,160.46
Eligibility YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
NA
Services for Seniors ‐ Heart of the Valley (Returning) Eligibility Checklist (staff use only)

Program: Starting the Conversation and Mindful Self-Care Agency: Chinese American Coalition for Compassionate Care

City of Cupertino Community Funding Grant
Annual Project Report

Agency/Organization
Chinese American Coalition for Compassion

Project
Starting the Conversation and Mindful Self-Ca

Contact Person
Jeanne Wun

Title
Past Board Chair

Phone
408-896-7366

E-Mail
[email protected]

Grant Received:
$6,000

A. Project Results:

Was your program/project/event affected by COVID-19?
Yes
No

Was the program/project/event successful? Please indicate how success was measured:

2020/2021 was an extraordinary and challenging time for everyone. We had to adjust and address the needs of our constituents, the Chinese community, caregivers, healthcare professionals, trained volunteers and staff who were all impacted by the pandemic. With a generous $6K community grant from the City of Cupertino and funding from other sources, CACCC successfully hosted seven (7) Heart to Heart Cafés with 166 participants; held eight (8) Advance Care Planning presentations and Advance Health Care Directive workshops with 377 participants; provided 81 Weekly Mindful Caregiver Stress Reduction sessions with 2877 participants for a total of 3420 participants served during the grant period. All conducted virtually, in Mandarin, at no charge to the participants.

• CACCC exceeded the number of proposed participants served by 64% • CACCC exceeded the number of proposed Cupertino Residents served by 4% (Note, we reduced the proposed number of Cupertino residents reached from 80% to 30%, due to the pandemic. We did not have access the Cupertino Library to distribute Advance Directives.

At the conclusion of each event, participants complete a program evaluation survey and CACCC is able to capture and access the registration and attendance information using Eventbrite and the Zoom platform applications.

Success was measured by the number of programs and events held and program attendance for each one based on proposed numbers of participation against actual participation numbers.

Additionally, success was measured by what participants had to say about our programs:

Weekly Mindful Caregiving Stress Reduction:
• Improved my daily life by using Mindfulness. Wish I knew about it much earlier in my life.
• It's so great to learn with a group who share similar cultures with me. • This weekly session helped me go through these difficult pandemic times.

Heart to Heart Cafés:
• Heart to heart support, especially in the midst of pandemic. • I'm excited to receive the Heart to Heart cards and talk about it with my parents so I know what end of life and death wishes they have that they'd like me to follow.
• Having the Heart to Heart Cards, I can discuss with patients and family, which is easier than asking an open ended question such as "what are your goals at the end of your life?"
ACP Presentation
• I know more about hospital care, hospice care and preparation for the last period of my life.

B. Clients Served:

Please report the number of clients served as a result of this grant:

Proposed in Application Actual from Event
Total Number of Individuals 1232
3420

Cupertino Residents 985
1026

Particular community groups served:

Was the program/project/event available to the entire community/public or were there any eligibility criteria?

Yes. All programs and events are free to the community and general public who speak Chinese.

Was there a charge or fee for the program/project/event? Yes
No

What outreach methods did your organization use to promote the program/project/ event?

CACCC utilized our website; social media: Facebook, Eventbrite, Twitter; WeChat and Line Group; E-distribution list; partner organization referrals; word of mouth; news release; promotional flyers and TV/radio interviews to promote our programs and events.

C. Budget:

Please enter your proposed budget from your application, and your actual expenses accrued from this grant:

Category Application Budget Actual
Expenditures % of Total
Admin Staff $3000
$3000
25%

Materials/Equipment $5000
$4720
39%

Entertainment

Room/Venue Rental $800

Professional Services (describe)
$800
$1200 10%

Other:
$2400

$3265.82
26%

Other:

Total 12000
$12,185.82
100%
Remaining Balance

Note: Minus -$186 to balance actual to $12K.

Do you intend to apply for Community Funding next year? Yes
No
If yes, how much to you intend to apply for?
$12000

Please list any additional funding received last year from other sources for this program:

CACCC requested a $12,000 community funding grant from the City of Cupertino and received a gracious $6,000 for this program. A grant received from Mount Zion Health Fund in 2020 was used to cover a portion of this program.

Uploaded Documents:

Please upload all receipts for your program/project/event.

Provide your financial statement if available.

Click here to go to the Upload Documents page (Your report will be saved)

Person who Prepared Form
Jeanne Wun

Title
Past Board Chair

Phone Number
408-896-7366

Date: 06/25/2021

2 of 7 CACCC

3 of 7 CACCC

4 of 7 CACCC

5 of 7 CACCC

6 of 7 CACCC

Date Description Amount
7/6/2020 USPS - Heart to Heart cards to Heart to Heart Café attendees $ 37.69 7/10/2020 USPS - Heart to Heart cards to Heart to Heart Café attendees $ 15.05 7/17/2020 USPS: End-of-Life educational materials $ 15.50 7/27/2020 6 Books - The Five Invitation $ 125.94 8/13/2020 USPS: Mailing out educational materials $ 23.25 8/21/2020 USPS: Shipping out AHCD forms to a warmline caller $ 7.75 8/24/2020 USPS: Shipping out AHCD forms to a warmline caller $ 7.75

7 of 7 CACCC

10/3/2020 One month of Zoom Webinar $ 140.00
10/17/2020 Amazon purchase of certificate holders $ 19.99 10/30/2020 USPS: Mailing out heart to heart cards $ 22.39 10/31/2020 Amazon purchase of 100 envelopes and certificate papers $ 27.66 11/6/2020 USPS: Mailing out educational materials, HTH cards $ 104.84 11/16/2020 One Year of Zoom Meeting $ 149.90
11/16/2020 One Year of Zoom Webinar $ 1,400.00
11/19/2020 USPS: Heart to Heart cards, AHCD & book $ 34.25 11/24/2020 USPS: Heart to Heart cards, AHCD & book $ 18.83 11/27/2020 USPS: Mailing out educational materials $ 11.20 12/4/2020 Printing Cost: 150 copies of Program Book $ 654.50 12/23/2020 USPS: Mailing out educational materials $ 5.60 12/29/2020 USPS: Mailing out educational materials $ 5.60 12/31/2020 USPS: Mailing out educational materials $ 11.73 1/4/2021 USPS: Heart to Heart cards, AHCD & book $ 14.00 1/19/2021 USPS: Heart to Heart cards, AHCD & book $ 38.30 1/28/2021 USPS: media mail $ 2.89
1/29/2021 USPS: Heart to Heart cards, AHCD & book $ 86.94 2/11/2021 USPS: x1 HTH Cards $ 4.15
2/16/2021 USPS: Heart to Heart cards, AHCD & book $ 21.39 2/22/2021 USPS: Heart to Heart cards, AHCD & book $ 47.23 2/23/2021 USPS: Heart to Heart cards, AHCD & book $ 48.75 2/26/2021 USPS: Heart to Heart cards, AHCD & book $ 18.65 3/29/2021 USPS: Heart to Heart cards, AHCD & book $ 69.48 4/6/2021 USPS: Heart to Heart cards, AHCD & book $ 40.75 4/6/2021 USPS: Book $ 2.89
4/24/2021 USPS: Book $ 2.89
5/6/2021 USPS: Heart to Heart cards, AHCD & book $ 10.84 5/29/2021 USPS: Heart to Heart cards, AHCD & book $ 17.25 $ 3,265.82

Eligibility YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
NA
Chinese American Coalition for Compassionate Care (Returning) Eligibility Checklist (staff use only)

CBSCI Event/Festival is not yet completed. Hence, we do not have the expenses/revenue or the number of persons.

Eligibility YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
NA
Cupertino Bhubaneswar Sister City Initiative (Returning) Eligibility Checklist (staff use only)

Euphrat Museum of Art’s Income Statement for fiscal year 2020 – 2021

SUPPORT
De Anza Associated Student Government grant $8,650

Individual Donations/Event
Fundraisers $10,548
Individual donations $15,000
$25,548
County and City
City of Cupertino $10,000

Subtotal support $44,198

REVENUES
Arts & Schools Program Fees/Services
2020 De Anza Summer Academy with Community Education Division $14,765

Interest/Payout Income $3,120
Subtotal revenue $17,885

TOTAL INCOME $62,083

EXPENSES
Director’s salary $85,980

Part-Time Staff
Preparator $3,172
Arts & Schools Program Instructors $0
(Summer Academy instructor fees deducted from final revenue check) 1st Thursday open mic host and special guest fees (L.E.A.’s with DASG) $4,200 $7,372

Hourly Students
Student Salaries $0

Benefits
Director $35,252
Casual Hourly $288
Student Hourly $0
$35,540

Subtotal Salaries + benefits $128,892

Marketing
Reception and event refreshments and meals $0
Postage $310
Online ad fees $375
Promotional vinyl signage $0
Announcement postcards and event flyers $0
$685
Exhibition/Production
‘Hope and Solace’ banners $3,891
Exhibition and public art supplies and materials $68 Fine Art and Fed Ex shipping $0
Arts & Schools Program supplies and materials $0
$3,959
Production Services
Tech & Prof Services (total) $3,500

Travel $0

Other
Equipment Rent/Lease $0

TOTAL EXPENSES $137,036

REVENUE OVER EXPENSES (-$74,953)

Note: In-kind support from the college is not included (i.e. facility and maintenance)

campus and community. Poet Laureates included Jing Jing Wang of Cupertino and Arlene Biala, Santa Clara County.

Dreaming and Imagining, February 4, 6:30 – 7:30 p.m., featured chef and social justice activist Jocelyn Jackson and other community caretakers and cultural curators.

Hope Takes Shape, May 20, 6:30-7:30 p.m., featured AAPI musicians, poets, and artists and celebrated the power of the Arts and Humanities to preserve and give voice to our diverse stories. The event included a Tabla performance by Cupertino Fine Arts Commissioner Satish Tare and his sons, The Last Hoisan Poets and the Del Sol Quartet, and more.
1st Thursday Open Mic Nights, December 3, April 1, May 6, and June 3, hosted by McTate Stroman II with special guests each event.

Other:
• Silicon Valley Reads’ Kickoff with Sources of Solace Slideshow, 1/28/21 • Presentation to San Jose High School Art Classes, 1/25/21 • Art with Poetry workshop for De Anza students, guest artists Juliana Kang- Robinson, Flo Oy Wong, Jing Jing Wang, 3/9/21
• Director a Cupertino Rotary Club High School Poetry Contest Judge, 5/21

Select Press:

Silicon Valley Reads: Euphrat exhibit provides ‘Sources of Solace’

https://www.mercurynews.com/2021/01/16/euphrat-exhibit-provides-sources-of- solace/
De Anza public art project aims to give ‘Hope and Solace’ https://www.mercurynews.com/2021/06/06/de-anza-public-art-project-aims-to- give-hope-and-solace/
2020-2021 Grant Expenditure Details

Admin staff - $1,800
• Applied to Director’s salary

Materials/Equipment - $3,891
• Hope and Solace project outdoor banners + equipment

Technical/Professional - $1,500
• Designer for Hope and Solace banner series, Juliana Kang-Robinson

Marketing (online) - $375
• Instagram, Facebook, Constant Contact

Total = $7,566*
Due to the pandemic and community closures we were not able to utilize all of the grant funds by June 2021. The remaining $2,434 has been applied to 2021- 2022 museum exhibitions and events, details will be in the 2021-2022 report.

Attendance
Exhibitions and programming in 2020-2021 were online and included a public art/poetry project at the perimeter of De Anza College on Stevens Creek Blvd. and Stelling Road.

Estimated online views of exhibitions and related events: total 6,440

Estimated viewers of Hope and Solace project:

Pedestrians – c. 1,650
Vehicles waiting at stoplights – c. 32,500

Eligibility YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
NA
Euphrat Museum of Art (Returning) Eligibility Checklist (staff use only)

Acknowledgement and General Information for
2020Entities That File Returns Electronically

PLEASE DO NOT SEND A PAPER COPY OF ENTITY'S RETURN TO THE IRS. IF YOU DO, IT WILL DELAY THE PROCESSING OF THE RETURN.

Thank you for participating in IRS e-file.

Entity address

1. 2020 income tax return for was filed electronically.

The electronic filing services were provided by .

2. income tax return was accepted on using a Personal Identification Number (PIN) as an electronic signature. The entity entered a PIN or authorized the Electronic Return Originator (ERO) to enter or generate a PIN signature.

The submission ID assigned to this return is .

EF ACK.LD
Name(s) as shown on return Employer Identification Number MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC **-***2635
21840 MCCLELLAN ROAD
Cupertino, CA 95014
X 990EZ Federal

ABC TAX AND ACCOUNTING
X 990EZ 10-31-2021
7723922021304i4kcvt0
(see the instructions for Part I)
Check if the organization used Schedule O to respond to any question in this Part I 990-EZ 2020
Short Form
Return of Organization Exempt From Income Tax
Open to Public
Inspection
Part I Revenue, Expenses, and Changes in Net Assets or Fund Balances Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) Do not enter social security numbers on this form as it may be made public.

A For the 2020 calendar year, or tax year beginning , 2020, and ending , 20 B D Employer identification number
E
F
G H
I Website:

J
K
L
1 1
2 2
3 3
4 4
5a 5a
b 5b
c 5c
6 a
6a
b
Revenue
6b
c 6c
d
6d
7a 7a
b 7b
c 7c
8 8
9 9
10 10
11 11
12 12
13 13
14 14
Expenses15 15
16 16
17 17
18 18
19 19
20 20
Net Assets21 21
For Paperwork Reduction Act Notice,
see the separate instructions.

Go to www.irs.gov/Form990EZ for instructions and the latest information.

Telephone number
Group Exemption
Number
Accounting Method: Cash Accrual Other (specify) Check if the organization is not required to attach Schedule B
Tax-exempt status (check only one) - (Form 990, 990-EZ, or 990-PF).

Form of organization: Corporation Trust Association Other Add lines 5b, 6c, and 7b to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part II, column (B)) are $500,000 or more, file Form 990 instead of Form 990-EZ $ Contributions, gifts, grants, and similar amounts received Program service revenue including government fees and contracts Membership dues and assessments
Investment income
Gross amount from sale of assets other than inventory
Less: cost or other basis and sales expenses
Gain or (loss) from sale of assets other than inventory (subtract line 5b from line 5a) Gaming and fundraising events:

Gross income from gaming (attach Schedule G if greater than $15,000)
Gross income from fundraising events (not including $ of contributions from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributions exceeds $15,000) Less: direct expenses from gaming and fundraising events Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c)
Gross sales of inventory, less returns and allowances
Less: cost of goods sold
Gross profit or (loss) from sales of inventory (subtract line 7b from line 7a) Other revenue (describe in Schedule O)
Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 Grants and similar amounts paid (list in Schedule O)
Benefits paid to or for members
Salaries, other compensation, and employee benefits
Professional fees and other payments to independent contractors Occupancy, rent, utilities, and maintenance
Printing, publications, postage, and shipping
Other expenses (descr be in Schedule O)
Total expenses. Add lines 10 through 16
Excess or (deficit) for the year (subtract line 17 from line 9) Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with end-of-year figure reported on prior year's return)
Other changes in net assets or fund balances (explain in Schedule O) Net assets or fund balances at end of year. Combine lines 18 through 20 Form 990-EZ (2020)
C
OMB No. 1545-0047
Form
Department of the Treasury
Internal Revenue Service
Name of organizationCheck if applicable:

Address change
Number and street (or P.O. box if mail is not delivered to street address) Room/suiteName change Initial return
Final return/terminated
City or town, state or province, country, and ZIP or foreign postal codeAmended return Application pending
501(c)(3) 501(c)( ) (insert no.) 4947(a)(1) or 527 EEA
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07-01 06-30 21
MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC 82-2152635
21840 MCCLELLAN ROAD (408)797-7443
Cupertino, CA 95014
X X
X
X
88,615
X
53,221
35,394
88,615
50,401
324
44,310
95,035
(6,420)
39,052
32,632
Form 990-EZ (2020)
(A) Beginning of year (B) End of year
(Required for section
501(c)(3) and 501(c)(4)
organizations; optional for
others.)
Balance Sheets (see the instructions for Part II)
Check if the organization used Schedule O to respond to any question in this Part II Statement of Program Service Accomplishments (see the instructions for Part III) Check if the organization used Schedule O to respond to any question in this Part III Part II
Part III
Part IV
22 22
23 23
24 24
25 Total assets 25
26 26
27 27
Expenses
28 28a
29 29a
30 30a
31 31a
32 32

Page 2 ends

Cash, savings, and investments
Land and buildings
Other assets (descr be in Schedule O)
Total liabilities (describe in Schedule O)
Net assets or fund balances (line 27 of column (B) must agree with line 21) What is the organization's primary exempt purpose?
Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title. (Grants $ ) If this amount includes foreign grants, check here (Grants $ ) If this amount includes foreign grants, check here (Grants $ ) If this amount includes foreign grants, check here Other program services (describe in Schedule O)
(Grants $ ) If this amount includes foreign grants, check here Total program service expenses (add lines 28a through 31a) List of Officers, Directors, Trustees, and Key Employees (list each one even if not compensated - see the instructions for Part IV) Check if the organization used Schedule O to respond to any question in this Part IV Form 990-EZ (2020)
(c) (d)(b) (e)
(a)
(if not paid, enter -0-)
Reportable Health benefits,Average Estimated amount ofcompensation contributions to employeeName and title hours per week other compensation(Forms W-2/1099-MISC) benefit plans, and devoted to position deferred compensation
EEA
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MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC 82-2152635
X
39,057 32,815
0 0
0 0
39,057 32,815
5 183
39,052 32,632

HIGH SCHOOL SPEECH BOOSTER CLUB

HIGH SCHOOL SPEECH INTER SCHOOL TOURNAMENT
0 0
Gopalswamy Rama Venkataraman
CHIEF FINANCIAL OFFICER 8.00 0 0 0
Rajeswari Mahalingam
CHIEF EXECUTIVE OFFICER 10.00 0 0 0
Lalitha Krishnan
SECRETARY 2.00 0 0 0
Jasneet Anand
Vice President 8.00 0 0 0
(Note the Schedule A and personal benefit contract statement requirements in the instructions for Part V.) Check if the organization used Schedule O to respond to any question in this Part V Part V Other Information
Yes No
33 33
34 34
35 a
35a
b 35b
c
35c
36 36
37 a 37a
b 37b
38 a
38a
b 38b
39 a 39a
b 39b
40 a
b
40b
c
d
e
40e
41 42 a
b Yes No
42b
c 42c
43 43
Yes No
44 a
44a
b
44b
c 44c
d
44d
45 a 45a
b
45b

Page 3 ends

Did the organization engage in any significant activity not previously reported to the IRS? If "Yes," provide a detailed description of each activity in Schedule O
Were any significant changes made to the organizing or governing documents? If "Yes," attach a conformed copy of the amended documents if they reflect a change to the organization's name. Otherwise, explain the change on Schedule O. See instructions
Did the organization have unrelated business gross income of $1,000 or more during the year from business activities (such as those reported on lines 2, 6a, and 7a, among others)? If "Yes," to line 35a, has the organization filed a Form 990-T for the year? If "No," provide an explanation in Schedule O Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e) notice, reporting, and proxy tax requirements during the year? If "Yes," complete Schedule C, Part III Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during the year? If "Yes," complete applicable parts of Schedule N Enter amount of political expenditures, direct or indirect, as described in the instructions Did the organization file Form 1120-POL for this year?
Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were any such loans made in a prior year and still outstanding at the end of the tax year covered by this return? If "Yes," complete Schedule L, Part II, and enter the total amount involved Section 501(c)(7) organizations. Enter:

Initiation fees and capital contr butions included on line 9 Gross receipts, included on line 9, for public use of club facilities Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under:
section 4911 ; section 4912 ; section 4955
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year, or did it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912, 4955, and 4958
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax on line 40c reimbursed by the organization
All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? If "Yes," complete Form 8886-T
List the states with which a copy of this return is filed The organization's books are in care of Telephone no.

Located at ZIP + 4
At any time during the calendar year, did the organization have an interest in or a signature or other authority over a financial account in a foreign country (such as a bank account, securities account, or other financial account)? If "Yes," enter the name of the foreign country
See the instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).

At any time during the calendar year, did the organization maintain an office outside the United States? If "Yes," enter the name of the foreign country
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041-Check here and enter the amount of tax-exempt interest received or accrued during the tax year Did the organization maintain any donor advised funds during the year? If "Yes," Form 990 must be completed instead of Form 990-EZ
Did the organization operate one or more hospital facilities during the year? If "Yes," Form 990 must be completed instead of Form 990-EZ
Did the organization receive any payments for indoor tanning services during the year? If "Yes," to line 44c, has the organization filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O
Did the organization have a controlled entity within the meaning of section 512(b)(13)? Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," Form 990 and Schedule R may need to be completed instead of Form 990-EZ. See instructions
Form 990-EZ (2020)
Form 990-EZ (2020)
EEA
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MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC 82-2152635
X
X
X
X
X
X
X
X
X
Gopalswamy Rama Venkataraman 408-797-7443
21921 Dolores Ave, Cupertino, CA 95014
X
X
X
X
X
X
X

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.

OMB No. 1545-0047
2020
Public Charity Status and Public SupportSCHEDULE A
Open to Public
Inspection
Part I Reason for Public Charity Status. (All organizations must complete this part.) See instructions. (Form 990 or 990-EZ)
Attach to Form 990 or Form 990-EZ.
1 2
3 4
5 6
7 8
9 10
11 12
a
b
c
d
e
f
g
Yes No
(A)
(B)
(C)
(D)
(E)
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Go to www.irs.gov/Form990 for instructions and the latest information.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.) A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).) A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)
A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.) A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.) An agricultural research organization described in section 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land-grant college of agriculture (see instructions). Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions - subject to certain exceptions; and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.) An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations descr bed in section 509(a)(1) or section 509(a)(2). See section 509(a)(3).

Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distr bution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations
Provide the following information about the supported organization(s).

Name of the organization Employer identification number Schedule A (Form 990 or 990-EZ) 2020
Department of the Treasury
Internal Revenue Service
(i) Name of supported organization (ii) E N (iii) Type of organization (iv) Is the organization (v) Amount of monetary (vi) Amount of (described on lines 1-10 listed in your governing support (see other support (see above (see instructions)) document? instructions) instructions) EEA
.........................................

MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC 82-2152635
X
Calendar year (or fiscal year beginning in)
1 2
3 4
5 6
7a
b
c
8 Calendar year (or fiscal year beginning in)
9 10a
b
c
11 12
13 14
15 15
16 16
17 17
18 18
19a
b
20 (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (f) Total Tax revenues levied for the
organization's benefit and either paid to
or expended on its behalf
The value of services or facilities
furnished by a governmental unit to the
organization without charge
Total. Add lines 1 through 5
Amounts included on lines 1, 2, and 3
received from disqualified persons
Amounts included on lines 2 and 3
received from other than disqualified
persons that exceed the greater of $5,000
or 1% of the amount on line 13 for the year
Add lines 7a and 7b
Public support. (Subtract line 7c from
line 6.)
(a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (f) Total
Amounts from line 6
Unrelated business taxable income (less
section 511 taxes) from businesses
acquired after June 30, 1975
Add lines 10a and 10b
Net income from unrelated business
activities not included in line 10b, whether
or not the business is regularly carried on
Other income. Do not include gain or
loss from the sale of capital assets
(Explain in Part VI.)
Total support. (Add lines 9, 10c, 11,
and 12.)
First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here
Public support percentage for 2020 (line 8, column (f), divided by line 13, column (f)) % Public support percentage from 2019 Schedule A, Part III, line 15 % Investment income percentage for 2020 (line 10c, column (f), divided by line 13, column (f)) % Investment income percentage from 2019 Schedule A, Part III, line 17 % 33 1/3% support tests - 2020. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization 33 1/3% support tests - 2019. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions Part III Support Schedule for Organizations Described in Section 509(a)(2) Section A. Public Support
Section B. Total Support
Section C. Computation of Public Support Percentage
Section D. Computation of Investment Income Percentage
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II.

If the organization fails to qualify under the tests listed below, please complete Part II.)

Page 3 ends

Gifts, grants, contributions, and membership fees
received. (Do not include any "unusual grants.")
Gross receipts from admissions, merchandise
sold or services performed, or facilities
furnished in any activity that is related to the
organization's tax-exempt purpose
Gross receipts from activities that are not an
unrelated trade or business under section 513
Gross income from interest, dividends,
payments received on securities loans, rents,
royalties, and income from similar sources
Schedule A (Form 990 or 990-EZ) 2020
Schedule A (Form 990 or 990-EZ) 2020
EEA
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MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC 82-2152635
6,245 42,175 53,219 101,639
6,245 42,175 53,219 101,639
101,639
6,245 42,175 53,219 101,639
769 252 1,021
769 252 1,021
48,158 42,497 35,142 125,797
0 54,403 85,441 88,613 228,457

44.49 0.00

0.00 0.00
X
2020
Supplemental Information to Form 990 or 990-EZSCHEDULE O Open to Public
Inspection
(Form 990 or 990-EZ) Complete to provide information for responses to specific questions on Form 990 or 990-EZ or to provide any additional information.

Attach to Form 990 or 990-EZ.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Go to www.irs.gov/Form990 for the latest information.

Employer identification number
Schedule O (Form 990 or 990-EZ) (2020)
OMB No. 1545-0047
Department of the Treasury
Internal Revenue Service
Name of the organization
EEA
MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC 82-2152635

01. Description of other revenue (Part I, line 8)
Description Amount TOURNAMENT INCOME 29,139 SALES OF PRODUCT INCOME 1,590 SUMMER CAMP INCOME 4,413 OTHER INCOME 252

02. Description of other expenses (Part I, line 16)
Description Amount ACCOUNTING 1,896 TAX PREPARATION 439 TRANSPORTATION 30 WEB HOSTING 810 INSURANCE 540 BANK FEES 8 STRIPE FEES 2,124 ACCOUNTING SOFTWARE 211 LEAGUE MEMBERSHIP 900 SPEECH CURRICULUM 212 TOURNAMENT 27,663 ENTERTAINMENT 307 SPECIAL EVENTS 190 SUPPLIES 2,181 LEGAL 25 LEGAL SOFTWARE 100

2 Employer identification number
Schedule O (Form 990 or 990-EZ) (2020)
Schedule O (Form 990 or 990-EZ) (2020) Page
Name of the organization
EEA
MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC 82-2152635
PROJECT TRACKING SOFTWARE 600 BUSINESS ENABLEMENT SOFTWARE 2,236 OTHER NON PERSONAL EXPENSES 2,063 MARKETING 1,544 BILL PAY FEES 21 OTHER ORGANIZATION EXPENSES 210

03. Description of total liabilities (Part II, line 26) Category Beginning of Year End of Year CREDIT CARD 5 183

Total gross sales or receipts from other sources. Add line 1 through line 7. Enter here and on Side 1, Part I, line 1 043 3652204
Part II Organizations with gross receipts of more than $50,000 and private foundations regardless of amount of gross receipts - complete Part II or furnish substitute information. 1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
Schedule L Balance Sheet Beginning of taxable year End of taxable year Assets (a) (b) (c) (d)
1 2
3 4
5 6
7 8
9 10 a
b
11 12
13 Total assets
Liabilities and net worth
14 15
16 17
18 19
20 21
22 Total liabilities and net worth
Schedule M-1 Reconciliation of income per books with income per return 1 7
2 3 8
4 5 9
10 6
Gross sales or receipts from all business activities. See instructions 00 Interest 00
Dividends 00
Gross rents 00
Gross royalties 00
Gross amount received from sale of assets (See Instructions) 00 Other income. Attach schedule 00
00 Contributions, gifts, grants, and similar amounts paid. Attach schedule 00 00 Disbursements to or for members 00
Compensation of officers, directors, and trustees. Attach schedule 00 Other salaries and wages 00
Interest 00
Taxes 00
Rents 00
Depreciation and depletion (See instructions) 00
Other expenses and disbursements. Attach schedule 00
Total expenses and disbursements. Add line 9 through line 17. Enter here and on Side 1, Part I, line 9 00 Cash
Net accounts receivable
Net notes receivable
Inventories
Federal and state government obligations
Investments in other bonds
Investments in stock
Mortgage loans
Other investments. Attach schedule
Depreciable assets
Less accumulated depreciation
Land
Other assets. Attach schedule
Accounts payable
Contributions, gifts, or grants payable
Bonds and notes payable
Mortgages payable
Other liabilities. Attach schedule
Capital stock or principal fund
Paid-in or capital surplus. Attach reconciliation
Retained earnings or income fund
Do not complete this schedule if the amount on Schedule L, line 13, column (d), is less than $50,000 Net income per books Income recorded on books this year Federal income tax not included in this return. Attach schedule Excess of capital losses over capital gains Deductions in this return not charged Income not recorded on books this year. against book income this year.

Attach schedule Attach schedule
Expenses recorded on books this year not Total. Add line 7 and line 8 deducted in this return. Attach schedule Net income per return.

Total. Add line 1 through line 5 Subtract line 9 from line 6 Side 2 Form 199 2020
Receipts
from
Other
Sources
Expenses
and
Disburse-
ments
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82-2152635

Monta Vista Speech Boosters Inc
21840 McClellan Road
Cupertino
CA 95014 Jan 31, 2022
Our organization was approved for the Cupertino Community Funding grant and $3000 was awarded to us in 2021. This is a report of how the grant was used.

This is how we had requested for the grant in 2021-22.Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put $0:
a) Admin Staff $10,024
b) Materials/Equipment $0
c) Entertainment $0
d) Room/Venue Rental $0
e) Other Professional Services $0
f) Other Scholarships $3,000
Total $13,024
Out of the $13, 024 we had requested, we were awarded $3,000. We used the grant money for hiring coaches who specialize in the OO (Original Oratory) branch of speech. This served 26 students which is about 24% of our MV Speech club.

The contract for the coaches are as follows:
● Compensation Rates:
○ $30 per hour for synchronous coaching (working directly with students, either 1:1 or in groups)
○ $25 per hour for asynchronous coaching (research, email follow-up, video watching/feedback and other offline tasks)
● Billable hours:
○ Regular Season:
■ Regular Coaching: Maximum of 8 hours per week
● 6 hours of synchronous coaching per week during scheduled Monta Vista Speech practices
● 2 hours of asynchronous coaching per week
■ Variable hours to provide coaching support for a variety of meetings/initiatives such as:
● Parent and/or student interest meetings and showcase events ● Parent Judging Night
● Parent Coffees

Page 1 of 3 ends

The table below shows how effective our coaches have been in enabling our students to win/break at tournaments:
# of Coach Watches YTD2 # of Students Final/Semi
Break Ratio
0-2 37 16%
3-5 29 27%
6+ 34 41%
First Semester Speech Highlights
● Stephen Stewart Invitational (200 competitors)
○ 4 tournament champions in HI, DI, OI and IMP
○ 21 Finalists and Semifinalists
● CFL Novice (125 competitors)
○ MVHS fielded the largest Novice team (36 novices)
○ 80% of our novices won an award (v. 44% field)
○ 5 tournament champions in DI, OI, NX, IX, OO
● CFL 1 and CFL 2
○ 4th highest number of ‘Wildcards’
○ 4th largest school in CFL out of 30 schools
● Fall SCU
○ Varsity: Break ratio at 36% (v. 24% schools >=10 entries) ○ Novice: Break ratio at 55% (v. 28% schools >=10 entries) The Monta Vista Speech club caters to about 109 students this academic year 2021-22. This club is open to the entire Monta Vista High School community of the Monta Vista area of Cupertino. The coaching has enabled the students to perform well in all the tournaments they attended. Detailed above are the first semester speech highlights.

All middle (Kennedy, Lawson) and high school (Monta Vista) students / children in the community served by the Monta Vista area of the city of Cupertino. Monta Vista high school currently serves approximately 2,350 students in grades 9-12. Kennedy middle school currently serves approximately 1,198 students in grades 6-8. Lawson middle school currently serves approximately 1,138 students in grades 6-8.

The monthly timesheets/invoices of the two OO coaches (or all 5 coaches) for the first semester can be provided if needed.

Page 3 of 3 ends

We are excited at this opportunity of our first successful grant and how it helped set up the Monta Vista Speech team for success this coming year.

Sincerely,
------------------------------------------
Rajeswari Mahalingam
President and CEO, Monta Vista Speech Boosters Inc
408 838 6093
-------------------------
Date

Page 4 of 3 ends

Eligibility YES NO Notes:

Be made or sponsored by a 501(c)(3) non‐profit organization with experienced members capable of implementing and managing the program/project/event
X
Identify how the funds will be used to benefit the Cupertino community X
Be awarded only once per projec
t x
For specific needs, not on going, operational costs X
Have more than 75% of the requested funds allocated for direct service costs versus administrative costs X
Be complete and submitted by the application deadline X Restrictions/Guidelines YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
NA
Monta Vista Speech Boosters (Returning) Eligibility Checklist (staff use only)

Fall Festival
2021 Actual
Revenue $40,469
Sponsorships (1) $37,250
Elect Retail Inc in booths
Bus and NP booths gross $1,919
Kids Zone (net) net $0
Soda, Beer, etc. $1,300
Expenses $22,255
Advertising/marketing $1,092 Insert
Sticker $0
Graphics $600
Printing $0
Program book our portion $1,543 Printing
Signs/banners $800
Sound System $2,000
Entertainment $100
Cultural Fair
Food
Beer,soda $500
Rental Equipment $11,000
Porta potties $1,100
Golf Carts $1,820
Sheriffs
ABC plus Foodpermit $700
Art show ??
Health permits
Misc $1,000
Net for charitable Giving $18,214
1/27/2022 11:39 AM
Eligibility YES NO Notes:

Be made or sponsored by a 501(c)(3) non‐profit organization with experienced members capable of implementing and managing the program/project/event
X
Identify how the funds will be used to benefit the Cupertino community X
Be awarded only once per projec
t X
For specific needs, not on going, operational costs X
Have more than 75% of the requested funds allocated for direct service costs versus administrative costs x
Be complete and submitted by the application deadline X Restrictions/Guidelines YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
NA
Rotary Club of Cupetino (Returning) Eligibility Checklist (staff use only)

Program Report: Gi of Hope 2021
City of Cuperno Community Gr ant Funding
West Valley Community Services
Thank you for your generous support of Gi of Hope 2021.

The event was held the weekend of December 11, 2021.

With your help, we were able to serve 1,586 men, women and children in our community, a 25% increase over last year. Of that number, 286 were Cuperno residents, including 40 unhoused Cuperno residents.

Below are photos of some of this year’s parcipants. There is no way we could have brought joy and hope to so many people without you.

West Valley Community Services depends on the support of our local community to help families facing food and housing insecurity. Your kindness and generosity makes our work possible.

Respecully submied by Josh Selo, Execuve Director

Eligibility YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
NA
West Valley Community Services (Returning) Eligibility Checklist (staff use only)

Name & Occupation Email Address City of Residence Term Expiry Susan Sweedler,
President

[email protected]

Los Gatos
2022
Bob Aptekar,
Physician
[email protected] Los Altos Hills 2023
Arnnon Geshuri,
Vice President,
Human Relations

[email protected] San Jose 2023
Yael Landan,
Private Investor

[email protected] Los Altos 2022
Tina Levenfeld,
Marketing

[email protected] Saratoga 2023
Mark Levine,
Communications
Consultant

[email protected] Sunnyvale 2023
Ruth Litwin,
Community Volunteer

[email protected]
San Jose 2023
Dana Magat,
Rabbi

[email protected] San Jose 2022
Jeremy Roschelle,
Strategy
[email protected] Portola Valley 2022
Rob Rubenstein,
Retired Businessman

[email protected] Palo Alto 2023
Eta Somekh,
Private Investor &
Community Volunteer

[email protected] Los Altos Hills 2023
Marian Scheuer Sofaer,
Lawyer

[email protected] Palo Alto 2022

Eligibility YES NO Notes:

An organization that is applying for multiple grants shall only submit one application NA
Proceeds generated from the funded activity may only be used for the conducted activity NA
admission to or participation in the event must be ʺfree of chargeʺ to Cupertino residents unless stated in the application and approved by Parks and Recreation Commission
x Admission is charged for tickets
or movie passes (amount not specified).

Silicon Valley Jewish Film Festival (Returning) Eligibility Checklist (staff use only)

Cupertino City CouncilMay 19, 2022

Cupertino City Council
May 19, 2022