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Date of application: <br />January 16, 2013 <br />Item 6 <br />Program Planning Report <br />and Attachments <br />ATTACHMENT # 1 FOR PROGRAM PLANNING COMMITTEE REPORT <br />Small Grants Facilitation Support Fund <br />Grant Application Cover Sheet <br />Dec 28, 2012 Project dates: 2 events between February 2012 <br />and Mav 2012 <br />Organization Information <br />City of Roseville Human Rights Commission <br />Name of organization <br />651-792-7000 <br />Phone <br />Carolyn Curti <br />Name of top paid staff <br />Gary Grefenberg <br />Name of contact person regarding this application <br />Roseville MN 55113 <br />City, State, Zip <br />651-792-7030 <br />Fax <br />Com�nunications Specialist <br />Title <br />Human Rights Commission <br />Chair <br />Title <br />Legal name, if different <br />NA <br />Employer ldentification Number (EIN) <br />http: //www. ci.roseville.mn.us/ <br />Web site <br />651-792-7026 carolyn.curti@ <br />ci.roseville.mn.us <br />Phone E-mail <br />651-645-6161 <br />Phone <br />Is your organization an IRS 501(c)(3) not-for-profit? If yes, please provide IRS letter <br />If no, is your organization a public agency/unit of government? <br />ggrefenberg@ <br />comcast.net <br />E-maal <br />Yes x No <br />x Yes No <br />If no, list name and address of fiscal agent who is a 501 (c) (3) and their IRS letter. <br />Roseville's Federal ID# is 41-6007849 <br />Proposal Information <br />Fiscal agent's EIN number <br />Please give a 2-3 sentence summary of request: <br />We request funds to support two half-day community dialogues in Roseville, MN on the topic of interpersonal <br />violence — ranging from playground bullying to more harmful criminal acts. The goals of the events are to bring the <br />community together to a) examine the complex factors that contribute to violence (including but not limited to the <br />social stigma around mental illness), and b) identify what we, as individuals and as a community, can do to prevent <br />violence. We are hosting this dialogue in part due to the horrific homicides committed on the east coast of the U.S. <br />in the last few weeks, but also as part of an emerging grassroots inovement in Roseville to build neighborhood <br />cohesion and communiiy connectedness. We hope these events will inspire participants io work in their <br />neighborhoods to help prevent future violence and foster healthy communities. <br />Population served: We are inviting various community Geographic area served: Roseville, MN <br />stakeholders to participate, including Roseville's elected city <br />officials and commissioners, area K12 schools (esp. social <br />workers and behavioral intervention staffl, police <br />Program Planning Committee Report of January 16, 2013 3 <br />