STARRY STARRY NIGHT_SRPMIC_APPLICATION.PDF

SALT RIVER PIMA-MARICOPA
INDIAN COMMUNITY
10005 E. Osborn Road, Scottsdale, Arizona 85256 / Phone 480-362-7520 / Fax 480-362-7593
12% Gaming Grant Program Application
Calendar Year 2020
About the Grant Program Application:
The Salt River Pima-Maricopa Indian Community 12% Gaming Grant Program (“Program”) application
will serve to provide a comprehensive review of the programming requests for Arizona cities, towns,
counties, non-municipal public service organizations, and non-profit organizations selected to apply for
grant funding. It is not the intent of the Program to award grants that would benefit individuals, be used
as sponsorships, be used for religious activities, primarily fund the indirect or administrative costs of a
program/organization, or be used for the direct benefit of the Salt River Pima Maricopa Indian
Community.
Date of Application: 8/30/19
Organization Name: Starry Starry Night
Organization/Municipal Government Mailing Address: 20715 N. Pima Road Suite F-108, Scottsdale, Az 8525
Organization History: See attachment
(Provide a brief summary of the origins of the organizations and any notable milestones and/or
significant audit findings)
Organization Structure: See Board Members via attachment
(Provide a list of current board members and key staff members)
Do any conflicts of interest exist within the organization structure? No
(I.e. family, professional or personal conflicts, SRPMIC representatives on board, etc.)
Contact Person and Project Manager if different from Contact Person: Bobby A Vossoughi,
President and Chairman of the Board
Title: President and Chairman of the Board
Address: 20715 N. Pima Road Suite F-108, Scottsdale, Az 85255
Phone: (480) 291-2124
Fax:
Email Address: bobby@bavventures.com
Project Name: School Based Intervention Program
Provide a brief description of the project being submitted to the 12% SRPMIC Grant program. In
the description provide a summary of the relevant experience, administrative activity, and program
development related to the grant request.

What percentage of the grant request are Direct Costs of the programming and Indirect Costs,
respectively? 70% Direct Costs and 30% are indirect costs
Define the Project Category and/or relevant sub-category:
(i.e. Education, Public Safety, Transportation, Economic Development, Health Care, Social Services,
or Cultural and Environment) Health Care and Education
Beginning Date of Project: End Date of Project: 11/1/20
11/1/19 Geographic Area to
be served: Low to moderate ** Attach Detailed Budget**
Amount of Total Project: $25,000 Amount of 12% Request: $5,000
(No Multi-Year Request will be accepted)
If the amount of funding received is less than the amount needed for the project, do you have
other funds to complete the project? (Please Explain): Yes we do we are partnering with multiple
organizations, donors and foundations to support this inititative.
If you receive SRPMIC 12 % funding, will it be spent (Check One):
Monthly
Quarterly
XLump Please pay lump sum at once
Sum
List any SRPMIC 12% funds you have received in the past. If the organization has received funding
through the SRPMIC 12% Gaming Grant Program for five consecutive years, they will be required to
submit a comprehensive report of grant funding toward the stated program objectives and mission of
the organization. In addition, you will be asked to provide a formal presentation to the 12% Gaming
Grant Committee prior to the awarding of any additional funding.
List any other 12 % grant funds your organization may be seeking from other Tribal Governments in
2019-2020.
List any other funds you have received from the Salt River Pima-Maricopa Indian Community
(Enterprises Included) and identify the amount and the source:
Has your organization ever applied for and received any local, state or federal grants? If so, please
detail. Local grants via Helios Education Foundation and Isagenix Foundation
Funding for project/programs may be based on available funding. As such, if funding were not
available for the full the amount of request how would you prioritize funding.
1. Individual Donors
2. Corporate Partnerships
3. Foundations

Which municipal governmental entity will serve as your pass through agency to accept 12% gaming
grant on your behalf? SRPMIC
By execution of the 12% Gaming Contribution Grant Application the undersigned agrees that the
information contained in the Application is true to the best of the Applicants knowledge. The
Applicant shall notify the SRPMIC if any information in this Application changes.
8/30/19
Signature for the Applicant Date
President and Chairman Starry Starry Night
Name and Title
The Application shall be signed by the senior elected official of the local government, or in the case of
a non-profit entity, the Chief Executive Officer authorizes to commit the non-profit entity to apply for,
accept, and implement an award from the SRPMIC utilizing 12% Gaming Contributions.