VISIONQUEST 20 20 SRPMIC 2016.PDF

Admin Tribe Selection
Last updated: 09/08/2016
This is my Form.
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Please select to which tribe this Organization has applied to:
Salt River
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Last updated: 09/08/2016
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General information
Organization VisionQuest 20/20
Contact First name Rich
Contact Last name Tirendi
Contact e-mail rtirendi@visionquest2020.org
Contact phone number 602-791-7140
Address
Street 4113 E. Pinchot Ave
City Phoenix
State AZ
ZIP Code 85018
What is the name of the program or project for which your organization is
requesting grant funds?
EyeSpy 20/20: Promoting the Health and Educational Success of AZ Children through Advanced
Vision Screening Technology
For what grant amount has the organization requested from the tribe?
25000
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SALT RIVER PIMA-MARICOPA INDIAN COMMUNITY
10005 E. Osborn Road, Scottsdale, Arizona 85256 / Phone 480-362-7520 / Fax 480-362-7593
12% Gaming Contributions Application
Date of Application: July 15, 2016
Organization Name: VisionQuest 20/20
Organization/Municipal Government Street & Mailing Address:
VisionQuest 20/20
C/O Richard Tirendi
4113 East Pinchot Avenue
Phoenix, Arizona 85018
Contact Person and Project Manager if different from Contact Person:
Title: Richard Tirendi, CEO Lisa Glow, Grant Writer
Address: 4113 East Pinchot Avenue, Phoenix, AZ 85018
Phone: 602-791-7140 602-448-2270
Fax: 480-336-2855 Same
Email Address: rtirendi@visionquest2020.org lisa.glow@cox.net
Project Name: EyeSpy 20/20: Promoting the Health and Educational Success of AZ
Children through Advanced Vision Screening Technology
Please provide a brief description of the project being submitted to the 12% SRPMIC
Grant program.
Thank you for your prior generous support and consideration of this request to continue to
promote children’s vision screening in Arizona public schools. VisionQuest 20/20, a 501(c) (3)
non-profit organization, is requesting a grant in the amount of $35,000 to further expand the
EyeSpy 20/20 vision screening to Yuma County public schools.
For this proposal, VisionQuest 20/20 (VQ 20/20) will partner with schools in the Crane
Elementary School District (CESD) to provide lifetime licenses of the state-of-the-art EyeSpy
20/20 vision screening for children in 10 elementary schools in the CESD and 1 community
center serving the district.. VQ2020 has placed EyeSpy 20/20 in one school in Crane Elementary
School District in 2015 and as a result of their experience, CESD has expressed interest in
expanding the program to all of their schools within the district. All 11 schools within CESD are
Title 1 schools and support active duty and reserve military personnel and their families who are
posted in the greater Yuma community. A grant of $35,000 from the Salt River Pima-Maricopa
Indian Community would support free vision screening to 5,500 children in the 10 elementary
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SALT RIVER PIMA-MARICOPA INDIAN COMMUNITY
10005 E. Osborn Road, Scottsdale, Arizona 85256 / Phone 480-362-7520 / Fax 480-362-7593
12% Gaming Contributions Application
schools and 1 district community center in the 2016-2017 school year and every year thereafter,
expanding the impact of your initial investment to a lifetime of vision screenings.
VisionQuest 20/20 Overview
Founded in 2003, by James W. O’Neil, M.D., a nationally renowned pediatric ophthalmologist,
and Richard Tirendi, an accomplished technology developer, VisionQuest 20/20’s (VQ 20/20)
mission is to protect children and their families from the devastating academic, psychosocial, and
lifelong economic consequences of undetected vision disorders and preventable blindness.
Vision disorders are the 4th leading health crisis for children in America, impacting up to 1 in 4
children. Arizona children are at particular risk for undetected vision disorders. Arizona is one
of only 8 states that does not require screening school children for vision disorders. VQ 20/20 is
a nonprofit organization committed to addressing this gap and reaching the tens of thousands of
Arizona children whose vision issues are going undetected. VQ 20/20 is also committed to
building the infrastructure needed to ensure future generations of Arizona school children are
vision screened.
EyeSpy 20/20 Overview
EyeSpy 20/20 accurately assesses visual acuity, depth perception and color vision while a child
“plays” a 3-minute video game. Independently and scientifically validated, EyeSpy 20/20
provides results comparable to those achieved by a certified ophthalmic technician and does not
require certification or specialized training to administer. The vision screening software is
downloaded via the Internet allowing school children in remote locations access to accurate and
reliable vision screenings previously unavailable. Results are immediately reported and
automated data collection, storage, and reporting with lifetime access to data in a HIPAA -
compliant repository allows for real-time and longitudinal assessment. Screening reports can be
printed in Spanish and English or customized for any language. Integration with school health
information systems saves time, money, and ensures data integrity.
In 2015, 214 schools in Arizona trusted EyeSpy 20/20 to assess the vision of more than 66,000
children. Notably, all schools received a lifetime, unlimited use license for vision screening;
thus, schools can continue to screen 1000’s of children every year after they receive the
program. The agency’s goal for 2016 is to expand to at least 50 Arizona schools.
“My son was having trouble in school with his writing. The doctor said his vision was fine and
he passed the wall chart screening in school. When he received the EyeSpy 20/20 screening, he
failed, including the 3D portion. We saw an eye specialist and my son was diagnosed amblyopic.
He was fitted for glasses, uses an eye patch and now sees much better." Tiffani Vold, School
Nurse and Parent, Arizona
Beginning Date of Project: End Date of Project:
September, 2016 September, 2017
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SALT RIVER PIMA-MARICOPA INDIAN COMMUNITY
10005 E. Osborn Road, Scottsdale, Arizona 85256 / Phone 480-362-7520 / Fax 480-362-7593
12% Gaming Contributions Application
Geographic Area to be served: Yuma County, Crane Elementary School District
** Attach Detailed Budget**
Amount of Total Project: Amount of 12% Request:
(No Multi-Year Request will be accepted)
$189,000 $35,000
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. VisionQuest 20/20 is looking to leverage the Salt River Pima-Maricopa Indian Community
grant with the United Way of Yuma County and Arizona Community Foundation - Yuma. VQ
20/20’s 2016 goal is to serve 50 additional K-8 schools, throughout Arizona. The focus is on
serving the school districts in the areas with the greatest economic need. If the amount of
funding received is less than our requested amount, VQ 20/20 would work first with the schools
with the highest number of Title 1 students as our guide.
If you receive SRPMIC 12 % funding, will it be spent (Check One):
-Monthly
-Quarterly
-Lump Sum XXX
List of SRPMIC 12% funds you have received in the past.
VQ 20/20 received $25,000 from SRPMIC 12% funds in 2015 and it is being used to implement
vision screening in Title 1 schools in the Peoria Unified School District.
List any other 12 % grant funds your organization may be seeking from other Tribal
Governments in 2016-2017.
VQ 20/20 has submitted an application with the Tohono-O’odham Nation for $35,000 to
implement expansion in Maricopa County schools. VQ 20/20 has also applied to the Gila River
Indian Community for $75,000 to fund the expansion of EyeSpy 20/20 in K-8 schools in eastern
Maricopa County schools.
List any other funds you have received from the Salt River Pima-Maricopa Indian
Community (Enterprises Included) and identify the amount and the source:
N/A
3

SALT RIVER PIMA-MARICOPA INDIAN COMMUNITY
10005 E. Osborn Road, Scottsdale, Arizona 85256 / Phone 480-362-7520 / Fax 480-362-7593
12% Gaming Contributions Application
Has your organization ever applied for and received any local, state or federal grants? If
so, please detail.
N/A
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. Schools within the district with the largest Title 1 populations would be prioritized first.
Which municipal governmental entity will serve as your pass through or accept 12% funds
on your behalf?
Maricopa County
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.
July July 10, 10, 2016 2016
Signature for the Applicant Date
Richard Richard S. S. Tirendi Tirendi CEO CEO & & Co-founder Co-founder
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.
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VisionQuest 20/20: 2016 Expansion Budget to Reach 50 Arizona Schools with EyeSpy 20/20
Budget Items Amount requested Amount from Total
from Salt River other Funders
Pima-Maricopa
Indian Community
Salaries and Employee Related Expenses:
Director of Operations and Program Manager [Works closely with the schools on program $15,000 $43,000 $58,000
implementation]
Director of Outreach Coordinator [Works with the schools, communities and families who $0 $30,000 $30,000
have children with vision disorders]
IT Program Staff [Support the installation of EyeSpy 20/20 into the 10 Yuma schools and $5,000 $20,500 $25,500
1 community center serving the district, along with training]
Materials and Supplies for expansion into 50 Arizona Schools. These costs include the $15,000 $22,000 $37,000
EyeSpy 20/20 software, as well as all testing equipment and materials that are provided to
the schools. The schools are given non-expiring licenses for EyeSpy 20/20.
Consulting support, including Marketing and Fundraising $0 $36,000 $36,000
Travel $0 $2,500 $2,500
Total $35,000 $154,000 $189,000

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ALHAMBRA TRADITIONAL SCHOOL PHOENIX 85019 DESERT SANDS MIDDLE SCHOOL PHOENIX 85033
Alhambra Tuition Out Phoenix 85019 Desert Star Academy Fort Mohave 86426
ALTA E BUTLER SCHOOL PHOENIX 85009 DESERT VALLEY ELEMENTARY BULLHEAD CITY 86442
AMY L. HOUSTON ACADEMY PHOENIX 85042 DESERT WINDS ELEMENTARY SCHOOL PHOENIX 85027
ANDALUCIA MIDDLE SCHOOL PHOENIX 85031 Diamondbacks Elementary School Bullhead City 86442
ARIZONA DESERT ELEMENTARY SCHOOL TOLLESON 85353 Dignity Healthcare Chandler 85224
Arizona Lutheran Academy Phoenix 85041 Dunbar Elementary School Phoenix 85007
Augustus H. Shaw Montessori School Phoenix 85034 EAGLE COLLEGE PREP Phoenix 85041
BARCELONA MIDDLE SCHOOL GLENDALE 85301 ED & VERMA PASTOR ELEMENTARY SCHOOL PHOENIX 85041
Barker Branch Scottsdale 85257 ENCANTO SCHOOL PHOENIX 85013
BELLAIR ELEMENTARY SCHOOL GLENDALE 85308 ESPERANZA ELEMENTARY SCHOOL PHOENIX 85027
BENJAMIN FRANKLIN CHARTER SCHOOL - GILBERT GILBERT 85296 ESPERANZA ELEMENTARY SCHOOL PHOENIX 85009
BERNARD BLACK ELEMENTARY SCHOOL PHOENIX 85041 ESTRELLA MIDDLE SCHOOL PHOENIX 85033
Berumen Elementary School Avondale 85392 EXCELENCIA SCHOOL PHOENIX 85006
BETTY FAIRFAX HIGH SCHOOL Laveen 85339 FORT MOHAVE ELEMENTARY SCHOOL FORT MOHAVE 86426
Biltmore Preparatory Academy PHOENIX 85018 FOX CREEK JR HIGH SCHOOL BULLHEAD CITY 86442
BRADSHAW MOUNTAIN HIGH SCHOOL PRESCOTT VALLEY 86314 FRANK BORMAN MIDDLE SCHOOL PHOENIX 85033
BRADSHAW MOUNTAIN MIDDLE SCHOOL DEWEY 86327 G. FRANK DAVIDSON PHOENIX 85033
BRET R. TARVER PHOENIX 85031 GARFIELD SCHOOL PHOENIX 85006
Bright Futures Preschool Prescott Valley 86314 GARY A. KNOX ELEMENTARY SCHOOL YUMA 85364
BROOKS ACADEMY PHOENIX 85040 GATEWAY POINTE ELEMENTARY HIGLEY 85236
Brophy College Preparatory Phoenix 85012 GATEWAY SCHOOL PHOENIX 85008
BULLHEAD CITY JR HIGH SCHOOL BULLHEAD CITY 86442 GLASSFORD HILL MIDDLE SCHOOL PRESCOTT VALLEY 86314
C J JORGENSEN SCHOOL PHOENIX 85041 GLENN L. DOWNS SCHOOL PHOENIX 85031
C O GREENFIELD SCHOOL PHOENIX 85042 GRANADA EAST SCHOOL PHOENIX 85017
CAMP MOHAVE ELEMENTARY BULLHEAD CITY 86426 GRANADA PRIMARY SCHOOL PHOENIX 85017
CAPITOL ELEMENTARY SCHOOL PHOENIX 85007 GRANVILLE ELEMENTARY SCHOOL PRESCOTT VALLEY 86314
CARL T. SMITH MIDDLE SCHOOL PHOENIX 85043 HEATHERBRAE SCHOOL PHOENIX 85033
CAROL G. PECK ELEMENTARY SCHOOL GLENDALE 85301 HIGLEY ELEMENTARY SCHOOL HIGLEY 85236
CARTWRIGHT SCHOOL PHOENIX 85031 HIGLEY HIGH SCHOOL GILBERT 85296
CATALINA VENTURA SCHOOL PHOENIX 85019 HOHOKAM ELEMENTARY SCHOOL SCOTTSDALE 85257
CESAR E CHAVEZ COMMUNITY SCHOOL PHOENIX 85040 HOLIDAY PARK SCHOOL PHOENIX 85033
Chandler CARE Center Chandler 85225 Hopefest Phoenix Phoenix 85018
CHARLES W. HARRIS SCHOOL PHOENIX 85035 HUMBOLDT ELEMENTARY SCHOOL HUMBOLDT 86329
CHEATHAM ELEMENTARY SCHOOL LAVEEN 85339 HURLEY RANCH ELEMENTARY TOLLESON 85353
Children First Academy Phoenix Phoenix 85034 IGNACIO CONCHOS SCHOOL PHOENIX 85041
Children First Academy Tempe Tempe 85281 INGLESIDE MIDDLE SCHOOL PHOENIX 85018
Christ Lutheran School Phoenix 85018 ISAAC MIDDLE SCHOOL PHOENIX 85009
CLARENDON SCHOOL PHOENIX 85013 ISAAC PRESCHOOL PHOENIX 85009
CLOVES C CAMPBELL SR ELEMENTARY SCHOOL PHOENIX 85042 J B SUTTON ELEMENTARY SCHOOL PHOENIX 85009
COMPASS CENTER PHOENIX 85016 JAMES W. RICE PRIMARY SCHOOL Phoenix 85031
CONSTITUTION ELEMENTARY SCHOOL PHOENIX 85023 JOHN F KENNEDY ELEMENTARY SCHOOL PHOENIX 85042
CORDOVA MIDDLE SCHOOL PHOENIX 85017 JOHN F. LONG PHOENIX 85031
CORDOVA PRIMARY SCHOOL PHOENIX 85019 JOHN R DAVIS SCHOOL PHOENIX 85041
CORONADO ELEMENTARY SCHOOL GILBERT 85297 JOSEPH ZITO ELEMENTARY SCHOOL PHOENIX 85035
COUNTRY GARDENS CHARTER SCHOOL LAVEEN 85339 JUSTINE SPITALNY SCHOOL PHOENIX 85031
COYOTE CANYON SCHOOL BULLHEAD CITY 86442 KENILWORTH ELEMENTARY SCHOOL PHOENIX 85003
COYOTE SPRINGS ELEMENTARY SCHOOL PRESCOTT VALLEY 86314 KEYSTONE MONTESSORI CHARTER SCHOOL PHOENIX 85048
CREIGHTON ELEMENTARY SCHOOL PHOENIX 85008 KIN DAH LICHII OLTA' CHARTER SCHOOL GANADO 86505
Crews'N Healthmobile Phoenix 85016 Kings Ridge Preparatory Academy Phoenix 85043
DEER VALLEY MIDDLE SCHOOL PHOENIX 85027 LAKE VALLEY ELEMENTARY SCHOOL PRESCOTT VALLEY 86314
DESERT CANYON ELEMENTARY SCOTTSDALE 85255 LARRY C KENNEDY SCHOOL PHOENIX 85016
Desert Meadows Elementary School Laveen 85339 LAVEEN ELEMENTARY SCHOOL LAVEEN 85339

Lehi Branch Mesa 85203 PUEBLO DEL SOL MIDDLE SCHOOL PHOENIX 85019
LELA ALSTON ELEMENTARY PHOENIX 85019 R E SIMPSON SCHOOL PHOENIX 85015
LIBERTY TRADITIONAL SCHOOL PRESCOTT VALLEY 86314 RALPH WALDO EMERSON ELEMENTARY SCHOOL PHOENIX 85006
LOMA LINDA ELEMENTARY SCHOOL PHOENIX 85016 Rául H. Castro Middle School Phoenix 85035
LONGVIEW ELEMENTARY SCHOOL PHOENIX 85014 Red Mountain Branch Scottsdale 85256
LOWELL SCHOOL PHOENIX 85003 Redfield Elementary School Scottsdale 85260
MADISON #1 ELEMENTARY SCHOOL PHOENIX 85016 RIVER VALLEY HIGH SCHOOL MOHAVE VALLEY 86440
MADISON CAMELVIEW ELEMENTARY PHOENIX 85016 RIVERSIDE ELEMENTARY SCHOOL PHOENIX 85043
MADISON ELEMENTARY DISTRICT PHOENIX 85016 Rose Lane Branch Scottsdale 85250
MADISON HEIGHTS ELEMENTARY SCHOOL PHOENIX 85020 ROSE LINDA SCHOOL PHOENIX 85040
MADISON MEADOWS SCHOOL PHOENIX 85013 Rotary International District 5510 Payson 85541
MADISON PARK SCHOOL PHOENIX 85014 Salt River Pima Maricopa Indian Community Scottsdale 85286
MADISON RICHARD SIMIS SCHOOL PHOENIX 85020 SAN TAN ELEMENTARY GILBERT 85297
MADISON ROSE LANE SCHOOL PHOENIX 85014 SEVILLA PRIMARY SCHOOL PHOENIX 85019
MADISON TRADITIONAL ACADEMY Phoenix 85016 SEVILLA WEST SCHOOL PHOENIX 85019
MAGNET TRADITIONAL SCHOOL PHOENIX 85009 SHEELY FARMS ELEMENTARY SCHOOL PHOENIX 85037
MAIE BARTLETT HEARD SCHOOL PHOENIX 85015 SIERRA VISTA ELEMENTARY SCHOOL PHOENIX 85040
MANUEL PENA JR. SCHOOL PHOENIX 85035 SILVESTRE S HERRERA SCHOOL PHOENIX 85034
MARC T. ATKINSON MIDDLE SCHOOL PHOENIX 85031 SOLANO SCHOOL PHOENIX 85015
Maricopa County Head Start Program Mesa 85210 SOUTHWEST ELEMENTARY SCHOOL PHOENIX 85041
MARTIN LUTHER KING JR ELEMENTARY SCHOOL PHOENIX 85040 SOUTHWEST ELEMENTARY SCHOOL PHOENIX 85041
MARY MCLEOD BETHUNE SCHOOL PHOENIX 85007 St. Gregory Elementary School Phoenix 85015
MAURICE C. CASH ELEMENTARY SCHOOL PHOENIX 85041 St. John Bosco Interparish School Phoenix 85048
MAXINE O BUSH ELEMENTARY SCHOOL PHOENIX 85042 St. Thomas the Apostle Catholic School Phoenix 85016
MAYER ELEMENTARY SCHOOL MAYER 86333 STARLIGHT PARK SCHOOL PHOENIX 85033
MAYER JUNIOR/SENIOR HIGH SCHOOL MAYER 86333 SUNDANCE ELEMENTARY BUCKEYE 85326
McKee Branch Fountain Hills 85268 SUNLAND ELEMENTARY SCHOOL PHOENIX 85041
MIRAGE ELEMENTARY SCHOOL GLENDALE 85308 SUNRISE ELEMENTARY BULLHEAD CITY 86429
MITCHELL ELEMENTARY SCHOOL PHOENIX 85009 SUNRISE ELEMENTARY SCHOOL PHOENIX 85053
MOHAVE ACCELERATED ELEMENTARY SCHOOL BULLHEAD CITY 86442 SUNSET SCHOOL PHOENIX 85033
Mohave Accelerated Learning Center Bullhead City 86442 T G BARR SCHOOL PHOENIX 85042
Mohave Accelerated Learning Center-East Campus Bullhead City 86429 Tavan Elementary Phoenix 86018
MOHAVE HIGH SCHOOL BULLHEAD CITY 86442 TAVAN ELEMENTARY SCHOOL PHOENIX 85018
MOHAVE VALLEY JUNIOR HIGH SCHOOL MOHAVE VALLEY 86446 TELESIS PREPARATORY ACADEMY LAKE HAVASU CITY 86403
MONTE VISTA ELEMENTARY SCHOOL PHOENIX 85018 THOMAS A EDISON SCHOOL PHOENIX 85006
MONTEBELLO SCHOOL PHOENIX 85017 Thunderbirds Branch Scottsdale 85255
MORRIS K. UDALL ESCUELA DE BELLAS ARTES PHOENIX 85009 TOMAHAWK SCHOOL PHOENIX 85033
MOUNTAIN VIEW ELEMENTARY SCHOOL PRESCOTT VALLEY 86314 TONALEA ELEMENTARY SCHOOL SCOTTSDALE 85257
MOYA ELEMENTARY PHOENIX 85009 TOPOCK ELEMENTARY SCHOOL TOPOCK 86436
New Way Academy Scottsdale 85257 TRAILSIDE POINT ELEMENTARY Laveen 85339
OSBORN MIDDLE SCHOOL PHOENIX 85013 Trinity Christian School Chino Valley 86323
P T COE ELEMENTARY SCHOOL PHOENIX 85009 UNION ELEMENTARY SCHOOL TOLLESON 85353
Paiute Branch Scottsdale 85251 V H LASSEN ELEMENTARY SCHOOL PHOENIX 85041
PALM LANE PHOENIX 85035 VALLEY VIEW SCHOOL PHOENIX 85041
PAPAGO SCHOOL PHOENIX 85008 VENTANA ACADEMIC SCHOOL CAVE CREEK 85327
PARK MEADOWS ELEMENTARY SCHOOL GLENDALE 85308 Vestar Branch Phoenix 85050
PASEO HILLS ELEMENTARY PHOENIX 85027 VILLAGE MEADOWS ELEMENTARY SCHOOL PHOENIX 85023
Peach Springs Branch Peach Springs 86434 WASHINGTON TRADITIONAL SCHOOL PRESCOTT 86301
PERALTA SCHOOL PHOENIX 85035 WESTWOOD PRIMARY SCHOOL PHOENIX 85015
PERCY L JULIAN SCHOOL PHOENIX 85040 WHITTIER ELEMENTARY SCHOOL PHOENIX 85006
Pinal Gila Community Child Services, Inc. Coolidge 85128 WILLIAM T MACHAN ELEMENTARY SCHOOL PHOENIX 85006
Piper Branch Scottsdale 85258 YAVAPAI ELEMENTARY SCHOOL SCOTTSDALE 85257
PORFIRIO H. GONZALES ELEMENTARY SCHOOL TOLLESON 85353
POWER RANCH ELEMENTARY GILBERT 85297