2016 GRIC APPLICATIONS 1.PDF

Maricopa County — Formal (2016-03-23)

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Created: 01/04/2016
Last updated: 03/08/2016
Page 1
General information
Organization Central Arizona Dental Society Foundation
Contact First name Elizabeth
Contact Last name Toth
Contact e-mail aikentoth.associates@cox.net
Contact phone number 602-881-2579
Address
Street 5300 N. Central Ave.
City Phoenix
State AZ
ZIP Code 85018
From what tribe is the organization requesting the grant?
Gila River Indian Community
Total grant amount request
30,000
The Gila River Indian Community offers multi-year awards. If your organization is requesting a multi-year grant for this
project or program from the Gila River Indian Community, enter the amount to be requested each year.
Amount
Year 1 (Gila River Indian Community Grants Only) 10,000
Year 2 (Gila River Indian Community Grants Only) 10,000
Year 3 (Gila River Indian Community Grants Only) 10,000
Year 4 (Gila River Indian Community Grants Only)
Year 5 (Gila River Indian Community Grants Only)
1 of 1

Gila River Indian Community Grant Application
Grant Cycle 2016
Cover Sheet
Municipality Information
1. Date of Application: 2/29/2016 (NOTE: Click or use up/down arrow keys to move among fields)
2. Name of City, Town or County: Maricopa County
3. Mayor (City or Town) or Board of Supervisor’s Chairman (County): Clint L. Hickman
4. Mailing Address: 301 W. Jefferson, 10th Fl.
5. City: Phoenix State: Arizona Zip Code: 85032
6. Acknowledgement of Submission by Authorized Municipality Representative:
Typed Name: Amanda Nash Signature:
Applicant Information
7. Department/Organization Name: Central Arizona Dental Society Foundation
8. Is this a non-profit 501c(3) Organization? No X Yes If yes, attach IRS Determination Letter
9. Application Contact Person: Liz Toth Title: Grants Manager
10. Phone Number: 602-567-3617
11. Mailing Address: 5300 N. Central Avenue
12. City: Phoenix State: Arizona Zip Code: 85012
13. Email Address: AikenToth.Associates@cox.net Website Address: Click here to enter text.
Project Information
14. Project Name: Arizona Dental Mission of Mercy
15. Purpose of Grant: Provide dental care to alleviate pain and infection.
16. Unable to Choose an item below for Priority Funding. It is - Healthcare
16. Priority Funding Area Choose an item.
17. Annual amount requested $10,000
18. Number of years that funding is Three
requested
19. Total amount requested (annual $30,000
amount x # of years)
20. Has your organization received past No
funding from GRIC? If yes, list each year
and amount
21. Geographic area served Maricopa County

Gila River Indian Community Grant Application
Grant Cycle 2016
over 22 hours in 2 days. Patients will be treated based on the most urgent needs, with infection
control and pain elimination as the priority.
4. Describe how the proposed project satisfies one or more of the priority funding areas
identified by the Gila River Indian Community.
The dental mission of mercy satisfies the Healthcare funding area. Dentists provide direct
patient care and all services provided are healthcare related, including dental health education
for future self-care.
5. Identify the needs/problems to be addressed, target population and number of people to be
served by the project.
The target population is low- and very low-income Maricopa County families who are not able to
access or afford dental healthcare including the working poor, the unemployed,
underemployed, veterans and the homeless. Some of our patients have not been able to eat
solid food for 10 years, 24% said they could not remember the last time they went to a dentist.
One out of every two American adults aged 30 and over has periodontal disease, according to
the Centers for Disease Control and Prevention (CDC) study titled Prevalence of Periodontitis in
Adults in the United States: 2009 and 2010 estimates that 47.2 percent, or 64.7 million
American adults, have mild, moderate or severe periodontitis, the more advanced form of
periodontal disease. In adults 65 and older, prevalence rates increase to 70.1 percent.
According to Dr. Pat Rabot, Phoenix Oral Surgeon, “Arizonans suffer from higher rates of dental
disease than many other states, and the AZ Dental Mission of Mercy is one way provide critical
dental care to those who need it most.”
Cost is the greatest barrier patients face to getting dentures. Insurance might pay 15%-50% of
the costs. However, the State of Arizona no longer provides for any dental healthcare coverage
for adults leaving an estimated 250,000 low-income adults, seniors and individuals with special
needs in Maricopa County without access to oral healthcare.
Lack of dental care can lead to tooth decay and oral disease, which can cause systemic health
issues such as kidney and cardiovascular problems. Poor oral health has a negative effect on
birth outcomes and can exacerbate heart disease, diabetes and other conditions.
Decayed, broken and/or missing teeth also affect self-esteem, employability and communication
skills.
We anticipate providing 14,000 dental procedures (partial dentures, root canals, extractions,
fillings, dental cleanings and crowns), valued at $2 million to 2,000 men, women and children
who experience barriers to dental care.

Gila River Indian Community Grant Application
Grant Cycle 2016
6. Define the project as a new or continuing program.
Continuing
7. Provide a brief timeline including start and finish dates. Indicate if the timeline is flexible.
The 18-member board of directors leads the following activities year-round: Q1 - Event review,
exit survey results reviewed, board considers recommendations, reports created for
stakeholders, next event planning begins, budget development, fundraising plan reviewed and
updated/solicitations continue year-round; Q2 - Sponsorship and volunteer opportunities
identified, fundraising strategies reviewed & created, volunteer recruitment begins; Q3 - Venue
logistics, clinic flow and patient safety plans created, Lead volunteer meetings; Q4 - Logistics
finalized, supplies confirmed, Thursday evening, December 8, pre-register those in line for am
crowd control; Day of Event - Friday December 9 6AM doors open and patients and families
register, medical & dental triage, x-ray and routing, children participate in the Youth
Education program after they register while waiting for treatment, anxieties are soothed by
visits with Santa, the Cardinal’s “Big Red,” and the Tooth Fairy, Saturday December 10, 5PM
doors close
8. Identify other organizations, partners or funders participating in the project and their roles.
Because CADSF could not fulfill its mission without many community partnerships and funders
the board focuses on cultivation and stewardship throughout the year to help ensure the
success of its dental clinic.
Partnerships include:
• Phoenix Endodontic Group – funding, volunteers, in-kind supplies
• North Scottsdale Center for Oral & Maxillofacial Surgery, funding volunteers, in-kind
supplies
• Larell Dentures – dentures, supplies, volunteer services and training
• City Serve / HopeFest – dental mission of mercy provider
• Del E. Webb Foundation – funding for denture lab
• Arizona Department of Health – vaccinations
• AT Still University – student volunteers, training
• Midwestern University – student volunteers, training
• AdMix Social – marketing and PR
• Benco Dental – dental supplies, volunteers
• Delta Dental Foundation – funding, other community funding introductions
• Henry Schein – dental supplies, volunteers
• Diane & Bruce Halle Foundation – funding
• DentaQuest – dental supplies, volunteers
• PactOne – dental supplies, volunteers
• Patterson Foundation – funding, supplies, volunteers
• Pacific Dental Services – funding, volunteers
• Price Kong – accounting services

Gila River Indian Community Grant Application
Grant Cycle 2016
• Premier - supplies
• Alliance Bank – funding
• Central AZ Dental Society members – funding
• United Concordia Dental – funding
• VelScope - equipment
• Arizona Lottery – funding
• Casino Arizona – funding
• SmartPractice - supplies
• Alisha Dawn - photography
• CNA Foundation - funding
• Desert Dental Refining - equipment
• Fry’s – in-kind
• Rio Salado College - funding
• Subway – in-kind
• Sundt - funding
• Fricke Dental - supplies
• CDA Foundation – administrative support
During board meetings members discuss these and other potential new strategic partnership
opportunities that could help us better serve our patients.
9. Would you be able to implement the proposed plan if your organization received partial
funding for this project?
Yes, perhaps CADSF will be able to provide free dental care to 2,000 patients this year with only
partial funding. However, because of funding insecurity, not knowing if past funders will renew
their donations, we rely on the success of new grant support every year. Being fully awarded
this multi-year grant would help ensure the continuation of our dental mission of mercy as it
stands currently for three years.
10. Describe your plan for project sustainability beyond the grant period. If this is a
program/project previously funded by the Gila River Indian Community describe efforts made
towards the previously described sustainability plan.
The CADSF board is committed to its annual Dental Mission of Mercy program and providing
dental healthcare services to those in need. The board’s three-year strategic plan (in
development) includes cultivating diversified revenue streams: (1) individual major gifts; (2)
grants; (3) in-kind (dental professionals’ time & equipment); (4) corporate sponsorships; (5)
annual/direct mail/online gifts; (6) special event fund/friend-raisers.
Revenue has increased an average of 22% each year for past three years, because of the
strategic planning process the board is now going through it is expected that revenue will
continue to grow. CADSF is supported by the dental supply industry, dental professionals, local
and national foundations, corporations, individuals and fundraising events and every CADSF
board is a donor.

Gila River Indian Community Grant Application
Grant Cycle 2016
11. Describe your plan to document progress and results.
Every year detailed documentation takes place through in-take and exit surveys. This year we
will also begin a second-stage survey approximately 9 months after the dental mission of mercy
event, and a volunteer survey.
Event summary and exit survey reports (included with this application) include the following
data: (1) number of patients served; (2) total number of procedures performed; (3) number of
volunteers; (4) dollar value of treatment provided; (5) age; (6) ethnic background; (7) gender; (8)
County/Zip code; (8) income; (9) veteran status.
Second-stage surveys seek to track health & pain status and any follow-up care sought including
ER visits. Ninety-two (92) percent of 2014 participants surveyed responded that they were
either Very Likely or Somewhat Likely to attend another AZMOM event, potentially increasing
ability to track patient outcomes and support after-care.
Example questions to be asked in the second-stage survey: (a) Did you experience total
elimination of pain? (b) Did you experience partial elimination of pain? (c) What, if any, dental
problems have you experienced in the past 9 months? (d) Did you seek emergency room care
for dental issues following AZMOM? (e) What, if any, follow-up care was sought following
AZMOM? (f) Are you currently seeking dental care? (g) For whom are you seeking it, self, family
member? (h) Will you attend the next AZMOM event? (i) The name of any free or reduced fee
dental clinics you have visited after AZMOM.
The processes to be measured are: (1) Patient satisfaction will be measured by Exit Survey
results, which is available in both English and Spanish; (2) Volunteer satisfaction will be
measured through a first-time on-line volunteer survey.
The most important outcome is the elimination of pain and/or infection for as many patients as
possible. AZMOM will provide the best possible free dental care to as many patients possible
over 22 hours in 2 days. Patients will be treated based on the most urgent needs, with infection
control and pain elimination as the priority.
12. Indicate any application to and/or awards made by a tribe other than the Gila River Indian
Community for state shared revenues for this and any other project. If this information is
included in a separate attachment, please indicate that here.
None.

Gila River Indian Community Grant Application
Grant Cycle 2016
Project Budget
Budget Period: Three Fiscal Years - January 1, 2016 to December 31, 2018
For each budget item listed here please provide a narrative description on the following Project
Budget Detail page.
2016
Amount Requested Amount requested In-Kind Total
Proposed Budget Expense
from GRIC from others Contributions Budget
In-kind services & equipment $1,905,741
Dental Chair Rental $45,000 $45,000
Salaries Ex. Dir. & Program Coord. $40,720 $40,720
Videographer $4,500 $4,500
Public Relations & Social Media $15,000 $15,000
Moving Truck $2,000 $2,000
Storage $1,600 $1,600
Awards $2,500 $2,500
Dental Equipment Rental &
Maintenance $5,000 $21,500 $26,500
Printing & Copying $1,350 $1,350
Dental Supplies $5,000 $30,000 $35,000
Non-dental Supplies $18,000 $18,000
Telephone & Insurance $3,910 $3,910
Benefits $3,600 $3,600
Volunteer Food & Travel $8,500 $8,500
Total Budget $10,000 $198,180 $1,905,741 $208,180
2017
Amount Requested Amount requested In-Kind Total
Proposed Budget Expense from GRIC from others Contributions Budget
In-kind services & equipment $1,981,970
Dental Chair Rental $46,800.00 $45,000
Salaries Ex. Dir. & Program Coord. $42,348.80 $40,720
Videographer $4,680.00 $4,500
Public Relations & Social Media $15,600.00 $15,000
Moving Truck $2,080.00 $2,000
Storage $1,664.00 $1,600
Awards $2,600.00 $2,500
Dental Equipment Rental & $5,000 $22,360.00 $27,360

Gila River Indian Community Grant Application
Grant Cycle 2016
Maintenance
Printing & Copying $1,404.00 $1,350
Dental Supplies $5,000 $31,200.00 $36,200
Non-dental Supplies $18,720.00 $18,000
Telephone & Insurance $4,066.40 $3,910
Benefits $3,744.00 $3,600
Volunteer Food & Travel $8,840.00 $8,500
Total Budget $10,000 $206,107.20 $1,981,970 $210,240
2018
Amount Requested Amount requested In-Kind Total
Proposed Budget Expense
from GRIC from others Contributions Budget
In-kind services & equipment $2,061,249
Dental Chair Rental $48,672.00 $45,000
Salaries Ex. Dir. & Program Coord. $44,042.75 $40,720
Videographer $4,867.20 $4,500
Public Relations & Social Media $16,224.00 $15,000
Moving Truck $2,163.20 $2,000
Storage $1,730.56 $1,600
Awards $2,704.00 $2,500
Dental Equipment Rental &
Maintenance $5,000 $23,254.40 $28,254
Printing & Copying $1,460.16 $1,350
Dental Supplies $5,000 $32,448.00 $37,448
Non-dental Supplies $19,468.80 $18,000
Telephone & Insurance $4,229.06 $3,910
Benefits $3,893.76 $3,600
Volunteer Food & Travel $9,193.60 $8,500
Total Budget $10,000 $214,351.49 $2,061,249 $212,382

Gila River Indian Community Grant Application
Grant Cycle 2016
Project Budget Detail
Please provide a narrative description for each of the project budget items listed on the previous
page. Include the dollar figure and how it was derived.
1. In-kind services and equipment – dental healthcare services performed by dentists and hygienists,
dental equipment and tools - $1,832,443
2. Dental Chair Rental dental operating stations; chairs, lights, hand- held equipment -$45,000
3. Salaries Ex. Dir. & Program Coord. administrative and event costs - $40,720
4. Videographer video of event, patient testimonials - $4,500
5. Public Relations & Social Media services for event promotion, acknowledge supports, recruit
volunteers $15.000
6. Moving truck for equipment and supplies $2,000
7. Storage of equipment and supplies $1,600
8. Awards for volunteers and donors $2,500
9. Dental equipment and tools; drills, picks, files, mirrors - $1,600
10. Printing & Copying; event signage, files, registration, badges $1,350
11. Dental supplies; gloves, masks, syringes, gauze $35,000
12. Non-dental supplies; badges, pens, folder, files, boxes, tape, staplers $18,000
13. Telephone & insurance; $3,910
14. Benefits; program coordinator car allowance - $3,600
15. Volunteer food & travel; coffee, water, sandwiches, pizza for 1,500 volunteers, reimbursable
mileage, visiting other AzMOM events -$8,500

2015 Mission of Mercy
Event Summary
$1,944,205.34 Dental Treatment Provided
13716 Total Procedures Performed
1825 Number of Patients Served
1467 Total Volunteers
249 Dentists
206 Hygienists & Students
371 Dental Assistants
100 Dental Students
28 Pharmacists & Pharmacy S
25 Lab Tech
20 X-Ray Techs
27 Vendors/Manufacturers
32 Medical Personnel
409 Community Volunteers
Wednesday, December 16, 2015 Page 1

2015 Mission of Mercy
Patient Age Range
Total % of Total Patient Age Range
Not Disclosed (N/A) 1 0.05% 500
400
18 & Under (<=18) 96 5.26% 300 SumOf# Patients in
200 Age Range
19-30 Years Old (19-30) 366 20.05% 100
0
31-40 Years Old (31-40) 412 22.58% N/A <=18 19- 31- 41- 51- 65+
30 40 50 64
41-50 Years Old (41-50) 422 23.12%
51-64 Years Old (51-64) 428 23.45%
65 Years or Older (65+) 100 5.48%
Patient Ethnic Background
Patient Ethnic Background
Total % of Total
White (W) 645 35.34%
W
Hispanic, Latino or Spanish (H/L/S) 657 36.00% H/L/S
B/AA
Black, African American (B/AA) 282 15.45% ASIAN
Asian (ASIAN) 33 1.81% AI
OTHER
American Indian (AI) 33 1.81%
Other (OTHER) 175 9.59%
Wednesday, December 16, 2015 Page 2

2015 Mission of Mercy
Patient Gender Patient Gender
Total % of Total
Male (M) 695 38.08%
M
Female (F) 1128 61.81% F
O
Other (O) 2 0.11%
Patients Served by County
Total % of Total
Maricopa County AZ 1717 94.08%
Patients Served by County
Pinal County AZ 35 1.92%
Yavapai County AZ 14 0.77%
Pima County AZ 13 0.71%
N/A 11 0.60%
Navajo County AZ 7 0.38%
Mohave County AZ 6 0.33%
Gila County AZ 4 0.22%
Apache County AZ 3 0.16%
Riverside County CA 2 0.11%
Denver County CO 2 0.11%
Bannock County ID 1 0.05%
Davis County UT 1 0.05%
Graham County AZ 1 0.05%
Wednesday, December 16, 2015 Page 3

2015 Mission of Mercy
Grand Forks County ND 1 0.05%
La Paz County AZ 1 0.05%
Larimer County CO 1 0.05%
Mariposa County CA 1 0.05%
Yuma County AZ 1 0.05%
Sierra County NM 1 0.05%
Taos County NM 1 0.05%
Los Angeles County CA 1 0.05%
Wednesday, December 16, 2015 Page 4

2015 Mission of Mercy
How Did You Hear About MOM?
Total % of Total Advertising
CHRCH
Church (CHRCH) 54 2.82%
CMTY
Community Outreach (CMTY) 55 2.87% SPCL
BRCHR
Special Event (SPCL) 21 1.10% EMAIL
Brochure/Flyer/Poster (BRCHR) 44 2.30% FAM/FRD
WEB
Email (EMAIL) 11 0.57% MEDIA
OTHER
Family/Friend (FAM/FRD) 802 41.84%
Internet/Social Media (WEB) 227 11.84%
Radio/TV/Newspaper (MEDIA) 331 17.27%
Other (OTHER) 372 19.41%
When Did You Hear
Time Frame
About MOM?
Total % of Total 1000
800
1 week or less (WEEK) 927 50.79% 600
SumOfTime Frames
400
Last month (1MONTH) 227 12.44% 200
0
Last 3 months (3MONTH) 83 4.55%
WEEK 1MONTH 3MONTH 6MONTH LASTYR
Last 6 months (6MONTH) 45 2.47%
Last Year or Last Event (LASTYR) 543 29.75%
Wednesday, December 16, 2015 Page 5

2015 Mission of Mercy
Procedures by Department
# By Dept # % of Total $ By Dept $ % of Total
Anesthesia (ANESTH) 486 3.54% $30,709.89 1.58%
Endodontics (ENDO) 146 1.06% $115,504.06 5.94%
Evaluation (EVAL) 1808 13.18% $160,184.69 8.24%
N/A - Dept Code Not Assigned 3 0.02% $213.78 0.01%
Oral Surgery (ORAL-S) 2510 18.30% $658,323.10 33.86%
Pharmacy (PHARM) 770 5.61% $3,043.03 0.16%
Preventive (PREV) 2688 19.60% $182,429.09 9.38%
Prosthodontics (PROSTH) 263 1.92% $289,332.84 14.88%
Restorative (REST) 951 6.93% $289,379.21 14.88%
Imaging (X-RAY) 4091 29.83% $215,085.65 11.06%
Totals: 13716 $1,944,205.34
# by Department ANESTH $ by Department ANESTH
ENDO ENDO
EVAL EVAL
N/A N/A
ORAL-S ORAL-S
PHARM PHARM
PREV PREV
PROSTH PROSTH
REST REST
X-RAY X-RAY
Wednesday, December 16, 2015 Page 6

2015 Mission of Mercy
Procedures by Dental Code
Code # Procedures $ Value
0150 Comprehensive Oral Exam 1807 $160,027.92
0160 Detailed & Extensive Oral Exam 1 $156.77
0210 Intraoral - Complete Series (including bitewings) 11 $1,455.74
0220 Intraoral-Periapical - first film 1174 $34,656.48
0230 Intraoral-Periapical - add'l film 790 $19,299.70
0270 Bitewing Xray 95 $2,707.50
0272 Bitewings - 2 films 527 $24,141.87
0273 Bitewings - 3 films 103 $5,766.97
0274 Bitewings - 4 films 613 $39,936.95
0330 Panoramic Film 778 $87,120.44
0431 Adjunctive Pre-Diagnostic for Mucosal Abnormalties 3 $213.78
1110 Prophylaxis - Adult 191 $17,499.42
1120 Prophylaxis - Child 31 $3,061.25
1206 Topical Fluoride Varnish; Therapeutic 352 $14,333.44
1208 Topical Fluoride 4 $150.64
1330 Oral Hygiene Instruction 1824 $98,404.80
1351 Sealant (per tooth) 31 $1,735.69
2140 Amalgam - One Surface 23 $3,301.42
2150 Amalgam - Two Surfaces 44 $7,972.80
2160 Amalgam - Three Surfaces 14 $3,092.74
2161 Amalgam - Four or More Surfaces 7 $1,817.13
Wednesday, December 16, 2015 Page 7

2015 Mission of Mercy
2330 Resin-Based Composite - One Surface, Anterior 87 $14,435.91
2331 Resin-Based Composite - Two Surfaces, Anterior 83 $17,068.12
2332 Resin-Based Composite - Three Surfaces, Anterior 86 $21,799.28
2335 Resin-Based Composite - Four or More Surfaces, Anterior 114 $36,208.68
2391 Resin-Based Composite - One Surface, Posterior 101 $18,404.22
2392 Resin-Based Composite - Two Surfaces, Posterior 130 $30,438.20
2393 Resin-Based Composite - Three Surfaces, Posterior 88 $25,531.44
2394 Resin-Based Composite - Four or More Surfaces, Posterior 31 $10,887.51
2643 Onlay - Porcelain/Ceramic - Three Surfaces 1 $1,079.00
2740 Crown - Porcelain/Ceramic Substrate 67 $77,345.47
2920 Recement Crown 5 $560.00
2930 Prefabricated Stainless Steel Crown - Primary Tooth 2 $551.74
2931 Prefabricated Stainless Steel Crown - Permanent Tooth 4 $1,319.32
2940 Sedative Filling 1 $122.16
2950 Core Buildup, Including Any Pins 63 $17,444.07
3110 Pulp Cap - Direct (Excluding Final Restoration) 2 $168.98
3220 Therapeutic Pulpotomy (Excluding Final Restoration) 3 $607.74
3310 Anterior Endodontic Treatment (Exclusing Final Restoration) 84 $64,134.00
3320 Bicuspid Endodontic Treatment (Exclusing Final Restoration) 52 $45,365.84
3330 Molar Endodontic Treatment (Exclusing Final Restoration) 5 $5,227.50
4341 Periodontal Scaling and Root Planing - Four or More Teeth per Quadrant 2 $517.14
4355 Full Mouth Debridement to Enable Comprehensive Eval and Diagnosis 255 $47,243.85
5110 Complete Denture - Maxillary 56 $96,913.60
5120 Complete Denture - Mandibular 50 $86,600.00
Wednesday, December 16, 2015 Page 8

2015 Mission of Mercy
5130 Immediate Denture - Maxillary 4 $7,398.80
5140 Immediate Denture - Mandibular 4 $7,419.16
5422 Adjust Parial Denture 9 $839.43
5650 Add Tooth to Existing Partial Denture 9 $2,061.45
5731 Reline Complete Mandibular Denture (chairside) 1 $376.66
5820 Interim Partial Denture, Maxillary 68 $47,349.08
5821 Lower All Resin Partial, Mandibular 57 $39,864.09
6093 Recement Implant Fixed Bridge 1 $97.67
6930 Recement Fixed Partial Denture 4 $412.90
7111 Extraction, Coronal Remnants - Deciduous Tooth 1 $173.06
7140 Extraction, Erupted Tooth or Exposed Root 682 $121,498.30
7210 Surgical Removal of Erupted Tooth Requiring Elevation & Removal of Bon 1344 $383,093.76
7220 Removal of Impacted Tooth - Soft Tissue 58 $18,539.70
7230 Removal of Impacted Tooth - Partial Bony 40 $16,084.40
7240 Removal of Impacted Tooth - Completely Bony 4 $1,962.72
7250 Surgical Removal of Residual Tooth Roots (Cutting Procedure) 354 $108,830.22
7310 Alveoplasty in Conjunction with Extractions - per Quadrant 24 $7,207.44
7410 Excision of Begnin Lesion up to 1.25cm 1 $416.36
9215 Local Anesthesia 483 $30,486.96
9230 Analgesia, Anxiolysis, Inhalation of Nitrous Oxide 3 $222.93
PRx1 Pre Med - Amoxicillin 500mg, #4, 4 tabs STAT 10 $12.70
PRx2 Pre Med - Clindamycin 150 mg, #4, 4 tablets STAT 2 $1.48
PRx3 Pre Med - Amoxicillin 250 mg/5ml susp., 50mg/kg STAT 2 $6.12
Rx1 Amoxicillin 500 mg, #21, 1 tab tid for 7 days 182 $1,213.58
Wednesday, December 16, 2015 Page 9

2015 Mission of Mercy
Rx2 Amoxicillin 250 mg Chew Tabs, #21, 1 tab tid for 7 days 4 $29.49
Rx3 Clindamycin 150 mg, #28, 1 tab qid for 7 days 27 $140.08
Rx4 Ibuprofen 400 mg, #20, 1 tab q(4 – 6)h prn pain 455 $1,397.76
Rx5 Acetaminophen 500 mg, #20, 1 tab q(4 – 6)h prn pain 88 $241.82
Totals: 13716 $1,944,205.34
Wednesday, December 16, 2015 Page 10

Veteran
Event Summary
$92,829.23 Dental Treatment Provided
481 Total Procedures Performed
355 Number of Patients Served
The Central Arizona Dental Foundation thanks our sponsors, in‐kind donors,
community volunteers and clinical professionals for their participation and support
to make this event possible. Together we have helped change lives, one smile at a

2015 Mission of Mercy
Income Level Summary
Income Level
Code Description Total % of Total
1 Less than $20,000 1058 77.28%
Income Level
2 $20,001 to $29,000 192 14.02%
1
3 $29,001 to $36,600 64 4.67% 2
4 $36,601 to $44,000 31 2.26% 3
4
5 $44,001 to $51,600 16 1.17% 5
6
6 $51,601 to $59,999 1 0.07%
7
7 $60,000 or more 7 0.51%

Last updated: 02/11/2016
Page 1
General information
Organization American Red Cross
Contact First name Barbara
Contact Last name Carey
Contact e-mail barbara.carey@redcross.org
Contact phone number 602-347-6508
Address
Street 4747 N. 22nd St., Suite 100
City Phoenix
State AZ
ZIP Code 85016
From what tribe is the organization requesting the grant?
Gila River Indian Community
Total grant amount request
200,000.00
The Gila River Indian Community offers multi-year awards. If your organization is requesting a multi-year grant for this
project or program from the Gila River Indian Community, enter the amount to be requested each year.
Amount
Year 1 (Gila River Indian Community Grants Only)
Year 2 (Gila River Indian Community Grants Only)
Year 3 (Gila River Indian Community Grants Only)
Year 4 (Gila River Indian Community Grants Only)
Year 5 (Gila River Indian Community Grants Only)
1 of 1

Gila River Indian Community Grant Application
Grant Cycle 2016
Cover Sheet
Municipality Information
1. Date of Application: 2/29/2016 (NOTE: Click or use up/down arrow keys to move among fields)
2. Name of City, Town or County: Maricopa County
3. Mayor (City or Town) or Board of Supervisor’s Chairman (County): Clint Hickman
4. Mailing Address: 301 W. Jefferson, 10th Floor
5. City: Phoenix State: Arizona Zip Code: 85032
6. Acknowledgement of Submission by Authorized Municipality Representative:
Typed Name: Amanda Nash Signature:
Applicant Information
7. Department/Organization Name: American Red Cross
8. Is this a non-profit 501c(3) Organization? No Yes If yes, attach IRS Determination Letter
9. Application Contact Person: Barbara Carey Title: Grants Manager
10. Phone Number: 602-347-6508
11. Mailing Address: 4747 N. 22nd St., Suite 100
12. City: Phoenix State: Arizona Zip Code: 85016
13. Email Address: barbara.carey@redcross.org Website Address: www.redcross.org/local/az-nm-el-paso
Project Information
14. Project Name: American Red Cross Community Services
15. Purpose of Grant: We respectfully request your support to adopt three American Red Cross fleet vehicles for the
coming 12 months and your support of Disaster Cycle Services and the Home Fire Preparedness Campaign in Maricopa
and Pinal Counties.
16. Priority Funding Area Healthcare
17. Annual amount requested $200,000.00
18. Number of years that funding is requested one
19. Total amount requested (annual amount x # $200,000.00
of years)
20. Has your organization received past funding 2015: $175,0000.00
from GRIC? If yes, list each year and amount
21. Geographic area served Maricopa and Pinal counties
For Office Use Only:
Data Entry Receipt Evaluation

Gila River Indian Community Grant Application
Grant Cycle 2016
Narrative
Please structure your proposal to provide the following information in the order indicated. Provide the narrative in
paragraph form in the text field provided. Please be thorough but strive for brevity.
1. Briefly describe the organization’s mission, history and goals.
For the past 100 years, the American Red Cross in Arizona proudly has delivered on our mission, helping
people prevent, prepare for and respond to emergencies. Arizona is home to three Red Cross Chapters (Northern
Arizona, Greater Phoenix, and Southern Arizona) serving all 15 Arizona counties and part of the American Red
Cross Arizona-New Mexico-El Paso Region.
Services are provided in accordance with our mission: The American Red Cross prevents and alleviates human
suffering in the face of emergencies by mobilizing the power of volunteers and the generosity of donors,
furthering our vision to partner with the people of Arizona to develop and foster safer families, neighborhoods
and worksites … to promote a system of community self-sufficiency and compassionate response when
emergencies arise.
American Red Cross volunteers and employees are committed to improving the quality of human life and
enhancing self-reliance by providing disaster response and recovery, emergency family services, and
preparedness and safety training. During FY 2015, your Red Cross in Arizona provided vital services to
families and individuals in crisis while preparing our community members with life-saving skills. Our
accomplishments included:
 Responded to 698 local disasters, of which approximately 95% involved home fires.
 Assisted 1070 families.
 Provided nearly $550,000 in direct financial assistance to local disaster clients.
 Trained 79,187 individuals in CPR, first aid, AED, Babysitting and Family Caregiving, Aquatics,
community disaster education and other life-saving classes, a figure which grows to 3,987,751 when we
include those who have downloaded our Red Cross apps and accessed various components of our electronic
and “Digital Reach” aspects of our Health and Safety information and training.
 Offered Service to the Armed Forces assistance to over 10,000 service members and their families,
including outreach services and pre-deployment briefings, emergency message relays, casework services,
and financial aid casework management.
 Worked with the International Red Cross and Red Crescent societies to link families separated by armed
conflict, natural disaster or civil unrest in their home countries, and offered International Humanitarian Law
classes
 As a subdivision of the single largest supplier of blood in the US, the Arizona Blood Services Region
typically collects and distributes donations from more than 34,000 blood and platelet donors annually,
conducts about 2000 mobile drives each year, and operates 24/7.
From mining towns to metropolitan areas, deserts to shining seas, nearly every second of every day, someone is
assisted by the American Red Cross. Every two seconds, someone in America needs blood. Every eight
minutes, the Red Cross responds to a disaster in the community. We are proud to uphold our pledge to the
American people: when the Red Cross is notified of a disaster, the Red Cross responds, 100% of the time.

Gila River Indian Community Grant Application
Grant Cycle 2016
2. If the organization is a non-profit 501c(3), please describe your relationship with the municipality including past
and present support, whether it be through partnerships, collaborations, in-kind contributions, grants, tax-based
funding or other. If the organization is a municipality governmental sub-division please enter the text “Not
applicable.”
The Red Cross worked with Maricopa County last year for funding from the Gila River Indian Community. Our
Disaster Cycle Services staff work in partnership with Maricopa County emergency services staff and first
responders in the context of disaster relief operations.
3. Describe the proposed project and planned goals and activities.
The project we propose to the Gila River Indian Community – The American Red Cross in Our
Communities – requests that you partner with us, focusing in particular on service delivery and the Home Fire
Preparedness Campaign and Disaster Cycle Services.
Delivering Our Mission: Humanitarian Services Fleet Vehicles
For the past century, the American Red Cross in Arizona has been delivering help and hope to neighbors down
the street and throughout our state. We provide relief in the form of shelter, food and supplies to families that
have lost everything to disasters. We offer the skills and confidence needed to save lives in an emergency. And
we support members of the military, veterans and their families throughout their service and beyond. With
nearly 500 chapters nationwide, every community can count on the Red Cross to fulfill our promise to alleviate
human suffering in the face of emergencies.
Fueled by the power and generosity of thousands of volunteers, the Red Cross stands ready to respond and
deliver our mission 24 hours a day, seven days a week and 365 days a year. We rely on a fleet of more than
3,100 vehicles to deliver these vital services across the country. Vehicles are used to transport volunteers,
shelter supplies, food and other relief items to disaster sites, including fires, floods and other natural disasters.
They’re also instrumental in delivering necessary supplies to health and safety trainings. Furthermore, we utilize
our vehicles to deliver comfort and care items to service members, veterans and their families. Our fleet of
vehicles is on the road every day helping us carry out our humanitarian mission.
Maintaining a reliable, high-quality vehicle fleet is critical to our programs and services. Our vehicle fleet
includes sedans and wagons, cargo and passenger vans, box trucks and heavy-duty trucks. Each vehicle travels
an average of 18,000 miles each year and can be on the road for up to eight years. Unfortunately, many current
vehicles have reached or exceeded their lifespan. Some are experiencing mechanical problems and must be
replaced in order to meet the needs of the communities we serve.

Gila River Indian Community Grant Application
Grant Cycle 2016
We are seeking the support of the Gila River Indian Community to improve our Humanitarian Services vehicle
fleet by adopting three vehicles at the Greater Phoenix Chapter, underwriting their maintenance and fuel costs,
helping us continue our lifesaving legacy in Maricopa and Pinal Counties.
We respectfully request that the Gila River Indian Community allocate $100,000 to adopt three vehicles in our
Red Cross Humanitarian Services fleet in Maricopa and Pinal counties.
Through partnership with the Gila River Indian Community, our goal is to maintain our mission-critical fleet
and, most importantly, remain constantly ready to respond at a moment’s notice.
Home Fire Preparedness: Reducing Injuries and Deaths from Home Fires by 25%
Nearly 1,000 times a day, fire departments are called to a home fire. Someone dies in a home fire seven times
each day, and a fire-related injury is reported every 45 minutes. Additionally, more than $8.1 billion worth of
property is destroyed by home fires every year. (“Home Fire Structure Fires,” National Fire Protection
Association, 2013 and 2014) The Red Cross is working to drastically reduce these statistics through the Home
Fire Preparedness Campaign (HFPC). Working with national, state, regional and local partners, this
organization-wide campaign combines grassroots neighbor-to-neighbor engagement with comprehensive
marketing and public relations outreach to decrease injuries and needless loss of life by reducing the number of
home fires. Through the campaign, we are canvassing communities, with particular focus on areas with
populations more vulnerable to home fires, providing lifesaving fire prevention and preparedness information
and tools. We also reach youth in schools and after-school programs with these tools and information, and we
seek to leverage our marking and communication vehicles to encourage people to take action and become more
prepared.
Annually, nearly 2,500 people die and 13,000 people are injured nationwide as a result of home fires. (National
Fire Protection Association, 2013) By 2020, the Red Cross Home Fire Preparedness Campaign aims to visit
more than 1.6 million homes nationwide to install and test smoke alarms, complete home safety checklists and
help families develop an escape plan, and ultimately reduce the number of fire deaths and injuries in the U.S. by
25 percent. To date, we are proud to claim 69 lives saved as a direct result of HFPC efforts.
Taking advantage of our role as a convener, the Red Cross has engaged a coalition of national, state, regional
and local partners in the HFPC, thus broadening our reach and enhancing our impact. We work with fire
departments, faith-based institutions, schools, neighborhood leaders, corporate partners and others to serve as
local campaign advocates and help us effectively communicate a message that resonates in the community.
Activities include:
 Canvassing Neighborhoods: Visiting homes to install smoke alarms, create escape plans and complete fire
safety check lists.
 Engaging Youth: Leveraging programs like the Pillowcase Project and the Paradigm Challenge to reach
youth with fire safety messaging.

Gila River Indian Community Grant Application
Grant Cycle 2016
 Generating Awareness: Leveraging advertising, social media and earned media to share preparedness and
prevention messages.
In Arizona, Red Cross volunteers, disaster cycle services staff and our community partners are working with
local fire departments to identify high-risk communities and are providing free smoke alarms, fire prevention
tips and disaster plans to households throughout the state. We’re recruiting and training teams of bilingual
volunteers to reach out to all of our communities. In Fiscal Year 2015, through HFPC activities, the Greater
Phoenix Chapter teams (Maricopa and Pinal counties) made 1002 in-home visits, served 3404 persons, installed
1188 smoke alarms, replaced 267 batteries, assisted 865 families, and engaged 649 3rd to 5th graders through
Pillowcase Preparedness presentations. Our goals for FY16 include installation of 1750 smoke alarms and
interaction with 1680 youth through Pillowcase Preparedness.
We respectfully request that the Gila River Indian Community allocate $100,000 to support Home Fire
Preparedness and engage Arizonans in this life-saving campaign.
The overall goal – reducing the number of fire deaths and injuries in the U.S. by 25 percent in five years – is
ambitious. Your Red Cross is committed to meeting the needs of disaster victims and increasing disaster
preparedness in communities across the nation. Immediate response by our disaster volunteers and smoke alarm
installations reach our most vulnerable citizens, meeting their needs, empowering their recovery, and providing
meaningful opportunities for all of us to be part of the solution: Sleeves up, hearts open, all in to save lives.
4. Describe how the proposed project satisfies one or more of the priority funding areas identified by the Gila River
Indian Community.
Seen through the lens of the priority areas identified by the Gila River Indian Community, American Red Cross
humanitarian services, with their emphasis on saving lives, relate most directly to health care services, with
secondary linkage to public safety and education.
The Home Fire Preparedness initiative, with its emphasis on reduction of injuries and deaths due to home fires,
represents the ultimate in health care and public safety. And for the cases where a home fire does occur, first
responders and local law enforcement know that the Red Cross will respond promptly and reliably, providing
those immediate emergency services which are vital components of the health and safety of the victims and the
community at large. In the case of a larger response where a respite center or shelter is opened, the critical role
of health care services and public safety is magnified, as the Red Cross works with local government,
emergency management agencies and community organizations to coordinate the immediate sheltering and
feeding of affected populations, providing a safe and secure environment for disaster victims. Finally,
education/preparedness is an over-arching component in all of our services, in particular through Pillowcase
Preparedness and family fire safety and fire escape planning.

Gila River Indian Community Grant Application
Grant Cycle 2016
5. Identify the needs/problems to be addressed, target population and number of people to be served by the
project.
In the broadest terms, the need which we address is identified in the opening words of our mission statement:
The American Red Cross prevents and alleviates human suffering in the face of emergencies. The American
Red Cross in Arizona serves everyone in our state, although this request to the Gila River Indian Community
focuses most specifically on services to the 4.2 million residents of Maricopa and Pinal counties, including the
11,257 residents of the Gila River Indian Community.
Our fleet vehicles are integral to service delivery, again with the potential to impact everyone in Maricopa and
Pinal counties. Looking more specifically at activities associated with the HFPC, we are canvassing homes
throughout the state, including with your permission within the Gila River Indian Community, visiting with our
neighbors, installing smoke detectors or replacing batteries, as well as working with residents to complete home
safety checklists and develop family escape plans. Our local disaster services staff members are in contact with
school officials to schedule times for Pillowcase Project presentations for 3rd through 5th graders in select
schools, targeting in particular those with low to medium income populations that have had a fire within .5 mile
of their school. Finally, we are addressing rural home fire and wildfire concerns as identified by local fire
departments. In FY15, our disaster teams served 718 families/2396 individual disaster clients, providing them
with over $300,000 in direct financial assistance to meet their immediate emergency needs: food, clothing,
shelter, bedding/mattresses, replacement of health-related items, and casework services. We expect similar
levels in FY16. Added to these numbers are our specific HFPC statistics, as cited earlier: 865 families/3404
individuals served and 649 children participating in Pillowcase Preparedness in FY15, numbers which will
increase in FY16 and subsequent years of the Home Fire campaign.
6. Define the project as a new or continuing program.
The American Red Cross has been serving the residents of Arizona for 100 years, so in that sense this is a
continuing project, as our efforts are constant and ongoing.
The Home Fire Preparedness Campaign is a five year initiative which began in October 2014.
7. Provide a brief timeline including start and finish dates. Indicate if the timeline is flexible.
The timetable for this grant application is for the upcoming fiscal year, namely July 1, 2016 through June 30,
2017. This timeline can be flexible in the sense that it can cover any 12-month period, for example starting on
the date when funds would be awarded.
8. Identify other organizations, partners or funders participating in the project and their roles.
The American Red Cross is unique in the breadth and depth of services we offer to our communities. However,
our service philosophy relies heavily upon cooperation and collaboration with other agencies and entities, with
priority given to growing our existing relationships while building new partnerships with organizations

Gila River Indian Community Grant Application
Grant Cycle 2016
including social service and faith-based institutions and government agencies. This commitment to effective
collaboration is necessary to the Chapter’s vision and includes:
 Membership in Arizona Voluntary Organizations Active in Disaster (AzVOAD), an umbrella organization
of agencies that work closely together to improve services and eliminate unnecessary duplication in disaster
response
 Working relationships with local fire departments; the Arizona Department of Homeland Security, Division
of Emergency Management, and Department of Public Safety; and County Emergency Managers’ and
Sheriffs’ departments
 Participation in state and county drills, exercises and conferences
 Providing liaisons to State and County Emergency Operation Centers during activation, including for
example during wildfires and large scale flooding
 Agreements with bordering Red Cross chapters through a robust divisional structure to leverage material
and human resources in larger disaster events
 Shelter agreements with local organizations and companies
For the Home Fire Preparedness initiative, we are working very closely with local fire departments and
emergency management throughout Arizona, and we seek volunteer involvement from corporate partners,
community organizations, service clubs and faith-based institutions, among others. We have also worked with
the Arizona Burn Foundation in many of the home canvassing efforts.
We have not approached any other funders about fleet vehicles. Disaster Services, and by extension the Home
Fire Preparedness initiative, receive funding from local corporate and foundation partners as well as Arizona
residents.
9. Would you be able to implement the proposed plan if your organization received partial funding for this project?
As part of the proposal for the Gila River Indian Community to fund the three fleet vehicles, we would be
honored to include your logo on these vehicles, which will be used throughout Maricopa and Pinal counties in
the coming 12-month period. We are unable to offer this opportunity if only partially funded.
10. Describe your plan for project sustainability beyond the grant period. If this is a program/project previously
funded by the Gila River Indian Community describe efforts made towards the previously described
sustainability plan.
Red Cross Humanitarian Services, including Disaster Cycle Services and the HFPC, are part of the core services
of the Red Cross and will require on-going funding. We will continue to seek such funding through United Way
and various corporate and foundation partners. The American Red Cross is not a government agency. All Red
Cross disaster assistance, including all elements of the Home Fire Preparedness initiative, is free; our appeals to
the compassion and generosity of Arizona residents, foundations and businesses enable us to provide these vital
services and will be on-going.
11. Describe your plan to document progress and results.

Gila River Indian Community Grant Application
Grant Cycle 2016
Outcome measurement is tracked by the Chapter’s regular collection of statistical data related to disaster
response:
 Number of incidents
 Type of incident
 Number of individuals/families impacted
 Amount/type of assistance provided
 Average amount of time to respond
 Average amount of time to close a case
For the HFPC, we will track relevant statistics, including:
 Number of smoke alarms installed
 Number of batteries replaced
 Number of homes visited
 Number of individuals assisted
 Number of home fire escape plans and home safety check lists completed
 Number of students reached through Pillowcase Preparedness
And of course, we will be monitoring the overall goal to reduce the number of fire deaths and injuries in the
United States by 25 percent by 2020. To date, we are proud to claim 69 saved lives directly attributable to the
HFPC.
Finally, we conduct quarterly and annual surveys of Red Cross clients, volunteers and community partners to
measure satisfaction on service quality and effectiveness.
12. Indicate any application to and/or awards made by a tribe other than the Gila River Indian Community for state
shared revenues for this and any other project. If this information is included in a separate attachment, please
indicate that here.
The Chapter has been awarded funding for Disaster Services from the Salt River Pima-Maricopa Indian
Community.

Gila River Indian Community Grant Application
Grant Cycle 2016
Project Budget
Budget Period: Click here to enter text.
For each budget item listed here please provide a narrative description on the following Project Budget Detail page.
Proposed Budget Expense Amount Amount In Kind Total Budget
(list each budget item) requested from requested or contributions
GRIC secured from
other funders
1. Adoption of 3 Humanitarian $100,000 $0 $0 $100,000
Services Fleet Vehicles
2. Support for Disaster Cycle $100,000 $1,509,164 $0 $1,609,164
Services/Home Fire Preparedness
Campaign
3. Click here to enter text. $0 $0 $0 $0
4. Click here to enter text. $0 $0 $0 $0
5. Click here to enter text. $0 $0 $0 $0
6. Click here to enter text. $0 $0 $0 $0
7. Click here to enter text. $0 $0 $0 $0
8. Click here to enter text. $0 $0 $0 $0
9. Click here to enter text. $0 $0 $0 $0
10. Click here to enter text. $0 $0 $0 $0
11. Click here to enter text. $0 $0 $0 $0
12. Click here to enter text. $0 $0 $0 $0
13. Click here to enter text. $0 $0 $0 $0
14. Click here to enter text. $0 $0 $0 $0
15. Click here to enter text. $0 $0 $0 $0
16. Click here to enter text. $0 $0 $0 $0
17. Click here to enter text. $0 $0 $0 $0
Total Budget $200,000 $0 $0 $1,709,164

Gila River Indian Community Grant Application
Grant Cycle 2016
Project Budget Detail
Please provide a narrative description for each of the project budget items listed on the previous page. Include the
dollar figure and how it was derived.
1. We are seeking the support of the Gila River Indian Community to improve our Humanitarian Services vehicle fleet
through the adoption of three fleet vehicles at the Greater Phoenix Chapter, serving Maricopa and Pinal counties.
Maintaining a reliable, high-quality vehicle fleet is critical to our programs and services. This request does not seek to
expand the number of vehicles we have but underwrites the maintenance costs and fuel for three vehicles.
2. Your support of Red Cross Disaster Cycle Services and, in particular, the Home Fire Preparedness Campaign will
underwrite efforts in Maricopa and Pinal counties, including with your permission within the Gila River Indian
Community, to canvass neighborhoods – visiting homes to install smoke alarms, create escape plans and complete fire
safety check lists; to engage you – leveraging programs like Pillowcase Preparedness and the Paradigm Challenge to
reach youth with fire safety messaging; and to generate awareness – leveraging advertising, social media and earned
media to share vital preparedness and prevention messages. We seek to meet the immediate emergency needs of
victims of natural or human-caused disasters while also stretching to meet our goal of reducing deaths and injuries
associated with home fires by 25% by 2020.
3. Click here to enter text.
4. Click here to enter text.
5. Click here to enter text.
6. Click here to enter text.
7. Click here to enter text.
8. Click here to enter text.
9. Click here to enter text.
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Gila River Indian Community Grant Application
Grant Cycle 2016
14. Click here to enter text.
15. Click here to enter text.
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17. Click here to enter text.
Other explanation: Click here to enter text.

Last updated: 02/12/2016
Page 1
General information
Organization Arizona Masonic Foundation for Children
Contact First name Henry
Contact Last name Spomer
Contact e-mail 1papapie@comcast.net
Contact phone number 520-661-2021
Address
Street 6360 N. Orange Blossom Laner
City Tucson
State Arizona
ZIP Code 85741
From what tribe is the organization requesting the grant?
Gila River Indian Community
Total grant amount request
36,000
The Gila River Indian Community offers multi-year awards. If your organization is requesting a multi-year grant for this
project or program from the Gila River Indian Community, enter the amount to be requested each year.
Amount
Year 1 (Gila River Indian Community Grants Only) 36000
Year 2 (Gila River Indian Community Grants Only)
Year 3 (Gila River Indian Community Grants Only)
Year 4 (Gila River Indian Community Grants Only)
Year 5 (Gila River Indian Community Grants Only)
1 of 1

Gila River Indian Community Grant Application
Grant Cycle 2016
Cover Sheet
Municipality Information
1. Date of Application: 2/19/2016 (NOTE: Click or use up/down arrow keys to move among fields)
2. Name of City, Town or County: Maricopa County
3. Mayor (City or Town) or Board of Supervisor’s Chairman (County): Maricopa
4. Mailing Address: 301 W Jefferson #10
5. City: Phoenix State: Arizona Zip Code: 85003
6. Acknowledgement of Submission by Authorized Municipality Representative:
Typed Name: Click here to enter text. Signature:
Applicant Information
7. Department/Organization Name: Arizona Masonic Foundation for Children
8. Is this a non-profit 501c(3) Organization? No Yes If yes, attach IRS Determination
Letter
9. Application Contact Person: Henry Spomer Title: Funding Chairman
10. Phone Number: 520-661-2021
11. Mailing Address: 6360 N. Orange Blossom Lane
12. City: Tucson State: Arizona Zip Code: 85741
13. Email Address: 1papapie@comcast.net Website Address: www.foundation4children.org
Project Information
14. Project Name: Children At Risk
15. Purpose of Grant: Train School Educators to identify, intervene with and develop intervention plans for At
Risk Students
16. Priority Funding Area Public Safety
17. Annual amount requested $36,000
18. Number of years that funding is requested 1 yr.
19. Total amount requested (annual amount x # of $36,000
years)
20. Has your organization received past funding 2014 - $36,000; 2005 thru 2008 - $72,000
For Office Use Only:
Data Entry
Receipt
Evaluation

Gila River Indian Community Grant Application
Grant Cycle 2016
from GRIC? If yes, list each year and amount
21. Geographic area served State of Arizona

Gila River Indian Community Grant Application
Grant Cycle 2016
contributions, grants, tax-based funding or other. If the organization is a municipality governmental
sub-division please enter the text “Not applicable.”
In the past we have received $5,000 donation of RICO funds from Maricopa County Attorney’s
Office. S3 School grants providing funding for one training session in the Phoenix area 2013.
Since 2006 we have provided our Workshop to 8 different Phoenix area school districts and 56
different schools for over 250 educators – representing a positive change in over 2000 at risk
children’s lives. Most recently we conducted our training at the East Valley Institute of
Technology (EVIT) in Mesa, which is one of the best resources Arizona's students have to
guarantee themselves success. EVIT programs are tuition-free to high school students who
live in 10 East Valley school districts – Mesa, Scottsdale, Fountain Hills, Tempe, Apache
Junction, Chandler, Gilbert, Higley, Queen Creek and J.O. Combs. In addition to the teams
from EVIT, teams from 2 other Phoenix area Districts attended. Thanks to this EVIT
experience, these districts will now become aware of our program.
3. Describe the proposed project and planned goals and activities.
Provide three (3) Children at Risk Intervention trainings for two hundred and fourty plus (240+)
Arizona School Teachers through the Masonic Model Student Assistance Program (MSAP) by
Newman/Stecker & Associates. The Arizona Masonic Foundation for Children (AMFC)
provides this highly professional, intensive three-day training workshop, for Arizona educators”
to learn to, or improve their ability to: identify, intervene with, and create appropriate
intervention plans for students that may be at risk. This workshop trains a core team of four to
eight educators from a school building in how to intervene early and effectively with students
that display patterns of behaviors that threaten their success at school and in life. MSAP
involves practical practice sessions designed to simulate real events along with presentations
on such subjects as: chemical dependency, depression and suicide, conflict, anger and
violence, communication skills and intervention, family dynamics, enabling, life skills
development, treatment and aftercare, and group process. Participants leave the training with
a specific plan for behavioral interventions, and a system for implementing MSAP in their
schools, and or incorporate worthwhile MSAP concept/practices into their current program.
4. Describe how the proposed project satisfies one or more of the priority funding areas identified by the
Gila River Indian Community.

Gila River Indian Community Grant Application
Grant Cycle 2016
Educators learn to identify High Risk Issues early on and how to intervene with appropriate
methods and actions. Public Safety: Violence, bullying, drug/alcohol use are identified earlier
and acted upon by proven (research based) intervention actions thus the youth community
and schools become a safer place for youth to grow and develop as future leaders of our
communities. Education: This program provides instruction in development of lacking life
skills and learning disabilities, which hinder development and education. Appropriate action
plans are developed for the student to address those needs or lack thereof. (Special Needs
students are most often not Special Education students.) High Risk Students are fitted with
specific intervention plans to address their risk and not referred to Special Education. This
reduces the over burdened on and the over flow of Special Education classes. With reduced
violence, substance abuse and other outside interference schools are able to provide more
and better uninterrupted instruction to students. Health Care: Some students are burdened
with simple issues as personal hygiene or clean clothes to the more extreme of Physical or
Mental Health. Each student is provided with a specific intervention program to address these
needs and to help the student overcome these issues.
Healthier, happier, safer and better educated youth will result in a healthier, happier, safer and
more productive community and society.
5. Identify the needs/problems to be addressed, target population and number of people to be served by
the project.
Whether the issues are related to physical and/or emotional health, safety, education, or
quality attention from a caring adult, statistics show i n 2015 Arizona ranked 46 th in Overall child
well-being, (4 th worst state)¹, 44th in Education Domain, 46th in Family and Community
Domain, we lack strong social and cultural institutions, good role models for children and the
resources to provide safe and good schools; 42nd in Economic Well Being & General Health.
49th in 16-19 year olds who are school dropouts, 47th in Birth to girls age 15-17, 37th in Juvenile
violent crime arrest rate, and we increased from 38th to 41st for Teen deaths¹¹. 655 youth die
each year with 72 children killed by guns and we have 1,737 youth in Juvenile Justice Custody
each day (40th).¹¹¹ There was 64 school shooting this past year with some here in Arizona. We
must increase our intervention efforts before we have more shooting and suicides. We must
continue to provide better protection for our children so they may obtain an education and
become our future leaders.
Just recently, two 15 year old girls were shot and killed at a high school in Glendale AZ, in
what appears to be a murder/suicide - - if only their Elementary, Middle, and High School had
a team trained in our Children at Risk Intervention model? We are expecting an increase in

Gila River Indian Community Grant Application
Grant Cycle 2016
demand from the schools in the Glendale area as a result of this tragedy.
Recently in Diane Sawyer’s interview of Sue Klebold, the mother of Columbine killer Dylan
Klebold about Columbine High School. Sue Klebold said: “I felt that I was a good mom… That
he would, he could talk to me about anything,” Klebold continued. “Part of the shock of this
was that learning that what I believed and how I lived and how I parented was-- an invention in
my own mind. That it, it was a completely different world that he was living in.”
This is exactly what our Foundation has been teaching and informing for years now. The world
of Children has changed and few recognize that, much less have developed an understanding
of it and a set of solutions for it. Parents cannot do this alone – they are not experts in at risk
behavior and the intervention required - we long ago at our inception partnered with Educator
to provide our At Risk Intervention model because they most frequently interface with the
children and can provide a safe and supportive environment necessary for change. However,
understand the Educator is not an expert either. There are no at risk intervention classes at the
university. That 21 – 22 year old College Graduate with an Education degree doesn’t come
with a kit bag full of knowledge on at risk children, their behavior, or intervention development
when they first enter the classroom. We give that tool to use. Even where there are existing
program in the schools, the Educator constantly tells that our model or some portion
supplementing or augmenting their program is of great value to them.
Funds are needed to increase the number of trainings provided, thereby increasing the
number of interventions with children who are “at risk” and will remain at risk until someone
intervenes.
While there is no known absolute head count for “At Risk Children” review of such available
data as that from the Children Defense Fund out of Wash DC www.childrendefense.org and
Arizona Children’s Alliance would lead anyone to the conclusion that this number is very large.
Out in their data base alone is:
Child Welfare in Arizona
Number of children who are victims of abuse and neglect 8,708
Number of children in foster care 10,883
Number of children adopted from foster care 2,275
Number of grandparents raising grandchildren 64,023
Youth at Risk in Arizona
Averaged freshman high school graduation rate 77%

Gila River Indian Community Grant Application
Grant Cycle 2016
Percent of teens not in school and unemployed 10%
Number of juvenile arrests 37,596
Number of children and teens in juvenile residential facilities 1,488
Ratio of cost per prisoner to cost per public school pupil 3.5
Number of children and teens killed by firearms 54
An article in the JAMA reported about a study based on 5.7M CPS confirmed cases between
2004 and 2011 which found that 1in8 or 12.5% of all children in the US experienced a CPS
confirmed case of maltreatment by age 18. In perspective this results in over 9.3M maltreated
children in the US and in Arizona over 200,000. Remember maltreatment consists of (neglect
or physical/sexual/mental abuse) and it is only one cause of at risk children
Target Population: We currently have a waiting list of 80+ individual educators across the
state and over 500 educators at Tucson Unified School District to train in order to satisfy their
edict that all TUSD Schools will have a core team trained in our workshop. This would equate
to 4000 Children in Pima County alone from TUSD receiving services from the training with
another 640 Children in Arizona. We also have three Schools in Glendale awaiting training.
With sixty (60) educators already signed up for the next scheduled training in June. Casa
Grande and Florence School Districts have been on the waiting list for two years due to lack of
funding to provide the training. This time we are proposing that some portion of the grant
money be used to conduct one of our intensive three-day Children at Risk Intervention
training workshop on your Reservation and other area schools so that you can
experience the positive results we have experience constantly over the past 19 years.
We may need some tribal assistance in making this happen.
Number of people to be served by the project: Two hundred and forty (240) educators will be
trained and approximately 1920 students will receive intervention assistance. There is no way to
determine how many other lives will be touched by the reduction of violence, substance abuse,
bullying and suicides.
Arizona has an estimated one million (1M) school students, 230 School Districts, 406 charter
holders and 13 Joint Technological Education Districts, over 2000 public schools, including
over 1500 district schools, over 500 charter schools and over 60,000 certified teachers.
Children at Risk intervention is making a very slow advance on this population as funding has
been and remains very limited for this very important individual, family, community and social
need.

Gila River Indian Community Grant Application
Grant Cycle 2016
6. Define the project as a new or continuing program.
This is an ongoing program for the past 19 years, with some six (6) classes proposed for this year.
7. Provide a brief timeline including start and finish dates. Indicate if the timeline is flexible.
After funding is received it takes about three months lead time for schools to arrange staff to
attend training. All training and funds will be completed within one year of funding receipt.
8. Identify other organizations, partners or funders participating in the project and their roles.
Click here to enter text.
Jim Click Charities Fundraising, RBC Wealth Management has become a major sponsor for
our Annual Fundraising Charity Golf Tournament, Grand Lodge of Free And Accepted Masons
of Arizona, Arizona Motor Vehicle Masonic License Plate Program and we are currently
working on a couple of RICO funding projects
9. Would you be able to implement the proposed plan if your organization received partial funding for this
project?
Yes, Intervention classes are scheduled about 3 months after funding becomes available.
10. Describe your plan for project sustainability beyond the grant period. If this is a program/project
previously funded by the Gila River Indian Community describe efforts made towards the previously
described sustainability plan.
Our membership provides the basic funding for two classes per year and has been do so for the
past 18 years.

Gila River Indian Community Grant Application
Grant Cycle 2016
11. Describe your plan to document progress and results.
Statistical questionnaires reports will be requested from the schools and collected for plotting results.
Statistical data is also collected by the Arizona State Department of Education, the National Children
Defense, Arizona Children’s Alliance and the Annie E. Casey Foundation. Final reports and news
articles will be submitted
12. Indicate any application to and/or awards made by a tribe other than the Gila River Indian Community
for state shared revenues for this and any other project. If this information is included in a separate
attachment, please indicate that here.
2011 - $24,000 Tohono O’odham Nation; 2009 - Pasqua Yaqui $12,000.

Gila River Indian Community Grant Application
Grant Cycle 2016
Project Budget
Budget Period: 2016
For each budget item listed here please provide a narrative description on the following Project Budget Detail
page.
Proposed Budget Expense Amount Amount In Kind Total Budget
requested from requested or contributions
(list each budget item) GRIC secured from
other funders
1. Contract Instructors $34,000 $0 $0 $34,000
2. Manuals $0 $1,600 $0 $1,600
3. Travel for Instructors $2,000 $0 $0 $2,000
4. Lunch and Refreshments $0 $1,500 $0 $1,500
5. Certificates $0 $30 $0 $30
6. Pencils/paper/markers/tape $0 $40 $0 $40
7. Plates/Cups/Napkins $0 $40 $0 $40
8. Travel Cost for Staff $0 $0 $200 $200
9. Lodgeing Cost for Staff $0 $0 $1,500 $1,500
10. Meals Cost for Staff $0 $0 $450 $450
11. Click here to enter text. $0 $0 $0 $0
12. Click here to enter text. $0 $0 $0 $0
13. Click here to enter text. $0 $0 $0 $0
14. Click here to enter text. $0 $0 $0 $0
15. Click here to enter text. $0 $0 $0 $0
16. Click here to enter text. $0 $0 $0 $0
17. Click here to enter text. $0 $0 $0 $0
Total Budget $36,000 $3,210 $2,150 $41,360

Gila River Indian Community Grant Application
Grant Cycle 2016
Project Budget Detail
Please provide a narrative description for each of the project budget items listed on the previous page. Include
the dollar figure and how it was derived.
1. $34,000 is the contract price for two instructors for three three-day training sessions.
2. $1,600 is the production and royalty cost for 240 education manuals.
3. $2,000 estimated travel cost from prior travel costs over the past years.
4. $1,500 estimated cost for lunch and refreshments for 240 people for three days based on prior years.
5. $30 cost of making and printing Children At Risk Training Certificates and State Education Continuing
Education Certificates
6. $40 cost for pencils, paper, pens, felt tip markers, poster paper, cards based on prior training costs.
7. $40 cost for plates, napkins, cups based on prior trainings cost.
8. $200 Estimated gas cost paid by Foundation staff to travel to out of town locations for the three training
sessions.
9. $1,500 Estimated lodging cost to be paid by Foundation Staff to travel to out of town locations for the three
training sessions.
10. $450 Estimated cost of 30 meals to be paid by Foundation Staff while at out of town trainings.
11. Click here to enter text.
12. Click here to enter text.
13. Click here to enter text.
14. Click here to enter text.
15. Click here to enter text.
16. Click here to enter text.
17. Click here to enter text.
Other explanation: Click here to enter text.

Newman/Stecher International …
Newman/Stecher International is an education consulting firm that provides training and
technical assistance for at-risk prevention/intervention student assistance programming to
school districts, state departments of education and community groups throughout the United
States.
Our Mission ...
Newman/Stecher International is dedicated to human excellence and systems transformation
through personal, group, school, business, and community growth and development. By
sharing skills, knowledge, beliefs and resources, we are all much more than the sum of our
parts. We strive to expand as tools for change in both healing and celebrating the human
spirit.
Our Trainers …
Larry Newman
Mr. Newman is the Chief Executive Officer of N/SI. Mr. Newman has worked with more than
2,500 school districts in 30 states, and Canada. He is the author of several widely utilized
programs focusing on at-risk issues. His "Raising Drug Free Kids" parent education program
is being implemented in dozens of school systems and communities across the United
States. "Classroom Management Strategies for the New Millennium" helps today's teachers
work more effectively within their classrooms.
Prior to co-founding Newman/Stecher International in 1986, Mr. Newman was the Special
Projects Coordinator for the Pennsylvania Department of Education. He was responsible for
the implementation of a statewide drug/alcohol prevention education curriculum in all of
Pennsylvania’s 501 school districts. Mr. Newman received his B.Ed. from West Chester
University in 1971. He was awarded a Masters equivalency from the Pennsylvania
Department of Education through West Chester University in 1976. Mr. Newman is a former
classroom teacher who combines a working knowledge of the addictions field with an in-
depth understanding of the educational system. He provides workshop participants with a
balance of theory and practical application.
Thom Stecher
Mr. Stecher is the Chief Operations Officer for N/SI. He is a nationally recognized
motivational speaker and education consultant. He specializes in student assistance program
training and implementation, staff wellness and self esteem development.
Mr. Stecher holds a M.Ed. degree from Rutgers University and has a B.A. dual major degree
in Arts & Humanities and Psychology from Stockton State College. Additionally, Mr. Stecher
1

holds a “Program Development Certificate” and a New Jersey Teaching Certificate, and he
has been a drug and alcohol counselor and crisis intervention specialist.
Raised in a family of educators, Mr. Stecher believes that education is a lifelong process. Mr.
Stecher is an inspirational speaker who motivates and creates an atmosphere of respect and
healing.
Dr. John Bearoff
Dr. Bearoff is both a licensed Psychologist in private practice, and a Certified School
Psychologist. Dr. Bearoff earned his Ph.D. in Counseling Psychology from Bryn Mawr
College in 1984, his M.A. degree in Psychology from West Chester University in 1975, and a
B.S. degree in Physics from Ursinus College in 1970.
Dr. Bearoff spent 24 Years working in Pennsylvania public schools, including 12 years as a
junior high science teacher. In 1987, Dr. Bearoff became responsible for initiating and
developing the North Penn School District’s Student Assistance Program for Drug and
Alcohol Intervention, and their Alternative Education and Suicide Prevention programs, all of
which were widely recognized as both innovative and effective. He also was the Student
Assistance Program Coordinator of four teams assisting 13,000 students in the district.
Joseph Brancoccio
Mr. Brancoccio brings a fresh perspective to the field of academia. He has an extensive
background in business, both as an owner and manager. His skills in negotiation techniques,
communication and conflict resolution are especially well-suited to help teachers, counselors,
and administrators increase their effectiveness when dealing with at-risk students and their
families.
Mr. Brancoccio’s expertise in creating “second chance companies” dedicated to the
employment of people in recovery provides him with insight into the problems and concerns
of families at risk, and the needs of children being raised in difficult circumstances. His
experience with assisting newly released prisoners in their searches for alternative career
choices supplies him with hands on experience helping to encourage success in lives where
none previously existed.
D. Craig Erb
Mr. Erb has been in the field of public/private school education, behavior management,
special education, and coaching for over 30 years. Since 1989, Mr. Erb has been an
experiential adventure-based facilitator having received training at Project Adventure in
Massachusetts, and the Outward Bound School of North Carolina. Since 1997, he has been
the President and owner of Experiential Dynamics, Inc., offering experiential adventure-based
education to private and public schools, universities, camps, and corporations. Mr. Erb holds
a B.A. in Health and Physical Education from West Chester University.
2

Mr. Erb also teaches courses about Adventure-Based education, Classroom experiential
activities, and Building Classroom Communities at Saint Joseph’s University, the Chester
County Intermediate Unit, and Ursinus College.
Timothy J. Erb
Mr. Erb is a licensed clinical psychologist with 35 years experience in education as a teacher,
counselor, coach and consultant. Mr. Erb currently works as an Adjunct Faculty member in
Psychology at La Salle University’s student counseling center. He also maintains a private
counseling practice in Willow Grove, PA. Mr. Erb received his B.A. degree in Psychology
from La Salle University, and his M.A. degree in Guidance Counseling from Villanova
University.
Mr. Erb is a trainer for Newman/Stecher International. He is also the co-founder of
CorpSeminars which uses experiential and recreational approaches to foster the
development of teamwork, goal setting and life skills with diverse groups including students,
educators, and businesspeople. Mr. Erb has been a clinical member of the American
Association of Marriage and Family Therapy for 20 years and has given presentations at
various national and state conferences. Mr. Erb recently presented at the U.S. Department of
Education’s Office of Safe and Drug Free Schools National Conference and also at the
American College Personnel Association’s National Conference on the topic of “Adolescents
Transitioning through High School.” He is a past President of the Montgomery County
Counseling Association. He has coached at the community, high school and collegiate levels,
and has been recognized with numerous service awards by various universities, schools and
organizations for his work with young people.
Linda Kraft
Ms. Kraft comes from a family of educators and has worked in the field of education for more
than 30 years. Ms. Kraft holds a M.Ed. degree in Counseling and Student Personnel Services
from Purdue University and she holds a B.S. Degree in Education from Pennsylvania State
University. Ms. Kraft has taught first, second, seventh and eighth grades as well as high
school and graduate level college courses. She has an extensive background in group
process, primary prevention, and school counseling. Ms. Kraft was a school counselor for
more than 10 years. One of her honors is being named as the Pennsylvania School
Counselor of the Year.
Currently, Ms. Kraft enjoys providing training and consultation for parents, teachers, students
and administrators in the areas of school safety, alcohol and other drug prevention, and the
intervention and support of at-risk students. Ms. Kraft has been involved with student
assistance since 1986 as a trainer as well as a Core Team member. She helped develop
3

Pennsylvania’s Alcohol and Other Drug Prevention curriculum guidelines and sits on
Pennsylvania’s Statewide SAP Committee.
Joann Mirgon
Ms. Mirgon has worked in the fields of adult education and leadership training in both school
systems and business for the past 25 years. She holds an M.A. degree in Business
Administration from the University of Denver and a B.A. degree in Psychology from
Pennsylvania State University. Ms. Mirgon began her career as a drug and alcohol
prevention specialist at Kennett Square Middle School in Pennsylvania. She worked with
school personnel, students and parents to educate and intervene with at-risk youth. She later
transferred to the business world and worked in the Human Resources and Training fields
with companies such as PepsiCo and Office Depot. Since 1997, Ms. Mirgon has been the
President and owner of Ashton Consulting Group which provides Human Resources
consulting and motivational and leadership training services to schools and businesses.
Gary L. Vermeire
Mr. Vermeire has been a leader in the education and human services professions for over 32
years, addressing comprehensive school and community prevention and intervention
programs and services for various at-risk behaviors. His extensive experience as a service
provider, trainer, administrator and consultant on national, state and local levels has revolved
around the development and implementation of systems-oriented approaches that empower
people and institutions to address and solve human problems.
Mr. Vermeire has served as an officer, leader and member of state and local boards, task
forces and advisory bodies, including the New Jersey Governor’s Council on Alcoholism and
Drug Abuse. He chaired the Interdepartmental Advisory Panel in New Jersey, and the
Pennsylvania Commonwealth Prevention Alliance, for which he was vice president. He is
also an Adjunct Faculty member to various colleges and universities. Mr. Vermeire has been
employed in a variety of capacities with the New Jersey Department of Education for more
than 17 years, working in the areas of student support services, intervention and referral
services, health education, comprehensive prevention and intervention programs, and
services for students with at-risk issues and concerns. Mr. Vermeire holds a B.A. degree from
Edinboro University of PA and is currently the Program Coordinator of the Safe and Drug
Free Schools Unit for the New Jersey Department of Education.
Masonic Model Student Assistance Program …
NS/I is the sole provider of MMSAP which is a comprehensive prevention and intervention
services training that can be integrated into district-wide policy, programs and curriculum.
MMSAP enables K-12 schools to accurately assess their current strengths and shortcomings
4

so that they may actively build a plan for future development. Through the dynamic
interaction of MMSAP-trained Core Team members, elementary schools are able to reduce
the number of referrals to Special Education. This model addresses the needs of the entire
school community by creating the consistency needed for student achievement, safety and
success. MMSAP believes that the earlier struggling students are identified and provided with
the help they need, the likelier they will succeed in school and rise to their true potential.
Over the years as the concept of Student Assistance services has grown, MMSAP training
has evolved to respond to the increasing demands placed on educators. In the early 1980s
Student Assistance Programs were focused on drug and alcohol issues. The Masonic Model
Student Assistance Program was one of the first SAP models to expand to a broad-brush
mental health approach. MMSAP seeks to address all at-risk youth behaviors while staying
specific to the educational concerns of behavior, attendance, health and academics. Our
focus on involving parents has also helped our schools create successful interventions. We
train teams to involve parents early and often in the children’s behavioral action plans.
Although schools cannot fix families, we train educators to understand what families are
going through and how to support them and support their children.
Very few elementary-aged children are involved personally with drugs and alcohol yet there is
significant research that points to precursor behaviors at the elementary level. We focus on
an early intervention formula that enables K-12 educators not only to address behaviors, but
also to address the life skill deficiencies that are predictors of behavior we see in later
development. Our work in life skills development, character education, multiple intelligences
and social emotional learning has allowed us to train educators to develop specific life skills
intervention plans for all students from grades K-12.
Satisfying the social and emotional needs of students does more than prepare them to learn -
it actually increases their capacities for learning. Social and emotional learning has been
shown to increase mastery of subject material, motivation to learn, commitment to school,
and time devoted to schoolwork. It also improves attendance, graduation rates, and
prospects for constructive employment while at the same time reducing suspensions,
expulsions, and grade retention. (Hawkins et al., 1999; Maleckie & Elliott, 2002).
Our training model invites participants to experience a variety of practical life skill intervention
activities that are useful for classroom implementation. MMSAP instructs Core Teams
through a specific, step by step, guided process, how to formulate a written behavioral action
plan that identifies who is responsible for accomplishing established objectives within an
appropriate timeline. Each participant leaves a training session with concrete, practical
behavioral action plan that can be immediately implemented in the school.
5

The Masonic Model Student Assistance Program has touched the lives of thousands of
children and families across North America. Our program helps to increase attendance,
improve academic performance and graduation rates, decrease disrespectful behaviors, and
increase a family’s ability to access behavioral health services. We have seen children who
were lost in the darkness of addiction and have helped them to dream of finding their life’s
purpose. We have brought children back from the brink of suicide and into the adventure of
life. We have intervened with children and families whose lives were full of fear because of
bullying and violence. We have touched their sorrow and brought them respect.
It is not important what our bank account says, what type of house we live in or what kind of
car we drive. Our titles are only invitations to humility. What is essential is the difference we
make in the world. The difference we make in the lives of our children. The Masonic Model
Student Assistance Program makes a difference!
6

Last updated: 02/12/2016
Page 1
General information
Organization Buckeye Valley Rural Volunteer Fire District
Contact First name Mike
Contact Last name Duran
Contact e-mail mikeduran@cox.net
Contact phone number 623-386-5906
Address
Street 25206 W. MC 85 (P.O. Box 75)
City Buckeye
State AZ
ZIP Code 85326
From what tribe is the organization requesting the grant?
Gila River Indian Community
Total grant amount request
88465.05
The Gila River Indian Community offers multi-year awards. If your organization is requesting a multi-year grant for this
project or program from the Gila River Indian Community, enter the amount to be requested each year.
Amount
Year 1 (Gila River Indian Community Grants Only)
Year 2 (Gila River Indian Community Grants Only)
Year 3 (Gila River Indian Community Grants Only)
Year 4 (Gila River Indian Community Grants Only)
Year 5 (Gila River Indian Community Grants Only)
1 of 1

Last updated: 02/15/2016
Page 1
General information
Organization Arizona Science Center
Contact First name Claudia
Contact Last name Vazquez
Contact e-mail vazquezc@azscience.org
Contact phone number 6027162000
Address
Street 600 E. Washington St.
City Phoenix
State AZ
ZIP Code 85004
From what tribe is the organization requesting the grant?
Gila River Indian Community
Total grant amount request
50,000
The Gila River Indian Community offers multi-year awards. If your organization is requesting a multi-year grant for this
project or program from the Gila River Indian Community, enter the amount to be requested each year.
Amount
Year 1 (Gila River Indian Community Grants Only)
Year 2 (Gila River Indian Community Grants Only)
Year 3 (Gila River Indian Community Grants Only)
Year 4 (Gila River Indian Community Grants Only)
Year 5 (Gila River Indian Community Grants Only)
1 of 1

Gila River Indian Community Grant Application
Grant Cycle 2016
Cover Sheet
Municipality Information
1. Date of Application: 2/29/2016 (NOTE: Click or use up/down arrow keys to move among fields)
2. Name of City, Town or County: Maricopa County Government Relations
3. Mayor (City or Town) or Board of Supervisor’s Chairman (County): Clint Hickman
4. Mailing Address: 301 W. Jefferson, 10th Floor
5. City: Phoenix State: Arizona Zip Code: 85003
6. Acknowledgement of Submission by Authorized Municipality Representative:
Typed Name: Amanda Nash Signature:
Applicant Information
7. Department/Organization Name: Arizona Science Center
8. Is this a non-profit 501c(3) Organization? No Yes If yes, attach IRS Determination Letter
9. Application Contact Person: Claudia Vazquez Title: Director of Corporate & Foundation Relations
10. Phone Number: 602-716-2000 x295
11. Mailing Address: 600 E. Washington St.
12. City: Phoenix State: Arizona Zip Code: 85004
13. Email Address: vazquezc@azscience.org Website Address: www.azscience.org
Project Information
14. Project Name: Hands-On Science Discovery Programs for Low Income Youth
15. Purpose of Grant: Provide access to meaningful science programs to underserved youth in Maricopa County.
16. Priority Funding Area Education
17. Annual amount requested $50,000.00
18. Number of years that funding is requested 1
19. Total amount requested (annual amount x $50,000.00
# of years)
20. Has your organization received past No
funding from GRIC? If yes, list each year and
amount
21. Geographic area served Maricopa County
For Office Use Only:
Data Entry Receipt Evaluation

Gila River Indian Community Grant Application
Grant Cycle 2016
Narrative
Please structure your proposal to provide the following information in the order indicated. Provide the narrative in
paragraph form in the text field provided. Please be thorough but strive for brevity.
1. Briefly describe the organization’s mission, history and goals.
Founded by the Junior League of Phoenix in 1980, Arizona Science Center is the only center of science education and
engagement of its kind in Arizona. The Center’s mission is to inspire, educate, and engage curious minds through
science, and this spirit of inquiry is embedded in our tagline – Never Stop Wondering. Using a hands-on approach to
science exploration and inspiration, the Center uses its 98,000 square feet of gallery spaces and over 300 hands-on
exhibits to spark an interest in science among its visitors. Additional learning opportunities and services include
professional development services for educational leaders, community STEM (science, technology, engineering, and
math) outreach programs, after school STEM clubs, standards-aligned field trips, camps, home school classes, public
workshops, adult programming and themed science engagement events. The Center annually impacts more than
500,000 visitors, including 140,000 students on a field trip with their teachers, 62,000 students who participate in
outreach programs and over 5,000 teachers who benefit from our professional development services. These programs
are provided in rural areas, tribal lands and at schools and community centers throughout Arizona. The Center opened
its newest addition in September 2015. CREATE at Arizona Science Center is a 6,500 square foot community hub where
people of all ages can share ideas, collaborate on projects and learn about science, technology, engineering, math and
art through making. By using state of the art, computer controlled equipment and traditional crafting tools, visitors have
the chance to cut, saw, code, hammer, sew, paint, solder, and much more. Arizona Science Center is dedicated to public
education and creating an interest for science by offering visitors new and relevant access to science in ways that excite
and delight. With history of exploration, innovation and collaboration, the Arizona Science Center has established itself
as an institution of learning for all. Our commitment to increase participation of Tribal and minority communities is
realized through key partnerships and development of engaging outreach programs and activities. Our vision is to be a
global leader in science experiences and have a 2020 Vision as a road map to realizing that vision.
2. If the organization is a non-profit 501c(3), please describe your relationship with the municipality including past
and present support, whether it be through partnerships, collaborations, in-kind contributions, grants, tax-based
funding or other. If the organization is a municipality governmental sub-division please enter the text “Not
applicable.”
Since 2004, the Maricopa County government office has been an important partner for Arizona Science Center in
obtaining generous funds from the 12% grant program of the Salt River Pima-Maricopa Indian Community.
3. Describe the proposed project and planned goals and activities.
Arizona Science Center respectfully requests funding from the Gila River Indian Community in the amount of $50,000 to
support the delivery of Hands-On Science Discovery Programs for Low Income Youth in Title-I schools located in
Maricopa County, at least 40% of attending students are eligible for the National School Lunch Program. These students
qualify for free in-class programming (Science on Wheels), field trips (Focused Field Trips), teacher materials and
educator workshops. The proposed program, which will be offered at no cost to participating school children and
teachers, will feature field trips to Arizona Science Center (Focused Field Trips), educator training for teachers bringing
youth on field trips, outreach workshops delivered directly to classrooms (Science on Wheels), and standards-based,

Gila River Indian Community Grant Application
Grant Cycle 2016
curriculum-enhancing educator resources that will better prepare teachers to deliver informal, extra-curricular science
programs. During their field trip to Arizona Science Center, students have the opportunity to learn and experience STEM
in new ways. They may explore the intricacies of sight by observing a cow eye dissection in the Daniel Cracchiolo
Demonstration Theatre; they can feel their heart beat on a drum in All About Me in the Steel Foundation Gallery or
experience a tornado in Forces of Nature in the Sybil B. Harrington Galleries. Teachers participating in a field trip attend
a two-hour workshop prior to their visit. The orientation introduces the Center’s exhibits and includes resources to
present vocabulary, reinforce scientific concepts, and encourage inquiry-based interaction and exploration. Science on
Wheels brings the excitement of hands-on science discovery directly to classrooms using entertaining demonstrations
and workshops typically 60 minutes in length. These programs engage youth in science explorations through educational
topics ranging from biology to astronomy; students can build their own soda bottle rockets or diagnose patients as
junior medical professionals. Science on Wheels also includes a menu of Family Science Nights and Universe on Wheels
programs. Family Science Nights are ideal for large audiences of any age - programs are generally up to two hours in
duration and can accommodate up to 300 participants. Current themes include: Brain Games, Astronomy, and Family
Engineering. Universe on Wheels brings the wonder of the Center’s Dorrance Planetarium as well our highly-qualified
staff to put on planetarium shows. Universe on Wheels is a portable, inflatable planetarium with a wheelchair entrance
which fits into most school gyms or cafeterias. The standards-based astronomy library of films include topics such as
Cosmic Coasters, Ice Worlds, Microcosm: The Adventure Within, New Horizons, Planet Hunters, and many more. At
Arizona Science Center, we believe that every student, regardless of race, disability or socioeconomic status, should
have the opportunity to experience the valuable hands-on science learning experiences that the Center offers. Studies
have shown that a key to increase interest in STEM subjects and positively impact student’s academic performance, is to
provide relevant and engaging learning opportunities that have real-world application (Heilbronner et al, 2011), thus, a
key component to these programs are to provide engaging activities that focus on its application to the real world.
Hands-On Science Discovery Programs for Low Income Youth goals include:
 To provide enriched, informal science experiences that educate students about STEM topics in a manner that
supports Arizona College and Career Readiness Standards.
 To help strengthen the foundation for learning science in grades K-8 through in-class outreaches that engage
children in learning science hands-on while modeling best teaching practices for educators, and
 To provide hands-on science discovery experiences to youth and teachers at Title-1 schools in Maricopa County.
Support from Gila River Indian Community 12% Gaming Contribution Funds would underwrite staffing, supplies,
transportation and other services required to provide, free of charge:
 40 Science on Wheels outreach programs (typically 60 minutes in length) for an estimated 1,875 youth in grades K-8,
including the production of kits and consumables. The number of programs/hours granted to a classroom/grade
level will highly depend on the school’s need for STEM outreach programs. Four districts will be targeted by this
proposal including Glendale Elementary District, Littleton Elementary District, Madison Elementary District and
Phoenix Elementary District. Arizona Science Center works with each district to make programming
recommendations and strategic decisions to have the greatest and most significant impact.
 Focused Field Trip experiences for an estimated 1,875 youth in grades K-8
 Pre-field trip orientation workshops for associated educators.
4. Describe how the proposed project satisfies one or more of the priority funding areas identified by the Gila River
Indian Community.

Gila River Indian Community Grant Application
Grant Cycle 2016
Arizona Science Center’s Hands-On Science Discovery Programs for Low Income Youth satisfies the Gila River Indian
Community’s priority funding in the area of Education. Focused Field Trips and Science on Wheels outreach programs
directly benefit students with meaningful science learning opportunities as well as provide standards-based, curriculum-
enhancing educator resources that will better prepare teachers to deliver informal, extra-curricular science programs in
their classrooms.
5. Identify the needs/problems to be addressed, target population and number of people to be served by the
project.
Arizona consistently ranks low in state aid education and the gap in school performance further indicates this
deficiency. According to the National Assessment of Educational Progress (NAEP), 60% of fourth-graders and 66% of
8th graders were not proficient in math. Likewise, 28% of fourth-graders, 37% of eighth-graders, and 40% of twelfth-
graders did not meet the basic standards of science knowledge. Change the Equation (CTEq) affirms “business
leaders in Arizona cannot find the science, technology, engineering and mathematics (STEM) talent they need to
stay competitive. Students' lagging performance in K–12 is a critical reason why.” At the core of this issue are the
types of educational experiences and instruction students are receiving in the classroom. Arizona Science Center
plays an ever-increasing role in Arizona’s public school system by supplementing classroom curriculum with applied
science experiences in a hands-on environment designed to encourage learning through discovery. The need for
these learning opportunities continues to rise at a rapid pace as community leaders, government officials and
residents demand improvements be made in our educational system. Hands-On Science Discovery Programs for Low
Income Youth comprising of Arizona Science Center’s Focused Field Trips and Science on Wheels programs fulfill a
specific niche by combining a formal, professional development opportunity for teachers with an engaging, hands-
on science learning opportunity for their students. The end result is a more meaningful and impactful experience for
both the teacher and the student. A grant award from Gila River Indian Community will target K-8 students
attending Title-I schools in Maricopa County including Glendale Elementary District, Littleton Elementary District,
Madison Elementary District and Phoenix Elementary District. Over the course of the year, the programs outlined in
this grant will serve 3,250 low-income youth who may not otherwise have opportunities to experience the programs
and resources of Arizona Science Center
6. Define the project as a new or continuing program.
Hands-On Science Discovery Programs for Low Income Youth includes Science on Wheels and Focused Field Trips which
are ongoing programs of Arizona Science Center. Science on Wheels’ track record of growth in recent years,
demonstrates the need for these valuable learning programs. For the fiscal year ending June 30, 2015, Science on

Gila River Indian Community Grant Application
Grant Cycle 2016
Wheels delivered over 1,000 outreach programs to 62,000 students throughout the state of Arizona. This is a 14%
increase over the previous year. A grant award from Gila River Indian Community would enable Arizona Science Center
to continue on its expansion course of providing support to Title-I schools in Maricopa County with essential STEM
education, which plays an integral role in helping the Center achieve its mission to inspire, educate and engage curious
minds through science.
7. Provide a brief timeline including start and finish dates. Indicate if the timeline is flexible.
Hands-On Science Discovery Programs for Low Income Youth will be delivered starting in November 1, 2016 through
October 31, 2017
8. Identify other organizations, partners or funders participating in the project and their roles.
Arizona Science Center proactively collaborates directly with School Districts to enable delivery of funded programs.
Additionally, the Center works with numerous partners to develop exhibits and deliver programming that impact all of
our guests. This support is programmatic, financial or a combination of both. Partners include but are not limited to:
American Airlines, APS, Arizona Republic, Boeing, Freeport-McMoRan, Helios Education Foundation, Wells Fargo, Salt
River-Pima Maricopa Indian Community, and SRP
9. Would you be able to implement the proposed plan if your organization received partial funding for this project?
Funding at the proposed $50,000 level from the Gila River Indian Community will enable the Center to offer services to
3,250 youth and educators in the Maricopa County community. If the amount of funding is under the requested
$50,000, the Center will need to scale the reach of the project deliverables proportionate to the amount of funding.
10. Describe your plan for project sustainability beyond the grant period. If this is a program/project previously
funded by the Gila River Indian Community describe efforts made towards the previously described
sustainability plan.
Arizona Science Center’s Focused Field Trips and Science on Wheels programs are sustained through a combination of
seven primary sources: earned income (61%); government grants (13%); corporate contributions (12%); foundation
giving (5%); special events (4%); individual contributions (3%) and other miscellaneous income (2%). To ensure
continuity of these programs, Arizona Science Center’s committed board of trustees and dedicated staff, continuously
seek to grow and diversify fundraising sources as philanthropic markets fluctuate. The number of students served and
programs delivered to communities is adjusted based on funding secured
11. Describe your plan to document progress and results.

Gila River Indian Community Grant Application
Grant Cycle 2016
In addition to tracking the number of youth, teachers, and families participating in Science on Wheels and Focused Field
Trips, Arizona Science Center has developed a formal assessment process to determine the degree to which the program
goals and objectives are being met. All participating teachers receive a survey, on which they are asked to detail their
experience, including: where the teacher first heard about the program; the teacher’s experience in the reservations
process; reasons for scheduling their specific outreach; age-appropriateness of the specific outreach; if the teacher will
be utilizing the program’s content in classroom activities; overall quality of the program; suggestions for additional
outreach topics and recommendations for improving the program. Additionally, staff utilizes the feedback from teachers
and youth participants in order to make necessary alterations to programming.
12. Indicate any application to and/or awards made by a tribe other than the Gila River Indian Community for state
shared revenues for this and any other project. If this information is included in a separate attachment, please
indicate that here.
Over the past eleven years, through the 12% grant program, Salt River Pima-Maricopa Indian Community has invested
more than $1.2 million dollars in Arizona Science Center’s mission. This generous support has resulted in science
programming being provided to thousands of students and teachers from Maricopa County Title-I schools.

Gila River Indian Community Grant Application
Grant Cycle 2016
Project Budget
Budget Period: November 1, 2016 through October 31, 2017
For each budget item listed here please provide a narrative description on the following Project Budget Detail page.
Proposed Budget Expense Amount Amount In Kind Total Budget
(list each budget item) requested from requested or contributions
GRIC secured from
other funders
1. Program Staff $24,100.00 $32,650.00 $0 $56,750.00
2. Program Staff Benefits $0 $13,052.50 $0 $13.052.50
3. Program Costs $25,900.00 $0 $0 $25,900.00
4. Overhead $0 $17,430.50 $0 $17,430.50
5. Click here to enter text. $0 $0 $0 $0
6. Click here to enter text. $0 $0 $0 $0
7. Click here to enter text. $0 $0 $0 $0
8. Click here to enter text. $0 $0 $0 $0
9. Click here to enter text. $0 $0 $0 $0
10. Click here to enter text. $0 $0 $0 $0
11. Click here to enter text. $0 $0 $0 $0
12. Click here to enter text. $0 $0 $0 $0
13. Click here to enter text. $0 $0 $0 $0
14. Click here to enter text. $0 $0 $0 $0
15. Click here to enter text. $0 $0 $0 $0
16. Click here to enter text. $0 $0 $0 $0
17. Click here to enter text. $0 $0 $0 $0
Total Budget $50,000.00 $63,133.00 $0 $113,133.00

Gila River Indian Community Grant Application
Grant Cycle 2016
Project Budget Detail
Please provide a narrative description for each of the project budget items listed on the previous page. Include the
dollar figure and how it was derived.
1. Program Staff budget includes the following: Professional Learning & Engagement Specialist, at 5% time ($3,750),
One, full-time Outreach Manager, at 20% time ($8,000), Two, full-time Outreach Program Specialists, at 50% time
($28,000), and reservations, gallery, and guest services staff ($17,000)
2. Program Staff benefits are calculated at 20% total salaries and wages
3. Program Costs include the following: General admission to the Arizona Science Center for 1,875 students @ $6 each
($11,250), Science on Wheels outreach vehicle expense/travel costs ($4,000), Science on Wheels outreach supplies to
serve 1,875 studetns ($5,000), field trip demonstration supplies ($1,500), printing, postage, publicity ($2,500), field trip
bus parking ($900), and Evaluation ($750).
4. Overhead is calculated at 20% of total
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Gila River Indian Community Grant Application
Grant Cycle 2016
17. Click here to enter text.
Other explanation: The source of other funding to be used by Arizona Science Center for this project includes earned
revenue through memberships, ticket sales, facility rentals and annual fund.