2016 GRIC APPLICATIONS 2.PDF

Last updated: 01/19/2016
Page 1
General information
Organization Circle the City
Contact First name Wendy
Contact Last name White
Contact e-mail WWhite@circlethecity.org
Contact phone number 602-357-4257
Address
Street 300 W. Clarendon Avenue, Suite 200
City Phoenix
State Arizona
ZIP Code 85013
From what tribe is the organization requesting the grant?
Gila River Indian Community
Total grant amount request
75,000
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) 75,000
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

W-9
Form Request for Taxpayer Give Form to the
(Rev. December 2014) requester. Do not
Identification Number and Certification
Department of the Treasury send to the IRS.
Internal Revenue Service
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
Circle the City
2. 2 Business name/disregarded entity name, if different from above
page
3 Check appropriate box for federal tax classification; check only one of the following seven boxes: 4 Exemptions (codes apply only to
on • Individual/sole proprietor or MI C Corporation • S Corporation iii Partnership • Trust/estate certain entities, not individuals; see
instructions on page 3):
single-member LLC
type • Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) Iii- Exempt payee code (if any)
or Instructions Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for Exemption from FATCA reporting
the tax classification of the single-member owner. code (if any)
Print
ISI Other (see instructions) II- 501(c)(3) (.4,oplies to accounts maintained outside too U.S.)
5 Address (number, street, and apt. or suite no.) Requester's name and address (optional)
Specific
300 W Clarendon Ave, Suite 200
6 City, state, and ZIP code
I See
Phoenix, AZ 85013
7 List account number(s) here (optional)
Part I Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN on page 3. or
Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for Employer identification number
guidelines on whose number to enter.
26 2 4 2 0 7 3 0
Part II Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage
interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
instructions on page 3
General In • Form 1098 (home mortgage interest), 109"8-E (student loan interest), 1098-T
(tuition)
Section references are to the Internal Revenue Code unless otherwise noted. • Form 1099-C (canceled debt)
Future developments. Information about developments affecting Form W-9 (such • Form 1099-A (acquisition or abandonment of secured property)
as legislation enacted after we release it) is at www.its.gov/fw9.
Use Form W-9 only if you are a U.S. person (including a resident alien), to
Purpose of Form provide your correct TIN.
An individual or entity (Form W-9 requester) who is required to file an information If you do not return Form W-9 to the requester with a TIN, you might be subject
return with the IRS must obtain your correct taxpayer identification number (TIN) to backup withholding. See What is backup withholding? on page 2.
which may be your social security number (SSN), individual taxpayer identification By signing the filled-out form, you:
number (ITIN), adoption taxpayer identification number (AllN), or employer 1. Certify that the TIN you are giving is correct (or you are waiting for a number
identification number (EIN), to report on an information return the amount paid to to be issued),
you, or other amount reportable on an information return. Examples of information
returns include, but are not limited to, the following: 2. Certify that you are not subject to backup withholding, or
• Form 1099-INT (interest earned or paid) 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If
• Form 1099-DIV (dividends, including those from stocks or mutual funds) applicable, you are also certifying that as a U.S. person, your allocable share of
any partnership income from a U.S. trade or business is not subject to the
• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) withholding tax on foreign partners' share of effectively connected income, and
• Form 1099-B (stock or mutual fund sales and certain other transactions by 4. Certify that FATCA code(s) entered on this form (if any) indicating that you are
brokers) exempt from the FATCA reporting, is correct. See What is FATCA reporting? on
• Form 1099-S (proceeds from real estate transactions) page 2 for further information.
• Form 1099-K (merchant card and third party network transactions)
Cat. No. 10231X Form W-9 (Rev. 12-2014)

INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY
P. O. BOX 2508
CINCINNATI, OH 45201
Date: SEP - 3 2008 Employer Identlficalzion Number:
26-2420730
DLN:
17053191342048
CIRCLE THE CITY Contact Person:
C/O ADELE °SULLIVAN NANCY L HEAGNEY ID # 31306
220 S 12TH AVE Contact Telephone Number:
PHOENIX, AZ 85007 (877) 829-5500
Accounting Period Ending:
June 30
Public Charity Status:
170(b)(1)(A) (vi)
FOLUI 990 Required:
Yes
Effective Date of Exemption:
March 6, 2008
Contribution Deductibility:
Yes
Advance Ruling Ending Date:
June 30, 2012
Addendum Applies:
No
Dear Applicant:
We are pleased to inform you that upon review of your application for tax
exempt status we have determined that you are exempt from Federal income tax
under section 501(c)(3) of the Internal Revenue Code. Contributions to you are
deductible under section 170 of the Code. You are also qualified to receive
tax deductible bequests, devises, transfers or gifts under section 2055, 2106
or 2522 of the Code. Because this letter could help resolve any questions
regarding your exempt status, you should keep it in your permanent records.
Organizations exempt under section 501(c)(3) of the Code are further classified
as either public charities or private foundations. During your advance ruling
period, you will be treated as a public charity. Your advance ruling period
begins with the effective date of your exemption and ends with advance ruling
ending date shown in the heading of the letter.
Shortly before the end of your advance ruling period, we will send you Form
8734, Support Schedule for Advance Ruling Period. You will have 90 days after
the end of your advance ruling period to return the completed form. We will
then notify you, in writing, about your public charity status.
Please see enclosed Publication 4221-PC, Compliance Guide for 501(c)(3) Public
Charities, for some helpful information about your responsibilities as an
exempt organization.
Letter 1045 (DO/CG)

2IRCLE THE CITY
Sincerely,
Robert Cho:
Director, Exempt Organizations
Rulings and Agreements
Enclosures: Publication 4221-PC
Statute Extension
Letter 1045 (DO/CG)

7-arm 1023 (Rev. 6-2006) Name Circle the City EIN: 26 _ 2420730
grir0 Public Charity Status (Continued) age 1 1
509(a)(4)—an organization organized and operated exclusively for testing for public safety.
509(a)(1) and 170(b)(1)(A)(iv)—an organization operated for the benefit of a college or university that is owned or
operated by a governmental unit.
g 509(a)(1) and 170(b)(1)(A)(vi)—an organization that receives a substantial part of its financial support in the form
of contributions from publicly supported organizations, from a governmental unit, or from the general public.
509(a)(2)—an organization that normally receives not more than one-third of its financial support from gross
investment income and receives more than one-third of its financial support from contributions, membership
fees, and gross receipts from activities related to its exempt functions (subject to certain exceptions).
i A publicly supported organization, but unsure if it is described in 5g or 5h. The organization would like the IRS to
decide the correct status.
6 If you checked box g, h, or i in question 5 above, you must request either an advance or a definitive ruling by
selecting one of the boxes below. Refer to the instructions to determine which type of ruling you are eligible to receive.
a Request for Advance Ruling: By checking this box and signing the consent, pursuant to section 6501(c)(4) of
the Code you request an advance ruling and agree to extend the statute of limitations on the assessment of
excise tax under section 4940 of the Code. The tax will apply only if you do not establish public support status
at the end of the 5-year advance ruling period. The assessment period will be extended for the 5 advance ruling
years to 8 years, 4 months, and 15 days beyond the end of the first year. You have the right to refuse or limit
the extension to a mutually agreed-upon period of time or issue(s). Publication 1035, Extending the Tax
Assessment Period, provides a more detailed explanation of your rights and the consequences of the choices
you make. You may obtain Publication 1035 free of charge from the IRS web site at www.irs.gov or by calling
toll-free 1-800-829-3676. Signing this consent will not deprive you of any appeal rights to which you would
otherwise be entitled. If you decide not to extend the statute of limitations, you are not eligible for an advance
ruling.
Consent Fixing Period of Limitations Upon Assessment of Tax Under Section 4940 of the Internal Revenue Code
For Organization
(Signature of Officer, Director, Trustee, or other iT pe or pnnt narne of signer) (Date)
authonzed official)
iType or pent title or authority of signer)
For IRS Use Only
IRS Director, Exempt Organizations
(Date)
b Request for Definitive Ruling: Check this box if you have completed one tax year of at least 8 full months and
you are requesting a definitive ruling. To confirm your public support status, answer line 6b(i) if you checked box
g in line 5 above. Answer line 6b(ii) if you checked box h in line 5 above. If you checked box i in line 5 above,
answer both lines 6b(i) and (ii).
(i) (a) Enter 2% of line 8, column (e) on Part IX-A. Statement of Revenues and Expenses
(b) Attach a list showing the name and amount contributed by each person, company, or organization whose Li1
gifts totaled more than the 2% amount. If the answer is "None," check this box.
(ii) (a) For each year amounts are included on lines 1, 2, and 9 of Part IX-A. Statement of Revenues and
Expenses, attach a list showing the name of and amount received from each disqualified person. If the
answer is "None," check this box. fl
(b) For each year amounts are included on line 9 of Part IX-A. Statement of Revenues and Expenses, attach
a list showing the name of and amount received from each payer, other than a disqualified person, whose
payments were more than the larger of (1) 1% of line 10, Part IX-A. Statement of Revenues and
Expenses, or (2) $5,000. If the answer is "None," check this box.
7 Did you receive any unusual grants during any of the years shown on Part IX-A. Statement of
Revenues and Expenses? If "Yes," attach a list including the name of the contributor, the date and Yes GZI No
amount of the grant, a brief description of the grant, and explain why it is unusual.
Form 1023 (Rev. 6-2006)

Gila River Indian Community Grant Application
Grant Cycle 2016
Cover Sheet
Municipality Information
1. Date of Application: 2/18/2016 (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): Steve Chucri
4. Mailing Address: 301 W. Jefferson Street, 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: Circle the City
8. Is this a non-profit 501c(3) Organization? No Yes If yes, attach IRS Determination Letter
9. Application Contact Person: Wendy White Title: Grants Specialist
10. Phone Number: 602-357-4257
11. Mailing Address: 300 W. Clarendon Avenue, Suite 200
12. City: Phoenix State: Arizona Zip Code: 85013
13. Email Address: wwhite@circlethecity.org Website Address: www.circlethecity.org
Project Information
14. Project Name: Medical Respite Care for Uninsured and Under-Insured People Experiencing Homelessness
15. Purpose of Grant: To provide critical medical respite care and wrap-around services to uninsured and under-
insured men and women experiencing homelessness while ill or injured.
16. Priority Funding Area Healthcare
17. Annual amount requested $75,000
18. Number of years that funding is requested 1
19. Total amount requested (annual amount x # $75,000
of years)
20. Has your organization received past funding Yes. Circle the City received a $70,000 grant from the Gila River
from GRIC? If yes, list each year and amount Indian Community for FY2014.
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.
Circle the City is a rapidly growing non-profit community health organization dedicated to creating and
delivering innovative healthcare solutions that compassionately address the needs of men, women, and children
facing homelessness in Maricopa County. Incorporated in 2008 by Sister Adele O’Sullivan, CSJ, MD, Circle the
City offers a continuum of homeless healthcare that is one-of-a-kind in the state and one of the only models of
its type in the nation. In 2012, Circle the City launched the state’s first and only medical respite center for men
and women experiencing homelessness while ill or injured. Always looking for opportunities to fill critical gaps in
the homeless healthcare system, in May 2015 Circle the City initiated a homeless-focused Assertive Community
Treatment (ACT) Team that provides street-based, intensive behavioral healthcare services including psychiatric
support, case management, and housing assistance for 100 of the most seriously mentally ill people
experiencing homelessness. In September 2015, Circle the City opened The Parsons Family Health Center, a
homeless-specialty primary care facility that provides comprehensive medical care as well as on-site wrap-
around services including case management. Furthering its community outreach, Circle the City also launched a
two-room mobile medical clinic that visits parks, supportive housing complexes, and other homeless community
service agencies in order to provide healthcare to those who cannot access the fixed primary care site.
Collectively, Circle the City expects to serve more than 4,000 individuals in FY2016. Ultimately, Circle the City is
committed to ending homelessness by providing high quality medical care and social services that give patients
the tools and resources to lead healthy, independent lives.
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.”
Circle the City was the recipient of a 2014 Maricopa County CDGB grant. Additionally, the organization
partnered with the Maricopa Association of Governments (MAG) on a 2014 Dignity Health Community of Care
grant that worked to test the Service Prioritization Decision Assistance Tool (SPDAT) on medically vulnerable
homeless persons in order to prioritize and expedite access to supportive housing for these individuals.
3. Describe the proposed project and planned goals and activities.
Project:

Gila River Indian Community Grant Application
Grant Cycle 2016
Before the Medical Respite Center opened in 2012, Phoenix was the largest metropolitan area in the
country without a medical respite facility for men and women experiencing homelessness. Hospitals provided
temporary medical care for the most acutely ill and injured but there was no post-discharge option for patients
to receive recuperative care. As a result, patients were discharged back to the streets or emergency shelters
where—without a clean bed, access to medication, oversight from a physician, and assistance from a
caregiver—recovery was difficult, if not impossible. Many patients suffered complications and, often via
expensive 911 calls, returned to hospitals and emergency rooms again and again, overutilizing an already
overburdened system and costing local taxpayers untold millions of dollars.
Since launching three years ago, the 50-bed, 24/7 Medical Respite Center has cared for more than 800
patients and has quickly become one of the nation’s leading models for holistic, homeless-focused integrated
healthcare. Approximately 30% of the patient population is either uninsured or under-insured but, at Circle the
City, no patient is ever turned away because of an inability to pay. In FY2016, Circle the City expects to provide
more than $1 million in charitable care to these patients.
Goals:
1. Provide more than 15,300 bed days of acute medical services and case management to ill or injured
homeless individuals. Of the approximately 340 total patients who will be cared for, upwards of 125 are
expected to be uninsured or under-insured;
2. Establish integrated, holistic plans of care for 100% of these uninsured or under-insured patients;
3. Maintain the necessary engagement to ensure that at least 75% of these patients successfully complete all
goals established in their respective care plans;
4. Successfully connect at least 90% of these patients with relevant benefits or entitlements, including
nutritional assistance, health insurance, income, and housing;
5. Successfully transition at least 75% of these patients into living situations other than the streets or
emergency shelter system.
Activities:
Each patient interacts daily with compassionate doctors and nurses and receives wrap-around services
on-site including psychiatric evaluation, physical therapy, and substance abuse intervention. Patients also meet
regularly with case managers to apply for identification and other documents, benefits, and housing to ensure
that they are successfully discharged to living environments other than the streets or emergency shelter system.
Additionally, more than 150 volunteers lead activities and events for patients including art classes, bingo, crafts

Gila River Indian Community Grant Application
Grant Cycle 2016
sessions, and tutoring. These activities are an important component in reintegrating patients back into the
community from which homelessness has isolated them.
4. Describe how the proposed project satisfies one or more of the priority funding areas identified by the Gila River
Indian Community.
This request meets the Gila River Indian Community’s Healthcare priority area, specifically direct patient care.
5. Identify the needs/problems to be addressed, target population and number of people to be served by the
project.
Needs:
Homelessness has devastating effects on a person’s health. In one study, the prevalence rate of chronic
medical illness in the homeless was one-half of the surveyed population compared with less than one-quarter of
the housed population (Donovan et al., 2007). Because of a lack of income, insurance, or transportation, these
health conditions are left untreated and are complicated by high incidences of mental health and substance
abuse disorders. As a result, people experiencing homelessness are some of the most frequent and costly users
of healthcare services. They visit emergency departments 9 to 12 times more than people who are housed, have
higher rates of hospitalization, and stay longer per admission (S.W. Hwang et al., 2011). But medical respite care
has proven to be a cost-effective and safe stabilization point for men and women to land after long and complex
periods of hospitalization or for individuals living in homelessness whose complicated illnesses or injuries have
begun to spiral out of control. For the average cost of one day of hospitalization--$2,194—Circle the City
provides each patient with more than 10 days of holistic, physican-supervised medical respite care in a safe and
clean environment.
Target Population:
Men and women experiencing homelessness while ill or injured are the Medical Respite Center’s target
population. Approximately 42% of Circle the City’s patients are age 55 and older. This data aligns directly with a
national phenomenon called “The Aging of the Homeless,” which was discussed in the October 2014 issue of The
Lancet medical journal. The median age of the homeless population in the United States has risen to nearly 50
years of age. Individuals between the ages of 50-61 have experienced homelessness at higher rates throughout
their lives than previous generations did. This is creating a more intensive medical need for the care of chronic
disease, geriatric conditions, frailty, and end-of-life issues. Circle the City has positioned itself to meet the needs
of this particularly vulnerable and growing population.
Number of People Served:
Circle the City expects to care for at least 125 uninsured and under-insured patients in FY2016.
6. Define the project as a new or continuing program.

Gila River Indian Community Grant Application
Grant Cycle 2016
The medical respite care program is a continuing project that began in October 2012. FY2016 began July
1, 2015, and ends June 30, 2016.
7. Provide a brief timeline including start and finish dates. Indicate if the timeline is flexible.
Medical respite care is an ongoing patient care program and, as such, the timeline is flexible with
patients being admitted and discharged on a continual basis. Please see the attachment for an example of a
timeline of one patient’s Medical Respite Center stay.
8. Identify other organizations, partners or funders participating in the project and their roles.
Circle the City collaborates with numerous community partners to provide an array of services for all its
patients, including those who are uninsured and under-insured. Four major hospital systems (Abrazo
Community Health Network, Banner Health, Dignity Health, and Honor Health) maintain referral contracts with
Circle the City and send patients experiencing homelessness to the Medical Respite Center for recuperative care
to heal from serious illnesses and injuries. While these hospital contracts pay for a portion of patient stays, Circle
the City must use charitable care monies to fund the balance for patients from hospitals or community settings
who are uninsured or under-insured.
Another important partner is Hospice of the Valley, which owns Circle the City’s building and exchanges
reduced rent for end-of-life care for homeless hospice patients.
Collaborating with additional local agencies is a critical means for meeting patients’ social service needs,
including post-discharge housing. These partners include Native American Connections, Arizona Housing Inc.,
and Ozanam Manor.
Circle the City also has academic affiliations with medical and nursing schools that rotate students into
the Medical Respite Center to learn about homeless-specific medical care. Participating schools include A.T. Still
University (first- and second-year medical students); Creighton University (fourth-year medical elective course);
Mayo School of Graduate Medical Education (resident education in neurology and internal medicine); and
Midwestern University (resident education in podiatry). Finally, employee groups from corporations such as
Willis of Arizona and Intel provide volunteers for various projects and conduct company-wide collections of
items needed by patients.
9. Would you be able to implement the proposed plan if your organization received partial funding for this project?
Yes. Circle the City’s ability to meet the needs of vulnerable members of the community—especially
those who are uninsured or under-insured—depends on the generosity of donors and grantors. Circle the City is
grateful for all levels of financial support. But in the unfortunate case that adequate funding is not secured to
support this activity, the organization would scale back either services or scope of operation until key resources
are once again secured.

Gila River Indian Community Grant Application
Grant Cycle 2016
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.
Since the Gila River Indian Community’s last grant, Circle the City has secured bed contracts with local
hospitals; continued to put on two annual fundraisers and will add a third annual event—a community
breakfast--this April; and has held periodic need-specific campaigns. One of the most important strategic
achievements for sustainability occurred in 2014 with the successful integration of the Medical Respite Center
into the local Medicaid (AHCCCS) health plans. Additionally, in May 2015, Circle the City received the highly
competitive designation of Federally Qualified Health Center (FQHC). This designation allows Circle the City to
receive enhanced Medicare and Medicaid reimbursement for eligible medical services. In this new funding
environment, Circle the City is able to leverage each philanthropic dollar granted to the organization by a factor
of three to four by matching it with the enhanced health services revenue. In FY2016, Circle the City projects to
provide, organization-wide, nearly $8M worth of holistic, high-quality healthcare on total fundraising of $2M.
11. Describe your plan to document progress and results.
Circle the City’s most advanced method for monitoring outcomes is its electronic medical record (EMR),
which tracks patient demographics, frequency and length of engagements with medical providers, and
outcomes, both medical and social. Provider notes, charts, and documents are scanned into the integrated
medical record, which is then reported on and analyzed to track outcomes for uninsured and under-insured
patients.
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.
Circle the City is not applying for additional tribal funding.

Gila River Indian Community Grant Application
Grant Cycle 2016
Project Budget
Budget Period: FY2016 (July 1, 2015, to June 30, 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
(list each budget item) requested from requested or contributions
GRIC secured from
other funders
1. Salaries and Wages $ 28,000 $1,357,000 $--------- $1,385,000
2. Consultants and Professional Fees $ 3,000 $ 185,000 $--------- $ 188,000
3. Insurance and Benefits $ 7,000 $ 374,000 $--------- $ 381,000
4. Supplies $ 3,000 $ 136,000 $--------- $ 139,000
5. Rent/Utilities/Phone $ 19,000 $ 697,000 $ 219,000 $ 935,000
6. Other $ 15,000 $ 718,000 $--------- $ 733,000
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 $ 75,000 $3,467,000 $ 219,000 $3,761,000

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. Salaries and Wages ($28,000 grant; $1,385,000 total) includes salaries for medical staff, behavioral health staff, case
managers, and other program direct staff.
2. Consultants and Professional Fees ($3,000 grant; $188,000 total) includes payment for services provided by contract
labor, including physical therapists and contract physicians.
3. Insurance and Benefits ($7,000 grant; $381,000 total) includes benefits for program staff.
4. Supplies ($3,000 grant; $139,000) includes medical supplies, linen and laundry, as well as clothing and personal care
items for the patients who often arrive without any belongings.
5. Rent/Utilities/Phone ($19,000 grant; $935,000 total) includes facility and administrative direct charges and
allocations. This category also includes in-kind rent.
6. Other ($15,000 grant; $733,000 total) includes additional direct respite center expenses, respite in-kind service and
expenses, total respite food, and total respite shelter.
7. *The Better Business Bureau’s Wise Giving Standards for Charity Accountability recommends that charities spend at
least 65% of total expenses on program activities, which Circle the City exceeds by 20%. Additionally, Circle the City is
18% below the 33% benchmark for spending on general, administrative, and fundraising expenses.
8. Click here to enter text.
9. Click here to enter text.
10. Click here to enter text.
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.

Gila River Indian Community Grant Application
Grant Cycle 2016
16. Click here to enter text.
17. Click here to enter text.
Other explanation: Click here to enter text.

M e d i c a l
R e s p i t e C a r e
healing and
P r i m a r y hope
H e a l t h c a r e
M o b i l e
Medical
Outreach
C a s e
M a n a g e m e n t E n d - o f -
a n d H e a l t h L i f e
N a v i g a t i o n C a r e
M e n t a l Administrative Office
a n d 300 W. Clarendon Avenue, Suite 200
B e h a v i o r a l Phoenix, AZ 85013
602-776-0776
H e a l t h c a r e info@circlethecity.org

To create and deliver innovative healthcare solutions that compassionately
address the needs of men, women, and children facing homelessness.
Services:
M e d i c a l
Circle the City’s Medical Respite Center is a 50-bed, 24/7 333 W. Indian School Road
R e s p i t e C a r e facility for homeless adults that provides supervised medical Phoenix, AZ 85013
care, behavioral healthcare, and case management
services in order to connect patients with housing and other 602-776-9000
social benefits prior to discharge. By offering patients
dedicated time and a place to heal, the Medical Respite
Center has helped more than 700 homeless men and
women recover from illnesses and injuries during the past
three years. Additionally, the respite center has placed 78%
of these individuals in living situations other than the streets
or emergency shelter system at discharge.
P r i m a r y
The Parsons Family Health Center is a homeless- 3522 N. 3rd Avenue
H e a l t h c a r e specialty primary care facility that provides Phoenix, AZ 85013
comprehensive medical care as well as
integrated psychiatric, behavioral health, and 602-776-7676
case management services. Circle the City
opened The Parsons Family Health Center to
address the gap in primary and preventative
healthcare for both individuals and families
journeying through homelessness. Services are
available through both prescheduled and walk-
up appointments during the weekdays between
8 a.m. to 5 p.m. (closed for lunch from 12-1
p.m.).
M o b i l e
Circle the City furthers its community outreach Please consult
M e d i c a l
through a two-exam room Mobile Medical www.circlethecity.org for
O u t r e a c h Clinic that visits parks, housing complexes, and the Mobile Medical Clinic’s
other community service agencies serving the schedule of visits.
homeless. Between the fixed site and the mobile
clinic, Circle the City will serve more than 4,000
individuals in 2015-2016.
B e h a v i o r a l
H e a l t h c a r e Continuing its mission to help end homelessness
through high quality, integrative healthcare, Circle 3522 N. 3rd Avenue
the City has launched Arizona’s first homeless-focused Phoenix, AZ 85013
Assertive Community Treatment (ACT) Team. This multi
-disciplinary mental health team serves 100 vulnerable 602-266-6000
adults experiencing homelessness and provides them
with intensive psychiatric support; nursing care; case
management; substance abuse intervention;
employment support; independent-living skills; and
housing assistance.
Donate now! For more information:
www.circlethecity.org/donations info@circlethecity.org
602-776-0776 602-776-0776


Created: 02/02/2016
Last updated: 03/09/2016
Page 1
General information
Organization Community Information and Referral Services (CIR)
Contact First name Catherine
Contact Last name Rea
Contact e-mail crea@cir.org
Contact phone number 602.263.8845
Address
Street 2200 N Central Ave Suite 211
City Phoenix
State Arizona
ZIP Code 85004
From what tribe is the organization requesting the grant?
Gila River Indian Community
Total grant amount request
250,000
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) 50,000
Year 2 (Gila River Indian Community Grants Only) 50,000
Year 3 (Gila River Indian Community Grants Only) 50,000
Year 4 (Gila River Indian Community Grants Only) 50,000
Year 5 (Gila River Indian Community Grants Only) 50,000
1 of 1

4." 1/41 M IRS Internal Department Revenue of the Treasury Service
P.O. Box 2508 In reply refer to: 0248344558
Cincinnati OH 45201 Mar. 10, 2015 LTR 4168C 0
86-0374813 000000 00
00017223
BODC: TE
COMMUNITY INFORMATION AND REFERRAL
SERVICES
2200 N CENTRAL AVE
PHOENIX AZ 85004
016912
Employer Identification Number: 86-0374813
Person to Contact: Mr. Burns
Toll Free Telephone Number: 1-877-829-5500
Dear Taxpayer:
This is in response to your Feb. 27, 2015, request for information
regarding your tax-exempt status.
Our records indicate that you were recognized as exempt under
section 501(c)(3) of the Internal Revenue Code in a determination
letter issued in January 1980.
Our records also indicate that you are not a private foundation within
the meaning of section 509(a) of the Code because you are described in
section(s) 509(a)(1) and 170(b)(1)(A)(vi).
Donors may deduct contributions to you as provided in section 170 of
the Code. Bequests, legacies, devises, transfers, or gifts to you or
for your use are deductible for Federal estate and gift tax purposes
if they meet the applicable provisions of sections 2055, 2106, and
2522 of the Code.
Please refer to our website www.irs.gov/eo for information regarding
filing requirements. Specifically, section 6033(j) of the Code
provides that failure to file an annual information return for three
consecutive years results in revocation of tax-exempt status as of
the filing due date of the third return for organizations required to
file. We will publish a list of organizations whose tax-exempt
status was revoked under section 6033(j) of the Code on our website
beginning in early 2011.

Gila River Indian Community Grant Application
Grant Cycle 2016
Cover Sheet
Municipality Information
1. Date of Application: 2/23/2016 (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: 85003
6. Acknowledgement of Submission by Authorized Municipality Representative:
Typed Name: Amanda Nash, Maricopa County Government Relations, 301 W. Jefferson, 10th Floor, Phoenix AZ 85003,
602-506-4485 Signature:
Applicant Information
7. Department/Organization Name: Community Information and Referral Services
8. Is this a non-profit 501c(3) Organization? No Yes If yes, attach IRS Determination Letter
9. Application Contact Person: Catherine Rea Title: CEO
10. Phone Number: 602-263-8845
11. Mailing Address: 2200 N. Central Ave., Suite 211
12. City: Phoenix State: Arizona Zip Code: 85004
13. Email Address: crea@cir.org Website Address: www.211arizona.org
Project Information
14. Project Name: 2-1-1 Arizona
15. Purpose of Grant: To increase direct service capacity of 2-1-1 Arizona Services
16. Priority Funding Area Healthcare
17. Annual amount requested $50,000
18. Number of years that funding is requested 5
19. Total amount requested (annual amount x # $250,000
of years)
20. Has your organization received past funding No
from GRIC? If yes, list each year and amount
State of Arizona, primarily Maricopa County at 81% of call center
21. Geographic area served
service
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.
Community Information and Referral Services (CIR) was founded in 1964 and incorporated in 1979 as
a 501(c)(3) nonprofit organization. CIR’s mission is “CIR transforms lives by linking individuals and
families to vital community services throughout Arizona”, and our vision is that “All Arizonans are
easily connected to available health and human services in their communities”.
CIR’s 2-1-1 Arizona program is the main source for health and human service information and referrals
in the State of Arizona. With currently over 37,000 services available provided by nearly 10,000
participating agency and community programs, 2-1-1 Arizona fulfilled over 1.3 million service requests
in FY 2015 through the 2-1-1 call center, our website at www.211arizona.org , a telephone Integrated
Voice Response system (IVR) and iPhone and Android applications. 2-1-1 Arizona provides callers with
information and referrals to basic human needs, physical and mental health resources, employment
support, older adult, persons with disabilities, children, youth and families support, and volunteer
opportunities and donations. 2-1-1 Arizona also provides easy access to vital community and
government service programs available, coordination of volunteer needs and opportunities statewide,
eliminates duplication of information and referral services for providers, provides demographic
feedback and tracking of trends in needs, services, gaps, and poverty areas, and valuable support for
emergency 9-1-1 operations and disaster relief efforts.
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.”
Community Information and Referral Services is a non-profit 501c(3) agency. We have worked with Maricopa
County on several projects including its Childhood Immunization program and Community Disaster Resilience
Partnership, and are currently contributing client demographic and need data to several departments.
3. Describe the proposed project and planned goals and activities.
2-1-1 Arizona is requesting $50,000 for FY 2016 and beyond to increase tribal resources available in
the 2-1-1 database and enhance call center capacity by increasing direct service to callers, and thereby
adding approximately hours of answer time available to callers.
Currently, due to increase demand for services, 2-1-1 Arizona is experiencing an average 25 % call
abandonment rate. Funding from Gila River Indian Community would greatly assist in increasing
fulfilling service requests to 2-1-1 Arizona callers, and to all the programs that depend on us for client
referrals.

Gila River Indian Community Grant Application
Grant Cycle 2016
4. Describe how the proposed project satisfies one or more of the priority funding areas identified by the Gila River
Indian Community.
2-1-1 Arizona services satisfy several priority areas identified by the Gila River Indian Community, but
namely the areas of healthcare and public safety information and referral services.
 Healthcare - health promotion, disease prevention, wellness activities, recreational activities that promote physical
fitness, nutrition, behavioral health programs, drug, alcohol or tobacco use cessation, direct patient care, health
education, and other programs that may assist in improving the overall health of participants or the community.
 Public Safety - programs and projects that enhance the efforts of police departments and fire departments, crime
prevention programs, reduction of environmental hazards, educational programs that promote public and
individual safety, shelters.
As a healthcare priority, 2-1-1 Arizona acts as the go-to number for healthcare enrollment agencies,
immunizations, food and nutrition assistance programs, substance abuse/detox treatment resources,
among many other healthcare services that are available in Arizona. For the public safety priority, 2-1-
1 Arizona acts as a backup to emergency and disaster relief efforts by directing those in need to shelters,
food, and other emergency services.
5. Identify the needs/problems to be addressed, target population and number of people to be served by the
project.
As the only 211 call center for the state of Arizona, and with the most comprehensive data base of services and
providers, the need that 2-1-1 Arizona fulfills is the ability to connect people to available health, human, community,
government and disaster relief services in a free, confidential and efficient manner. The target population of 2-1-1
Arizona are primarily low-income Arizonans with over 1.3 million service requests fulfilled last year through the 2-1-
1 dialling call center, website at www.211Arizona.org, Interactive Voice Response (IVR) system and iPhone and
Android applications.
6. Define the project as a new or continuing program.
2-1-1 Arizona was started in October 2011 and is a continuing program.
7. Provide a brief timeline including start and finish dates. Indicate if the timeline is flexible.
2-1-1 Arizona is a continual program.
8. Identify other organizations, partners or funders participating in the project and their roles.
2-1-1 Arizona collaborates with over 37,000 services available through nearly 10,000 providers that depend on 2-1-1
for efficient and confidential information and referrals for needed services available. Funders of 2-1-1 Arizona
include Valley of the Sun United Way, Arizona Departments of Economic Security and Housing, the City of Tempe,

Gila River Indian Community Grant Application
Grant Cycle 2016
the City of Peoria, the City of Goodyear, Yuma County United Way, United Way of Northern Arizona, Salt River
Project, APS, South West Gas, Cox Communications, and Seasons for Sharing.
9. Would you be able to implement the proposed plan if your organization received partial funding for this project?
Yes, but on a limited service basis.
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.
2-1-1 Arizona has been engaged in advocacy efforts towards a state wide funding appropriation through the Arizona
legislature
11. Describe your plan to document progress and results.
2-1-1 Arizona monthly monitors call and web site searches to determine needs, gaps in service areas, as well as
caller satisfaction survey call-backs for continual quality improvement. In addition the call center captures caller
demographics as well as the caller’s needs and the agencies referred to. The website at www.211arizona.org
captures the viewers city as well as the needs and agencies viewed. Finally, the IVR captures the caller entered zip
code and the recording of the need chosen. All of this data is collated and reported to funders and community
partners.
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.
2-1-1 Arizona received one-time funding from the Pima Salt River Indian Community in 2014 in the amount of
$78,000.

Gila River Indian Community Grant Application
Grant Cycle 2016
Project Budget
Budget Period: July 1, 2016-June 30, 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. Salaries $50,000 $275,309 $0 $325,309
2. Employee Benefits and Taxes $0 $65,709 $0 $65,709
3. Employee Education and Training $0 $3,000 $0 $3,000
4. Professional Fees and Contracts $0 $15,000 $0 $15,000
5. Communications (phone, postage) $0 $60,000 $0 $60,000
6. Supplies/Equip Rental and Maint. $0 $6,000 $0 $6,000
7. Occupancy (rent, utilities, building) $0 $30,000 $0 $30,000
8. Advertising / Printing $0 $6,000 $0 $6,000
9. Travel / Meetings/ Conferences $0 $6,000 $0 $6,000
10. Non-payroll Insurance $0 $3,000 $0 $3,000
11. Other $0 $-30,633 $0 $-30,633
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 $439,385 $0 $489,385

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. Salaries – 325,309 – Was derived from actual salary costs for 2-1-1 Arizona personnel
2. Employee Benefits and Taxes – 65,709 – Was derived from actual benefit costs for 2-1-1 Arizona personnel
3. Employee Education and Training – 3,000 – The amount needed for 2-1-1 Arizona personnel for the AIRS Conference
classes and for online class courses
4. Professional Fees and Contracts – 15,000 – Agency Audit cost 10,000, Design, Artwork of Directory, Annual Report,
Infographic Reports, Website designs – 5,000
5. Communications – 60,000 – Contract cost for telephone provider and average postage cost of mailed material
6. Supplies/Equip Rental and Maint – 6,000 – Equipment lease 2,000, office supplies 2,000, repairs and maintenance
2,000
7. Occupancy – 30,000 – Facility rent cost including electricity and water
8. Advertising/ Printing and Publications – 6,000 – Advertising/Employment adds 1,000, Printing of brochures, cards,
5,000
9. Travel / meetings / conferences – 6,000 – The amount of money needed by 2-1-1 Arizona personnel for air
transportation, hotel rooms and food for the AIRS Conference
10. Non-Payroll Insurance – 3,000 – Required insurance for the agency
11. Other – (30,633) – Board Meetings 1,000, Postage 2,500, Directory Postage 500, Public relations and fund raising
6,000 admin allocation 29,117, change in assets (69,750)
12. Click here to enter text.
13. Click here to enter text.
14. Click here to enter text.
15. Click here to enter text.

Gila River Indian Community Grant Application
Grant Cycle 2016
16. Click here to enter text.
17. Click here to enter text.
Other explanation: Click here to enter text.

Last updated: 02/04/2016
Page 1
General information
Organization Duet: Partners In Health and Aging
Contact First name Elizabeth
Contact Last name Banta
Contact e-mail banta@duetaz.org
Contact phone number 602 274 5022
Address
Street 555 W Glendale Avenue
City Phoenix
State AZ
ZIP Code 85012
From what tribe is the organization requesting the grant?
Gila River Indian Community
Total grant amount request
70000
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) 35000
Year 2 (Gila River Indian Community Grants Only) 35000
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

IRS Department or the Treasury
Internal Revenue Service
P.O. Box 2508, Room 4010 In reply refer to: 4077556534
Cincinnati OH 45201 Sep. 22, 2009 LTR 4168C 0
74-2370522 000000 00
00025918
BODC: TE
DUET PARTNERS IN HEALTH & AGING INC
555 W GLENDALE AVE
PHOENIX AZ 85021-8763
005227
Employer Identification Number: 74-2370522
Person to Contact: SHARON LENARD
Toll Free Telephone Number: 1-877-829-5500
Dear Taxpayer:
This is in response to your request of Aug. 28, 2009, regarding your
tax-exempt status.
Our records indicate that a determination letter was issued in
November 1985, that recognized you as exempt from Federal income tax,
and discloses that you are currently exempt under section 501(c)(3)
of the Internal Revenue Code.
Our records also indicate you are not a private foundation within the
meaning of section 509(a) of the Code because you are described in
section(s) 509(a)(1) and 170(b)(1)(A)(vi).
Donors may deduct contributions to you as provided in section 170 of
the Code. Bequests, legacies, devises, transfers, or gifts to you or
for your use are deductible for Federal estate and gift tax purposes
if they meet the applicable provisions of sections 2055, 2106, and
2522 of the Code.
If you have any questions, please call us at the telephone number
shown in the heading of this letter.
Sincerely yours,
Cindy Westcott
Manager, EO Determinations

Gila River Indian Community Grant Application
Grant Cycle 2016
Cover Sheet
Municipality Information
1. Date of Application: 2/5/2016 (NOTE: Click or use up/down arrow keys to move
among fields)
2. Name of City, Town or County: Maricopa
3. Mayor (City or Town) or Board of Supervisor’s Chairman (County): Clint L. Hickman
4. Mailing Address: 301 W. Jefferson St. 10th Floor
5. City: Phoenix State: Arizona Zip Code: 85003
6. Acknowledgement of Submission by Authorized Municipality Representative:
Typed Name: Amanda Nash, Maricopa County Government RelationsSignature:
Applicant Information
7. Department/Organization Name: Duet:Partners In Health and Aging
8. Is this a non-profit 501c(3) Organization? No Yes If yes, attach IRS
Determination Letter
9. Application Contact Person: Elizabeth Banta Title: Executive Director
10. Phone Number: 602 274 5022
11. Mailing Address: 555 W Glendale
12. City: Phoenix State: Arizona Zip Code: 85021
13. Email Address: banta@duetaz.org Website Address: www.duetaz.org
Project Information
14. Project Name: Aging With Dignity Through Escorted Transportation
15. Purpose of Grant: Gila River Indian Community’s support will lead to 17000 escorted, free-of-
charge rides to medical appointments and grocery stores for elders and adults with disabilities who
wish to remain living in their own homes.
16. Priority Funding Area Transportation
17. Annual amount requested $35,000
18. Number of years that funding is 2
requested
19. Total amount requested (annual amount x $70,000
# of years)
$43,000 in 2013
20. Has your organization received past $35,000 in 2015
funding from GRIC? If yes, list each year and Both grants were funded for vital transportation
amount services for isolated elders and adults with
disabilities.
For Office Use Only:
Data Entry
Receipt
Evaluation

Gila River Indian Community Grant Application
Grant Cycle 2016
Phoenix, Scottsdale south of Frank Lloyd Wright
21. Geographic area served Blvd, Glendale, Laveen, Peoria, and Fountain
Hills.

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 in 1981, Duet’s mission is to promote health and well-being through a broad range of
services to homebound adults, caregivers, faith communities, and grandparents raising
grandchildren.
Duet was the first in Arizona – beginning in 1984 - to offer free-of-charge volunteer services for
homebound adults. These simple yet vital services not only meet essential needs such as getting
food and medical care, but also relieve the isolation and depression common among homebound
elders. Nineteen Arizona programs launched programs utilizing our model. Duet refers to those we
serve through this program as “neighbors”.
Duet was the first organization in Arizona to address challenges facing grandparents who are raising
their grandchildren. We offer a wide range of services to help these caregivers persevere, including
support groups, family outings, workshops, respite, legal assistance, and personalized guidance.
Duet brought the concept of faith community nursing to Arizona in 1994, and is the only entity in the
state to offer courses that provide registered nurses the training to serve as faith community nurses.
Ongoing training and support help congregational health programs flourish. Seventy-two
congregations currently have active health programs in place. 63,900 health interventions help at
least 8,000 people in need during a year.
Duet helps family caregivers of older adults through support groups, respite, personalized guidance,
and workshops and retreats throughout the Valley. Duet was the first organization in Maricopa County
to offer general (versus disease-specific) caregiver support services.
The Virginia G. Piper Charitable Trust selected Duet as one of six nonprofits to participate in their
inaugural “ATLAS” capacity building initiative that began in 2012 and concluded in 2015. As a result of
this initiative, Duet board and staff strengthened our governance, financial, management, and
administrative systems. We carried out a comprehensive self-assessment and capacity-building work
plan, including restructuring and strengthening our development team. We implemented robust
outcomes evaluation processes to measure the impact of all services on an ongoing basis. Duet now
operates with a greater culture of analysis and longer-view perspective. To increase efficiency, we
implemented state-of-the-art software that will integrate multiple service and donor databases into
one. Building on the ATLAS work, the board created a new strategic plan that guides our mission-
driven work for the next five years.
We were honored when the Virginia G. Piper Charitable Trust invited Duet to submit a funding
proposal in 2016 to enhance and expand Duet’s caregiver services over the period of three years.
BHHS Legacy Foundation, after reviewing the volunteer services grant report we submitted, invited
Duet to apply to the Foundation for an increased investment to strengthen and expand our volunteer
transport and home-visiting services. Support will include the addition of personnel (part-time
outreach coordinator, and social media intern) to bolster outreach in order to recruit more volunteers
and inspire them to spread the word about the services available through Duet.

Gila River Indian Community Grant Application
Grant Cycle 2016
We know our programs are critical to the community, effective, and serve as models for other
communities. Still, not all needs in our geographic service area are being filled. Gila River Indian
Community’s financial support has been fundamental to our achievements. An award in 2016 will be
key to helping achieve our vision of completely meeting the need for our vital transportation services
in our service area. Duet’s volunteer services for homebound adults reach those in need in Phoenix,
Fountain Hills, Glendale, Laveen, Paradise Valley, Peoria, and Scottsdale – communities that
comprise 50% of the 65+ population in Maricopa County.
In 2015, 757 homebound or disabled adults were assisted with 46,566 hours of direct service help
from Duet volunteers, with 7,404 escorted rides provided to medical, grocery shopping and social
service appointments.
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.”
Duet provides unduplicated services for the Cities of Phoenix, Scottsdale, Glendale, Peoria
and Town of Paradise Valley, through contracted agreements. These services are
complementary rather than duplicative, and provide the extra support needed by elders and
adults with disabilities who must be accompanied to appointments and grocery stores. The
City of Scottsdale created a one minute public service announcement in partnership with Duet
that is on their website and airs on their Channel 11 cable station to recruit volunteers and to
let people know where to seek help.Through referrals and general funds, Duet partners with
these municipalities. Duet’s service area is Phoenix, Fountain Hills, Glendale, Paradise Valley,
Peoria, and Scottsdale, avoiding overlap with seven non-profit organizations which offer
volunteer services in-home in Maricopa County - all but one of which began by utilizing Duet’s
model. Our award-winning transportation model features an interactive website map that
shows people needing help in real time. Requests for our vital volunteer services are
constantly increasing. Transportation is the most requested service. Duet has a strong
presence in a local, age-friendly initiative with Maricopa Association of Governments,
addressing solutions to community transportation issues for seniors. Nancy Cantor is
Scottsdale's citizen liaison to the Maricopa Association of Governments Age-Friendly
Communities Project. In a September 2014 Op Ed in the Arizona Republic, Nancy states
“Probably the best kept secret in Scottsdale is that the city is coming to grips with its status as
the Number 1 city in the country with a population over 100,000 that has the biggest portion of

Gila River Indian Community Grant Application
Grant Cycle 2016
its population over age 65. Thankfully, this is not such a big secret to organizations like Duet:
Partners In Health and Aging, known more commonly as Duet.” She goes on to note “For more
than 30 years, Duet has worked diligently to improve the quality of life for older adults across
the Valley. While Duet helps thousands of elders, it promises to give each person
individualized attention and respect, understanding and support.”
3. Describe the proposed project and planned goals and activities.
No one should have to face life’s challenges alone. Duet helps homebound adults live in their own homes for
as long as possible by pairing them with caring volunteers. In partnership with Gila River Indian Community,
Duet will provide 32,000 escorted rides for elders who are too frail to travel unaccompanied to medical
appointments and the grocery store. At least 310 elders will receive transportation to medical appointments,
and 300 elders will receive ongoing escorted transportation for grocery shopping.
Duet offers the essential coordination needed to transform volunteers’ good intentions into action.
Volunteers provide their assigned neighbors with transportation – the focus of this proposal – as well
as friendly visiting and phoning, home repair services and home safety assessments, computer
assistance, respite, help with paperwork, and assistance in writing life stories. With the overarching
goal that elders and adults with disabilities who no longer drive will live safely, independently, and with
a sense of well-being in their own homes for as long as possible, the following highly effective
strategies will be carried out throughout the grant period.
• Recruit at least 200 new volunteers. Recruiting will include presenting before at least 30
community organizations, meeting with at least 40 current and prospective partner
congregations and distributing monthly articles for their use. We will conduct outreach through
regular press releases and story submissions to local media, social media such as Facebook
and Twitter, monthly e-news, radio advertising, and equipping and training existing volunteers
to reach out to prospective volunteers. We are hiring a part-time outreach staff member to
carry out the above recruitment activities together with other staff and communications
volunteers.
• Conduct at least 18 volunteer orientations, to include fingerprinting, creating photo name
badges, and completion of commitment sheets indicating the service(s) volunteers wish to
provide, how many neighbors they wish to help, and geographic area(s) they are willing to
serve.
• Generate community awareness so people in need and referral sources know where to turn to
for help through the same methods used to recruit volunteers, as well as by strengthening and
building collaborations with nonprofit, for-profit, business, and government partners. The
outreach position, noted above, will assist in these efforts, as will a social media intern
secured.
• Carry out telephone intakes and conduct home visits with neighbors seeking assistance.
• Pair neighbors with volunteers who have agreed to offer the specific kinds of service that have
been requested. Re-match as needed when volunteers are on vacation or retire from service.
• Carry out quality assurance phone calls to volunteers and neighbors, and collect and review
report forms submitted by volunteers. Provide ongoing supervision and problem-solving with
volunteers and neighbors.
• Recognize volunteers to assist with retention through a September, 2016, appreciation dinner,
as well as regular communication.

Gila River Indian Community Grant Application
Grant Cycle 2016
In its new strategic plan Duet committed to increasing the number of neighbors receiving service by a
minimum of 5% annually and increasing the net number of volunteers served by a minimum of 5%
annually, with a focus on areas of greatest need. We also commit to ensuring volunteers and
neighbors continue to have a positive experience from the time of orientation, the beginning of
services and beyond.
Presently, Duet is achieving 101% of our goal of number of service hours provided; 105% of our goal
of number of rides; 102% of our goal of neighbors served, and 96% of our goal of new volunteers.
In addition to the above outputs, we exceeded all goals relating to outcomes, as follows:
• 98% of individuals knew that they could call Duet if additional help was needed or to reach
their assigned volunteers (achieving 109% of our goal of 90%).
• Monthly reports submitted by volunteers and quality assurance calls to individuals reflected a
respectful, mutually positive match in at least 96% of cases (achieving 107% of our goal of
90%). Note – as part of our process we problem-solve any concerns, and rematch volunteers
as needed, typically due to scheduling incompatibility.
• 98% of neighbors surveyed by telephone reported that their ability to remain living at home has
increased due to Duet’s services (achieving 109% of our goal of 90%).
4. Describe how the proposed project satisfies one or more of the priority funding areas identified
by the Gila River Indian Community.
Duet will satisfy Gila River Indian Community’s priority regarding transportation. Duet will also support
the priority of improved healthcare.
Most of us don’t think twice about the freedom we have to drive to work, grocery stores, friends or
doctors. However, thousands of people in our community do not have that ability. Elders and adults
with disabilities often have health or vision issues that prevent them from driving. This can lead to
despair; many move out of their homes because they feel they have no other options. In addition,
some elders are too frail to travel unaccompanied, or to manage the long waits and transfers that
individuals face with bus and dial-a-ride service. By providing escorted, door-through-door
transportation, Duet fills a critical gap in publicly funded transportation services for fragile elders and
adults with disabilities. Compassionate volunteers enable homebound adults to fulfill basic needs,
thus making it possible to live at home. Family caregivers who work, manage needs from another
town, or are overwhelmed also benefit from support offered by caring volunteers to their loved ones.
5. Identify the needs/problems to be addressed, target population and number of people to be
served by the project.
A July 2015 AAA Foundation study found that driving cessation is associated with declines in general
health and physical, social, and cognitive functions, and with increased risks of admission to long-
term care facilities and mortality. To mitigate the potential adverse effects of driving cessation on
health and well-being in older adults, intervention programs ensuring mobility and social functions are
needed.

Gila River Indian Community Grant Application
Grant Cycle 2016
The US Census Bureau’s 2008 – 2012 American Community Survey reports that 69,341 people in
Duet’s service area live in their own homes or apartments and have difficulty doing errands such as
transportation or shopping due to physical, mental, or emotional conditions. Of these, 14,188 have
incomes less than $25,000 per year.
Our community benefits as we help elders maintain their dignity while making it possible for them to
remain in their own homes, and out of costly nursing homes, for as long as possible. Based on an
estimate of half of our neighbors delaying nursing home placement or assisted living by six months in
a given year, Duet’s services result in an annual savings of at least $10.6 million – an expense that
would largely be borne by taxpayers due to the low income nature of the population we assist.
310 people will be served by the project. Your investment will impact, on average, a woman with multiple health
problems over age 80 with a monthly income of less than $1,000. Of current neighbors, 84% are women who
live alone. Forty-four percent have incomes less than $1,000 per month; 34% have monthly incomes between
$1,001 and $1,500; 13% fall between $1,501 -$2,000 per month and 9% have monthly income of $2,000 or
more. Eighteen percent are 90+; 35% are 80 – 89; 21% are 70-79; 15% are 60 – 69; and 11% are between 19
and 59 years of age.
Approximately 50% of Duet volunteers are recruited from the community at large and 50% come from 114
congregations that partner with Duet. Recruiting sufficient volunteers to meet service demands is a continual
challenge. In addition to our existing strategies, we are building greater community awareness so that more
people learn about our meaningful, flexible service opportunities. While we secure coverage in print and radio
formats, and newsletters published by partnering faith communities and nonprofit partners, we are adopting, in
2016, fresh strategies for outreach that are sufficiently financed through a grant.
6. Define the project as a new or continuing program.
This transportation proposal is an ongoing component of Duet’s proven volunteer services for
homebound adults. Your funds will sustain and grow vitally needed, one-on-one transportation,
leading to 32,000 rides for individuals at risk for institutionalization.
7. Provide a brief timeline including start and finish dates. Indicate if the timeline is flexible.
Gila River Indian Community’s funding will support services for a two-year period beginning
November, 2016, through October, 2018. The budget below reflects the 5% increase in services
during year two.
8. Identify other organizations, partners or funders participating in the project and their roles.
The very name “Duet: Partners In Health & Aging” celebrates our nature as a collaborative, interfaith
organization. Duet meets pressing community needs because of long-standing collaborations with
community-based nonprofits, businesses, faith communities, and thousands of generous donors and
volunteers. Over 1,000 caring volunteers help fulfill Duet’s mission. We work in tandem with the
greater Phoenix community to provide crucial services to older adults. From referrals and volunteers,
to donations and in-kind support, our partners help us improve the lives of many who are facing
challenges associated with aging.

Gila River Indian Community Grant Application
Grant Cycle 2016
We work closely with the Foundation for Senior Living; the Area Agency on Aging, Region One; ASU;
Adult Protective Services; Rehabilitation and Blind Services; the Alzheimer’s Association; Jewish
Family and Children’s Services; ASU; Adult Protective Services, and SAIL (Senior Adults for
Independent Living); Foothills Caring Corps; About Care; Neighbors Who Care; Verde Cares; Y
OPAS; Benevilla; East Valley Adult Resources, and Muhammad Ali Parkinson Center. In addition,
partner congregations from many faiths and denominations have joined with us to create a service
network. Many members of the congregations become Duet volunteers and they typically also
provide meeting space and financial support. Duet currently is participating in an initiative with MAG
addressing solutions to community transportation issues - the number one concern for aging people.
Duet is the only organization in our service area that provides its services free-of-charge. There are
no other programs in the geographic area served by Duet that offer escort transportation, shopping,
friendly phoning and visiting, business assistance, and computer assistance at no fee.
9. Would you be able to implement the proposed plan if your organization received partial funding
for this project?
Duet will carry out the proposal even with partial funding. The amount of funding correlates to the
number of escorted rides we will be able to coordinate. As all services are provided at no cost, their
continuation and expansion depends on community support. Duet will stretch your dollars far to
change lives.
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.
In 2015 Duet was pleased to receive first-time support to fund aging-in-place services for homebound
adults from Del E Webb Foundation and the May and Stanley Smith Charitable Trust. Funding
partners include The Arizona Republic / 12 News Season for Sharing, Area Agency on Aging Region
One, City of Glendale From the Heart, City of Phoenix, City of Scottsdale, Town of Paradise Valley,
SRP, Boeing Employee Fund and Sundt Foundation. In addition, individuals have donated personal
gifts to sustain, and grow, our services.
Funding sources for Duet’s comprehensive free-of-charge services include corporations, individuals,
foundations, trusts, government sources, fundraising events, faith communities, and in-kind
occupancy. Duet created its Legacy Circle nine years ago to ultimately grow a robust endowment
fund. Eighty-six individuals have joined Duet’s Legacy Circle by including Duet in their estate plans.
Our 2016-2020 strategic plan incorporates a variety of initiatives designed to grow individual giving,
including a charitable tax credit campaign. The charitable tax credit campaign already has
significantly increased individual giving. Our annual Duet Cabaret fundraising event exceeded goal in
2015, and Duet’s winter 2015 fundraising event was one of the most successful in the history of the
event – raising $21,000 over the 2014 total. Still raising sufficient funds to continue and grow our
vitally needed services is a continual challenge that requires many partners in service. Gila River
Indian Community’s generous renewed support will be critical to bringing to life aging in place
services.

Gila River Indian Community Grant Application
Grant Cycle 2016
Duet’s compassionate and cost effective services leverage tens of millions of dollars of savings by
deferring or preventing placements in foster homes, hospitals, and nursing homes.
11.Describe your plan to document progress and results.
Measurements and Tracking:
• Monthly reports submitted by volunteers. Reports include type of service, number of hours
provided, and observations on condition of the neighbor served such as declining health or
unmet needs
• Number of new partner congregations
• Number of rides provided to medical appointments and grocery stores
• Number of new volunteers
• Number of service hours provided
• Total number of participants
Quantity of service and growth indicators combined with direct feedback from neighbors are the
primary indicators used when evaluating performance and determining if our services are indeed
improving the quality of neighbors’ lives.
Volunteers average 76 hours per client at 1.5 hours a week. 95% of clients indicate that Duet’s
services help them remain in their homes. Remaining in their own homes for an average of 2.3 years
saves 10.6 million in residential care annually.
Monthly report forms are submitted by volunteers. Service interactions are entered into our database
when each match is made. New volunteers are entered into our database after attending a volunteer
orientation. All outputs may be easily queried and reported.
Outcomes are measured through telephone and written surveys. Individuals receiving ongoing
service receive quality assurance calls one month after being paired with a volunteer and every six
months thereafter. In addition, outcome measurement surveys are mailed annually to all Duet
neighbors who have received a minimum of two months’ service. A stamped and addressed envelope
is included for ease of return.
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.
Duet received a first-time award of $7,500 from Salt River Maricopa Pima Indian Community in 2014
for general support of all of our programs, and has been invited to reapply. The funding is bolstering
services to family caregivers, grandparents and the children they are raising, and homebound adults.
Thank you for considering this proposal to partner in service with Duet over the period of two years to
provide transportation that will improve the health and well-being of at-risk individuals who wish to
age in place with dignity.

Gila River Indian Community Grant Application
Grant Cycle 2016

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 requested or contributions
from GRIC secured from
other funders
1. Click here to enter text. $0 $0 $0 $0
2. Click here to enter text. $0 $0 $0 $0
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
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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 $0 $0 $0 $0

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. Click here to enter text.
2. Click here to enter text.
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.
10. Click here to enter text.
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.

Duet: Partners In Health and Aging Budget, Gila River Indian Community, Aging With Dignity Through Escorted
Transportation
YEAR I
Proposed Budget Amount Amount In Kind Total Budget
Expense requested from requested or contributions
GRIC secured from
other funders
1. Staff to $26,700 $155,300 $0 $182,000
coordinate
services
2. Employee $0 $48,500 $0 $48,500
related expenses
3. Volunteer $3,000 $5,700 $0 $8,700
fingerprinting
4. Volunteer hours $0 $0 $704,000 $704,000
5. Mileage to $300 $1,000 $0 $1,300
assess clients
6. Rent and $0 $3,000 $13,300 $16,300
utilities
7. Volunteer $400 $1,900 $0 $2,300
training/apprec.
8. Supplies and $300 $1,600 $0 $1,900
postage
9. Telephone and $400 $2,200 $0 $2,600
copier
10. Printing for $400 $1,400 $0 $1,800
outreach
11. Volunteer $1,500 $4,900 $0 $6,400
insurance
12. Liability $0 $3,300 $0 $3,300
insurance
13. HR and $0 $2,400 $0 $2,400
accounting
services
14. Volunteer $2,000 $2,000 $0 $4,000
recruitment
15. Paid $0 $2,000 $0 $2,000
advertising
Total Budget $35,000 $235,200 $717,300 $987,500

YEAR II
Proposed Budget Amount Amount In Kind Total Budget
Expense requested from requested or contributions
GRIC secured from
other funders
1. Staff to $26,700 $160,300 $0 $187,000
coordinate
services
2. Employee $0 $50,000 $0 $50,000
related expenses
3. Volunteer $3,000 $5,700 $0 $8,700
fingerprinting
4. Volunteer hours $0 $0 $704,000 $704,000
5. Mileage to $300 $1,000 $0 $1,300
assess clients
6. Rent and $0 $3,000 $13,300 $16,300
utilities
7. Volunteer $400 $1,900 $0 $2,300
training/apprec.
8. Supplies and $300 $1,600 $0 $1,900
postage
9. Telephone and $400 $2,200 $0 $2,600
copier
10. Printing for $400 $1,400 $0 $1,800
outreach
11. Volunteer $1,500 $4,900 $0 $6,400
insurance
12. Liability $0 $3,300 $0 $3,300
insurance
13. HR and $0 $2,400 $0 $2,400
accounting
services
14. Volunteer $2,000 $2,000 $0 $4,000
recruitment
15. Paid $0 $2,000 $0 $2,000
advertising
Total Budget $35,000 $241,700 $717,300 $994,000

1. Staff to coordinate services: While volunteers give of their time, there are expenses to run an effective volunteer program. Staff
are needed to recruit, train, and supervise volunteers, as well as to process the growing requests for help and match people in
need with caring volunteers. The 4.5 full time equivalent employees (approximately 31 hours per week) needed to coordinate
Duet's critically needed transportation services will be supplemented this year by a part time outreach coordinator and a social
media intern.
2. Employee related expenses: Benefits including health insurance, FICa, and worker’s compensation will be paid by other
sources.
3. Volunteer fingerprinting: Your grant will help pay for fingerprinting to obtain Level One fingerprint clearance cards for all new
volunteers at the rate of $65 per volunteer. This fee is charged by the AZ Department of Public Safety. Our goal is to recruit
and train 200 new volunteers.
4. Volunteer hours: This reflects the tremendous contribution of thousands of hours of service provided by caring volunteers. The
rate per hour is based on Independent Sector: The Value of Volunteer Time and is $22 per hour.
5. Mileage to assess clients: This expense covers reimbursement to staff for mileage to home visit assessments of individuals
referred for service, as well as to volunteer orientations.
6. Rent and utilities: Church of the Beatitudes offers these key items largely as an in-kind contribution, thereby allowing
contributions from other sources to stretch further.
7. Volunteer training / appreciation: Duet hosts monthly volunteer orientations for new volunteers, and provides packets of training
materials. In addition, Duet hosts an annual partner appreciation dinner for all volunteers. Your funds will encourage volunteers
to continue in their service.
8. Supplies and postage: Mailings are necessary to communicate with volunteers who do not have email. Basic office supplies are
needed to coordinate the transportation services, on a modest basis.
9. Telephone and copier: It is essential to have telephones to accept requests for service and to communicate with volunteers. A
copier is also necessary to copy materials to volunteers regarding their assignments and to prepare training materials for
volunteers.
10.Printing for outreach: Brochures and collateral material are necessary to inform potential volunteers, clients, and supporters
about this vital project.
11.Volunteer insurance: Duet offers volunteer accident, excess auto, and personal liability insurance. This is a key volunteer
recruitment tool.
12.Liability insurance: Other sources will pay for liability insurance for Duet, although no claims have ever been filed.
13.HR and accounting services: Other sources will pay for costs necessary to having payroll, insurance, and accounting services
carried out on a contract basis.
14.Volunteer recruitment: A grant from Gila River Indian Community will allow Duet to pay for outreach and advertising that will
inspire people to join Duet as volunteer drivers.
15.Paid advertising: Duet will purchase targeted radio advertising on KJZZ and KBAQ, and other stations, and will equip volunteers
with t-shirts for volunteers to wear proudly when volunteering in public places.
YEAR II budget reflects a 3% increase in personnel expenses, which will be paid for through other sources.

t helps in every way knowing Jim
to be here twice a month
“It just helps in every way knowing Jim
is going to be here twice a month…”
Walter Rawlings was 85 years old in 2011 when Duet paired him with Jake Adams who
was 34. The more than 50 year age difference was no barrier to their wonderful
friendship. Every Wednesday, Jake picks Wally up at 7:30 am and they go to Fry’s.
Because Wally has macular degeneration, he cannot drive and needs help finding the
freshest produce and best sales. Jake said, "We're a great match because we're both very
thrifty." "I look forward to every Wednesday morning, and not just because that's when I
get my food. Jake and I have become fast friends and I look forward to seeing him every
week," said Wally.

Last updated: 02/12/2016
Page 1
General information
Organization Equine Spirit Programs
Contact First name Julie
Contact Last name Jimenez
Contact e-mail equinespiritprograms@gmail.com
Contact phone number 480 299 2506
Address
Street 17016 e. san tan blvd
City queen creek
State arizona
ZIP Code 85142
From what tribe is the organization requesting the grant?
Gila River Indian Community
Total grant amount request
102350.00
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

INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY
P. 0. BOX 2508
CINCINNATI, OH 45201
Employer Identification Number:
Date: JUL 15 2014 46-4604397
DLN:
17053066316004
EQUINE SPIRIT PROGRAMS Contact Person:
C/O JULIE JIMENEZ CUSTOMER SERVICE ID# 31954
17016 EAST SAN TAN BLVD Contact Telephone Number:
QUEEN CREEK, AZ 85242 (877) 829-5500
Accounting Period Ending:
December 31
Effective Date of Exemption:
February 5,2014
Addendum Applies:
No
Dear Applicant:
We are pleased to inform you that upon review of your application for tax
exempt status we have determined that you are exempt from Federal income tax
under section 501(c)(3) of the Internal Revenue Code. Contributions to you are
deductible under section 170 of the Code. You are also qualified to receive
tax deductible bequests, devises, transfers or gifts under section 2055, 2106
or 2522 of the Code. Because this letter could help resolve any questions
regarding your exempt status, you should keep it in your permanent records.
Based on the information you submitted with your application, we have
determined you are likely to qualify as a private operating foundation
described in section 4942(j)(3) of the Code. Accordingly, you are treated as a
private operating foundation for your first year. After that, you will be
treated as a private operating foundation as long as you continue to meet the
requirements of section 4942(j)(3). You are required to file Form 990-PF
annually.
For important information about your responsibilities as a tax-exempt
organization, go to www.irs.gov/charities . Enter "4221-PF" in the search bar
to view Publication 4221-PF, Compliance Guide for 501(c)(3) Private
Foundations, which describes your recordkeeping, reporting, and disclosure
requirements.
Sincerely,
Director, Exempt Organizations
Letter 1075

Gila River Indian Community Grant Application
Grant Cycle 2016
Cover Sheet
Municipality Information
1. Date of Application: 2/27/2016 (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: 85032
6. Acknowledgement of Submission by Authorized Municipality Representative:
Typed Name: Amanda Nash Signature:
Applicant Information
7. Department/Organization Name: Equine Spirit Programs
8. Is this a non-profit 501c(3) Organization? No Yes If yes, attach IRS Determination
Letter
9. Application Contact Person: Julie Jimenez Title: Program Manager
10. Phone Number: 480 299 2506
11. Mailing Address: 17016 San Tan Blvd
12. City: Queen Creek State: Arizona Zip Code: 85142
13. Email Address: equinespiritprograms@gmail.com Website Address: www.equinespiritprograms
Project Information
14. Project Name: Bullying Prevention for Casteel High School
15. Purpose of Grant: to provide health promotioin education for the students of Casteel High School
16. Priority Funding Area Healthcare
17. Annual amount requested $$102,350.00
18. Number of years that funding is requested 1
19. Total amount requested (annual amount x # of $$102,350.00
years)
20. Has your organization received past funding no
from GRIC? If yes, list each year and amount
For Office Use Only:
Data Entry
Receipt
Evaluation

Gila River Indian Community Grant Application
Grant Cycle 2016
21. Geographic area served Queen Creek

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.
The Equine Spirit Program (ESP) is a successful Equine Assisted Learning program with a 6 year
history of promoting resilience among at-risk youth. ESP is an established non-profit since 2014.
Equine Assisted Learning is listed as a Best Practice in the First Nations Behavioral Health Association
Catalogue of Effective Behavioral Health Practices. The mission of the program is to empower, enrich and
educate by providing a safe, research based and equine focused educational experience. ESP connects
rehabilitated horses with youth, adults, military veterans, corporate individuals or groups to promote self-
discovery, targeted areas of personal growth and professional development
We offer activity based life skill programs that utilize a research based equine assisted learning model. The
goal of ESP programs is to promote improved mental and physical health by utilizing equine assisted
learning through the development of personal interactions between humans and horses. The targeted area of
growth for this grant proposal will be anti bullying awareness.
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.”
ESP is a non –profit working in partnership with Casteel High scholl and the Town of Queen Creek,
Casteel High School has been requesting our equine services for the past year as we apply for funding
through various grant avenues. The town of Queen Creek wants to assist the local High school to meet
their goals of using horses to deliver the anti-bullying message to their students in this community of
horse enthusiasts.
3. Describe the proposed project and planned goals and activities.
The programs goal is to have 585 attending youth Improve their life skills by increasing their
sense of purpose and connectedness to their peers, school and community. This increase in
connectedness has a direct correlation to reducing bullying among peers.
Equined Assisted Learning ( EAL) is experiential in nature, allowing participants to learn about
themselves and others by participating in activities with the horses and then processing their
responses. The focus is on ground activities, there is no riding, which requires youth to
develop and apply certain life skills that can be translated from the arena to their personal life
in order to improve their interactions with family, school and community.

Gila River Indian Community Grant Application
Grant Cycle 2016
Each behavioral health educational lesson builds upon each other and includes creative
thinking, communication, problem solving, work ethic, responsibility, teamwork, and respect for
the individuals’ personal and cultural differences, self confidence and attitude, all cornerstones
for positive leadership.
The educational equine lessons will include 12 activities that develop and enhance positive
behavioral health resiliency characteristics. All lessons are delivered on school site at the
invitation and partnership with the school district being served (see attached letter of support).
Casteel High School is requesting life skills education for their students. They have agreed to
supply all youth through their referral system school staff volunteers to assist with program
operation, and a secured and safe location on campus for the program to operate.
4. Describe how the proposed project satisfies one or more of the priority funding areas identified by the
Gila River Indian Community.
Equine Assisted Learning (EAL) is as an effective research based approach to health care and
education, two of Gila River’s funding priorities.
5. Identify the needs/problems to be addressed, target population and number of people to be served by
the project.
There is a perceived need of this underserved rural community to have accessible youth
focused life skills programming to promote the individual students’ abilities to overcome
barriers. Increasing the ability of students to participate in youth programs that promotes
positive behavioral health , anti bullying strategies and life choices build the overall health of a
growing community. 585 students attending Casteel high school will attend the full cucle of
programming.
6. Define the project as a new or continuing program.
New
7. Provide a brief timeline including start and finish dates. Indicate if the timeline is flexible.
School year 2016-2017 (Oct 2016-May2017)
8. Identify other organizations, partners or funders participating in the project and their roles.

Gila River Indian Community Grant Application
Grant Cycle 2016
Casteel High School – will supply all participants, support staff as needed, agreed upon location at the
school site, assistance in the dissimination and collection of program evaluation surveys
9. Would you be able to implement the proposed plan if your organization received partial funding for this
project?
We would be able to serve a lesser number of students,.
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.
We will continue to partner with the High School and City to seach for funding to incorporate this
lprogram into the curriculum for all entry level freshman. 21st Century grants will become available to
this school next year.
11. Describe your plan to document progress and results.
Evaluation Methods: staff conducts a survey, and/or focus group at the end of each session to
process what was learned and how to apply it to everyday life. In addition, staff does ongoing
observation to monitor participants during program delivery, discuss and assess the findings,
to make necessary adjustments for ongoing program improvements.
Youth actively contribute to their surveys. A summary of the groups responses is created within
60 days of program completion, will be delivered to the grant funders and the Casteel High
School Principal to share with staff, youth and parents
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: 2016 -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
requested from requested or contributions
(list each budget item) GRIC secured from
other funders
1. Program horses10 $49910.00 $0 $0 $ 49910.00
2. Program equipment $ 3450.00 $0 $0 $ 3450.00
3. Truck/Trailer hauling $ 8280.00 $0 $0 $ 8280.00
4. Liability Insurance $ 1840.00 $0 $0 $ 1840.00
5. Mental health Professional $17250.00 $0 $0 $ 17250.00
6. EAGALA Equine specialist $ 8050.00 $0 $0 $ 8050.00
7. Equine assistant handler $ 3450.00 $0 $0 $ 3450.00
8. Program Grants Manager $ 6440.00 $0 $0 $ 6440.00
9. Program book keeper $ 3680.00 $0 $0 $ 3680.00
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 $102350.00 $0 $0 $102350.00

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 Horses Horses are part of the program team and are rotated to accommodate the need
for equine for various sessions. Horses are leased at $217 hour x230 program hours. $49910
2. Program equipment are includes the portable corrals necessary to create the area in which the
horses and participants conduct activities. In addition, equipment includes the items used to interact
with the horses in the actual activities: buckets, cones, brushes, curry combs, lead ropes, halters,
incentives etc. $3450
3. Truck Hauling Mobility of the program from site to site requires specialized truck and trailer to haul
all horses, equipment and staff to the program site. $8240
4. Liability Insurance is a required form of insurance for those at possible risk of being sued by third
parties for negligence. Among the most usual classes of mandatory policy are those that cover
businesses who offer professional services to the public. Public policy therefore requires that such
businesses should carry insurance so that, if their activities do cause loss or damage to another,
money will be available to pay compensation. $1840
5. Contracted Professional Fees allows the program to contract with the certified mental health
professional ($75 x 230 hours)$17250,
6. Contracted Professional Fees allows the program to contract with the equine specialist
$35x230hours) $8050,
7. Contracted Professional Fees allows the program to contract with grants manager($28 x 230)
$6440
8. Contracted Professional Fees allows the program to contract with equine assistant handler ($15x
230 hours) $3450
9. Contracted Professional Fees allows the program to contract with support staff/bookkeeper ($16
x 230hours) $3680
10. Click here to enter text.

Gila River Indian Community Grant Application
Grant Cycle 2016
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.

CHANDLER UNIFIED SCHOOL DISTRICT NO. 80
James T. Perry Administration Center • 1525 West Frye Road • Chandler, Arizona 85224
(480) 812-7000 • FAX: (480) 812-7015
"Dedicated to Excellence" Camille Casteel, Ed.D., Superintendent
February 10, 2016
To Whom It May Concern,
This letter is to confirm to you that the Chandler Unified School District is in support of the Equine
Assisted Growth and Learning Adventure program that will be utilized at Casteel High School as a part of
its anti-bullying and self-esteem building program.
We believe that this partnership, at this school, in this community will be a unique opportunity to
combine the best of Arizona's past, present and future resources as we work together to enable our
youth to form healthy connections within their school, families and community.
Please join us in assisting the efforts of Casteel High School and The Equine Spirit Program as they work
to make this program a success.
Sincerely
Craig L. Gilbert, Ed. D.
Assistant Superintendent of Secondary Education
Chandler Unified School District

Last updated: 02/12/2016
Page 1
General information
Organization Equine Spirit Programs
Contact First name Julie
Contact Last name Jimenez
Contact e-mail equinespiritprograms@gmail.com
Contact phone number 480 299 2506
Address
Street 17016 e. san tan blvd
City queen creek
State arizona
ZIP Code 85142
From what tribe is the organization requesting the grant?
Gila River Indian Community
Total grant amount request
25000
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

INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY
P. 0. BOX 2508
CINCINNATI, OH 45201
Employer Identification Number:
Date: JUL 15 2014 46-4604397
DLN:
17053066316004
EQUINE SPIRIT PROGRAMS Contact Person:
C/O JULIE JIMENEZ CUSTOMER SERVICE ID# 31954
17016 EAST SAN TAN BLVD Contact Telephone Number:
QUEEN CREEK, AZ 85242 (877) 829-5500
Accounting Period Ending:
December 31
Effective Date of Exemption:
February 5,2014
Addendum Applies:
No
Dear Applicant:
We are pleased to inform you that upon review of your application for tax
exempt status we have determined that you are exempt from Federal income tax
under section 501(c)(3) of the Internal Revenue Code. Contributions to you are
deductible under section 170 of the Code. You are also qualified to receive
tax deductible bequests, devises, transfers or gifts under section 2055, 2106
or 2522 of the Code. Because this letter could help resolve any questions
regarding your exempt status, you should keep it in your permanent records.
Based on the information you submitted with your application, we have
determined you are likely to qualify as a private operating foundation
described in section 4942(j)(3) of the Code. Accordingly, you are treated as a
private operating foundation for your first year. After that, you will be
treated as a private operating foundation as long as you continue to meet the
requirements of section 4942(j)(3). You are required to file Form 990-PF
annually.
For important information about your responsibilities as a tax-exempt
organization, go to www.irs.gov/charities . Enter "4221-PF" in the search bar
to view Publication 4221-PF, Compliance Guide for 501(c)(3) Private
Foundations, which describes your recordkeeping, reporting, and disclosure
requirements.
Sincerely,
Director, Exempt Organizations
Letter 1075

Gila River Indian Community Grant Application
Grant Cycle 2016
Cover Sheet
Municipality Information
1. Date of Application: 2/27/2016 (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: 85032
6. Acknowledgement of Submission by Authorized Municipality Representative:
Typed Name: Amanda Nash Signature:
Applicant Information
7. Department/Organization Name: Equine Spirit Programs
8. Is this a non-profit 501c(3) Organization? No Yes If yes, attach IRS Determination
Letter
9. Application Contact Person: Julie Jimenez Title: Program Manager
10. Phone Number: 480 299 2506
11. Mailing Address: 17016 San Tan Blvd
12. City: Queen Creek State: Arizona Zip Code: 85142
13. Email Address: equinespiritprograms@gmail.com Website Address: www.equinespiritprograms
Project Information
14. Project Name: Warrior Spirit
15. Purpose of Grant: to provide health promotioin education for veterans and their families
16. Priority Funding Area Healthcare
17. Annual amount requested $25000.00
18. Number of years that funding is requested 1
19. Total amount requested (annual amount x # of $25000.00
years)
20. Has your organization received past funding no
from GRIC? If yes, list each year and amount
For Office Use Only:
Data Entry
Receipt
Evaluation

Gila River Indian Community Grant Application
Grant Cycle 2016
21. Geographic area served Queen Creek

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.
The Equine Spirit Program (ESP) is a successful Equine Assisted Learning program with a 6 year
history of promoting resilience among at-risk youth. ESP is an established non-profit since 2014.
Equine Assisted Learning is listed as a Best Practice in the First Nations Behavioral Health Association
Catalogue of Effective Behavioral Health Practices. The mission of the program is to empower, enrich and
educate by providing a safe, research based and equine focused educational experience. ESP connects
rehabilitated horses with youth, adults, military veterans, corporate individuals or groups to promote self-
discovery, targeted areas of personal growth and professional development
We offer activity based life skill programs that utilize a research based equine assisted learning model. The
goal of ESP programs is to promote improved mental and physical health by utilizing equine assisted
learning through the development of personal interactions between humans and horses. The targeted area of
growth for this grant proposal will be engaging veterans in their own healing process through equine assisted
learning.
ESP founders are a military family with active military personnel currently serving. This brings a personal
passion to this program and a heart for our military who choose to dedicate their lives to serve.
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.”
ESP is a non –profit working in partnership with various veterans groups, including the Veterans
Serving Veterans group, an AmeriCorp group from Gila River Indian Community. and the Town of
Queen Creek to offer equine assisted learning to area veterans and their family members.
3. Describe the proposed project and planned goals and activities.
Goal:
The goal of this equine assisted learning (EAL) program is the healthcare education and learning of specific skills
as defined by the individual or group for the resiliency training for our military warriors. This is an experiential
process where individuals/groups participate with horses in assigned ground activities. There is no riding in this
program. Horses are attuned to the feelings more than the behaviors of people near them. This process allows
the horse to become "mirrors" of those authentic feelings.
EAL addresses a variety of mental health and human development needs including behavioral issues, attention
deficit disorder, PTSD, substance abuse, eating disorders, depression, anxiety, relationship problems and
communication needs.The unique synergy of the Human and the Horse creates new and challenging ways to

Gila River Indian Community Grant Application
Grant Cycle 2016
facilitate successful change in the areas of need. Participants are challenged by the experiential process to
problem solve, identify and obtain personal goals, build trust and ultimately accept change.
Clinical evidence and generations of human experience show that horses have a special ability to help people work
through emotional barriers without shame or stigma. This is especially true and valuable for people who suffer the
effects of trauma. This allows us to improve the overall health and wellness of those veterans who participate.
Activities:
4 cycles of 8 (1 hour) sessions of healthcare EAL sessions will be delivered where service members are engaged
in their own healing process.The solutions offered understand the specific needs of the veteran, respecst their
culture and meest them on their own terms. Programs are adapted to serve the needs of the veteran returning to
their community and the needs of the family members who support them. The veteran program utilizes the
research based curriculum designed for 8 sessions which includes an evaluation component. Each session
accommodates up tp 12 veterans. Programs are to be delivered to the group's meeting site within the community
of Queen Creek to be determined by the veterans group with active returning vets at the notification of funding.
The program is delivered to the agency/group by trucking horses to the site and/or rental facility, and utilizing
portable corrals to conduct the program sessions when required.
4. Describe how the proposed project satisfies one or more of the priority funding areas identified by the
Gila River Indian Community.
Equine Assisted Learning (EAL) is as an effective research based strategy to health care and
education, two of Gila River’s funding priorities.
5. Identify the needs/problems to be addressed, target population and number of people to be served by
the project.
There is a perceived need of this underserved population of area vererans to have accessible
focused life skills programming to promote necessary solutions to the health and personal
healing returning veterans .
6. Define the project as a new or continuing program.
New
7. Provide a brief timeline including start and finish dates. Indicate if the timeline is flexible.
Grant cycle year 2016-2017 (Sept. 2016-Sept.2017)
8. Identify other organizations, partners or funders participating in the project and their roles.

Gila River Indian Community Grant Application
Grant Cycle 2016
Veterans Serving Veterans, an Americorp group of Gila River Indian Community, will partner with us to
refer and supply program participants.
9. Would you be able to implement the proposed plan if your organization received partial funding for this
project?
We would not be able implement program.
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.
We will continue to partner with the City to seach for funding to bring this lprogram to the community by
applying for any available funding.
11. Describe your plan to document progress and results.
Evaluation Methods: staff conducts a survey, and/or focus group at the end of each session to
process what was learned and how to apply it to everyday life. In addition, staff does ongoing
observation to monitor participants during program delivery, discuss and assess the findings,
to make necessary adjustments for ongoing program improvements.
Veterans actively contribute to their surveys. A summary of the groups responses is created
within 60 days of program completion, will be delivered to the grant funders. And all
contributing agency partners upon request.
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: 2016 -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
requested from requested or contributions
(list each budget item) GRIC secured from
other funders
1. Program horses $ 4950 $0 $0 $
2. Program supplies $ 330 $0 $0 Click here to
enter text.
3. Truck/Trailer hauling $ 1815 $0 $0 $
4. Liability Insurance $ 1320 $0 $0 $
5. Mental health Professional $ 2805 Click here to $0 $
enter text.
6. EAGALA Equine specialist $ 2145 Click here to $0 $
enter text.
7. Equine assistant $ 825 Click here to $0 $
enter text.
8. Equine Helper $ 396 $0 $0 $
9. Program evaluation $ 825 $0 $0 $
10. Facility Rental $ 3979 $0 $0 $0
11. corral/arena set up $ 4950 $0 $0 $0
12. corral/arena clean up $ 660 $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 $ 25000 $0 $0 $

Gila River Indian Community Grant Application
Grant Cycle 2016

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 Horses 4 Horses are part of the program team and are rotated to accommodate the
need for equine for various sessions. Horses are leased at $150 hour x 33 program hours. $4950.00
2. Pogram supplies include the items used to interact with the horses in the actual activities:
buckets, cones, brushes, curry combs, lead ropes, halters, incentives etc. $10 x 33 program hours,
$330.00
3. Truck Hauling Mobility of the program from site to site requires specialized truck and trailer to haul
all horses, equipment and staff to the program site. $55 x 33 program hours $1815.00
4. Liability Insurance is a required form of insurance for those at possible risk of being sued by third
parties for negligence. Among the most usual classes of mandatory policy are those that cover
businesses who offer professional services to the public. Public policy therefore requires that such
businesses should carry insurance so that, if their activities do cause loss or damage to another,
money will be available to pay compensation. $40 x 33 program hours $1320.00
5. Contracted Professional Fees allows the program to contract with the certified mental health
professional $85 x 33 program hours. $2805.00
6. Contracted Professional Fees allows the program to contract with the equine specialist $65 x 33
program hours $2145.00
7. Contracted Professional Fees allows the program to contract with equine assistant $25x 33
program hours $825.00
8. Contracted Professional Fees allows the program to contract with equine helper $15 x 33
program hours $396.00
9. Facility Rental: arena time will be required at a Queen Creek facility to conduct all program sessions for
veterans and their families. $ x 33 program hours , $3979.00
10. corral/arena set up: staff will be required to set up corrals , and program equipment for each session $150
x 33 program hours, $4950.00

Gila River Indian Community Grant Application
Grant Cycle 2016
11. corral/arena take down & clean up: staff will be required to take down corrals and program equipment and
clean up facility arena. 420 x 33 program hours , $660.00
12. Program evaluation: allows the program to contract with an evaluator to conduct pre post surveys at the
completion of each of the 4 cycles. $25 x 33 program hours. $825.00
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.