STARRY FOUNDATION_12_GRANT_APPLICATION_FORM_2021.PDF

About the Grant Program Application: 
The Salt River Pima-Maricopa Indian Community 12% Gaming Grant Program (“Program”) application 
will serve to provide a comprehensive review of the programming requests for Arizona cities, towns, 
counties, non-municipal public service organizations, and non-profit organizations selected to apply for 
grant funding.  It is not the intent of the Program to award grants that would benefit individuals, be used 
as sponsorships, be used for religious activities, primarily fund the indirect or administrative costs of a 
program/organization, or be used for the direct benefit of the Salt River Pima Maricopa Indian 
Community.   
 
Date of Application:  
 
Organization Name:  
 
Organization/Municipal Government Mailing Address: 
 
Organization History:  
(Provide a brief summary of the origins of the organizations and any notable milestones and/or 
significant audit findings) 
 
Organization Structure:  
(Provide a list of current board members and key staff members) 
 
Do any conflicts of interest exist within the organization structure? 
(I.e. family, professional or personal conflicts, SRPMIC representatives on board, etc.)  
 
Contact Person and Project Manager if different from Contact Person:  
 
Title:  
Address: 
Phone:  
Fax: 
Email Address:  
 
Project Name:  
 
 
Provide a brief description of the project being submitted to the 12% SRPMIC Grant program.  In the 
description provide a summary of the relevant experience, administrative activity, and program 
development related to the grant request.  
 
Calendar Year 2021
12% Gaming Grant Program Application 
10005 E. Osborn Road, Scottsdale, Arizona  85256 / Phone 480-362-7520 / Fax 480-362-7593
INDIAN COMMUNITY
SALT RIVER PIMA-MARICOPA
9/20/20
Starry Foundation / DBA Starry Starry Night
20715 N. Pima Road, Suite F-108
We have recently started an Arizona based non-profit corporation, “Starry Fou
We will send this in an attachment.
No they do not.
Our grant request is for a program to directly impact 12 families 
Starry Foundation pilot program to support 12 families in SRPMIC in 2020 with Gentry 
PBS services.

What percentage of the grant request are Direct Costs of the programming and Indirect Costs, 
respectively? 
 
Define the Project Category and/or relevant sub-category:  
(i.e. Education, Public Safety, Transportation, Economic Development, Health Care, Social Services, or 
Cultural and Environment) 
 
 
Beginning Date of Project:  
 
 
 
 
End Date of Project:  
 
Geographic Area to be served:  
 
** Attach Detailed Budget** 
 
Amount of Total Project:  
 
 
 
Amount of 12% Request:  
 
 
 
 
 
 
 
 
 
(No Multi-Year Request will be accepted)  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
  
  
3.
2.
1.
available for the full the amount of request how would you prioritize funding.
Funding for project/programs may be based on available funding. As such, if funding were not
detail.
Has your organization ever applied for and received any local, state or federal grants?  If so, please
(Enterprises Included) and identify the amount and the source:
List any other funds you have received from the Salt River Pima-Maricopa Indian Community
2020-2021.
List any other 12 % grant funds your organization may be seeking from other Tribal Governments in
Grant Committee prior to the awarding of any additional funding.
the organization.  In addition, you will be asked to provide a formal presentation to the 12% Gaming
submit a comprehensive report of grant funding toward the stated program objectives and mission of
through the SRPMIC 12% Gaming Grant Program for five consecutive years, they will be required to
List any SRPMIC 12% funds you have received in the past.  If the organization has received funding

Lump Sum

Quarterly

Monthly
If you receive SRPMIC 12 % funding, will it be spent (Check One):
funds to complete the project? (Please Explain):
If the amount of funding received is less than the amount needed for the project, do you have other
X
Yes we do we via private donors, corporate donations and H
11/15/20
11/15/2021
Salt River Pima Maricopa Indian Community
$35,000
$7500
Helios Education Foundation $10,000
No they do not.
low to moderate income
Individual Donors
Corporate sponsors
Foundations
Health Care and Education

Which municipal governmental entity will serve as your pass through agency to accept 12% gaming 
grant on your behalf? 
 
 
By execution of the 12% Gaming Contribution Grant Application the undersigned agrees that the 
information contained in the Application is true to the best of the Applicants knowledge. The 
Applicant shall notify the SRPMIC if any information in this Application changes.  
 
 
 
Signature for the Applicant 
 
 
 
 
 
 
 
Date 
 
 
 
Name and Title 
 
 
 
The Application shall be signed by the senior elected official of the local government, or in the case of 
a non-profit entity, the Chief Executive Officer authorizes to commit the non-profit entity to apply for, 
accept, and implement an award from the SRPMIC utilizing 12% Gaming Contributions.  
SRPMIC
9/20/20
Founder and CEO, Bobby Vossoughi