Surprise and Sun City Rotary Charitable Fund Application

El Mirage Community Partnership Grant Program
Application
Program Overview 
The City of El Mirage Community Partnership Grant supports nonprofit organizations that provide essential
health and human services directly to El Mirage residents, including low-income families, seniors, youth,
and other individuals who may benefit from additional support.  
Health and human services refer to programs, projects, or activities that improve the general health,
including physical, mental, emotional, or social well-being, of individuals and families. These services
address basic needs, promote safety and stability, and enhance residents' overall quality of life.  
The program offers one-time funding of up to $10,000 per application annually from July 1 to June 30.
Eligible nonprofits and other qualified charitable organizations with 501(c)(3) status or IRS letter of
determination recognizing nonprofit status under A.R.S. §42-11154 may submit multiple applications for
funding, provided each application represents a distinct program or project.  
Applicants are limited to one application per program or project. Each application must specify the
minimum funding required. Applications are evaluated based on an evaluation scoring rubric approved by
the City Council. The ultimate funding decisions are made by the El Mirage City Council. 
Applicant Eligibility Criteria   

The applicant must be a 501(c)(3) nonprofit corporation or other qualified charitable or nonprofit
organization as provided for in A.R.S. §42-11154. 

The applicant must provide direct health and human services to El Mirage residents and
demonstrate how the program or project improves resident well-being. 

The applicant must demonstrate the ability to generate revenue from sources other than the City of
El Mirage. 

The applicant must submit the five following required documents:
    1) Proof of 501(c)(3) status or IRS determination letter under A.R.S. §42-11154. 
    2) Organizational mission statement. 
    3) Board of directors list, including roles and affiliations. 
    4) Last two years of IRS Form 990 filings (or explanation if not available or required to file). 
    5) Completed application signed by an authorized representative. 

If awarded, the applicant must register with the City of El Mirage as a vendor and provide an IRS

Form W-9 to receive funds. 

If awarded, the applicant must demonstrate satisfactory progress toward stated goals and
objectives and provide timely and accurate reports as required by the city. 
Application Directions 
Please answer the following questions in narrative form. Applicants will receive up to five points for a
complete and accurate application.  
Submission Directions 

One electronic copy of the application and required attachments must be submitted no later than
the date and time identified in the notice to apply. 

Late applications will not be accepted. 

Please save a copy of this application for your records.

Awarded applicants are required to report completed program or project goal measurements by a
date and time specified in the notice of award, before the end of the fiscal year of the award,
or sooner as may be required by the city.  
More Program Information
Visit www.ElMirageAZ.gov/Grants for more information about the program, including evaluation scoring
rubric.
Program-Related Inquiries  
For program questions or to update contact information, please contact Regan Jepson at
communityservices@elmirageaz.gov. 
Part 1: Agency and Program or Project
Section A: Agency Information 
Agency Name
Surprise & Sun City West Rotary Charitable Fund
Tax Number
74-2365800
Executive Director / CEO
Ken Mueldener/CPA
Website
Address
P.O. Box 7248, Surprise, Arizona 85374
Phone
(623) 546-8103

Section B: Agency Overview  
Briefly describe your organization, the services it provides, mission, goals, and population served. 
The Surprise & Sun City West Rotary Charitable Fund was originally incorporated in 1984 and was issued
a determination letter in January 1986 as a 501(c)(3) non-profit corporation. It provides financial assistance
and support for the charitable activities and projects of the Rotary Club of Surprise & Sun City West, The
Rotary Club, through the Charitable Fund, supports multiple projects and programs in the west valley,
including but not limited to: Benevilla, Sounds of Autism, Meals of Hope, Sleep in Heavenly Peace, Women
4 Women, OJC, Home School Educators, Homeless Youth Connection, and scholarships to high school
seniors. One of the programs operated by the Rotary Club is Dolly Parton's Imagination Library (DPIL) in
the City of El Mirage and the City of Surprise. Our Rotary Club is part of Rotary International, a world-wide
service organzaion of 1.4 million members with seven areas of focus: disease prevention, water/sanitation,
maternal/child health, basic education, community economic development, the environment, and
peacebuilding.
Please upload the following required documents: 
1.
Proof of Section 501(c)(3) Tax Exemption - IRS determination letter verifying nonprofit status under
A.R.S. §42-11154 from the Internal Revenue Service. Please upload. 
2.
Organizational mission statement. Please upload. 
3.
Board of Directors list including a current list of board members with roles and affiliations. Please
upload.  
Upload Files Here
Rotary Charitable Fd IRS Determinatin Ltr.pdf
Charitable Fund Mission.docx
Board of Directors.pdf
Section C: Program or Project Information 
Program or Project Name
Dolly Parton's Imagination Library
Program or Project Contact Person
Ron Klaphake
Email 
ron@mylakeplace.net
Phone
(218) 255-3526
Does the program or project directly serve residents of the City of El Mirage?
Yes
Please select one health & human services category that best aligns with the need met by the
program.
Child, Family, and Youth Programming and Development
If you selected "Other" above, please specify:

Part 2: Program Description
Section A: Narrative Description 
Please provide a detailed description of the program or project that these grant funds will support,
if awarded.
Dolly Parton's Imagination Library (DPIL) started sending books to children under the age of five 30 years
ago with the help of local partners paying for the wholesale costs of books and non-profit mailing postage.
Our area Rotary Club became the official local partner for the City of Surprise in early 2025 and launched
its operations in April 2025. As soon as we began to receive applications, it became apparent to us that
parents in El Mirage were eager to enroll their children and asked to participate. As a result and with the
approval of The Dollywood Foundation, we received permission to include children in El Mirage in our
program. The DPIL program provides FREE, age-appropriate books to each enrolled child between the
ages of 0 and 5, once a month directly from The Dollywood Foundation in Tennessee. Currently there are
11,419 children under the age of five in our DPIL service area, of which 2,941 are residents of El Mirage.
When we started this program, we anticipated enrolling 300 children the first year and another 300 the
second year, but after only 13 months of operation, we now have 1,254 children receiving free books. As a
result, we stopped accepting new online registrations while we search for funds to maintain the program.
The waitlist of parents seeking to have their child receive books grows each day. As the local program
partner, the Rotary Club markets the program, approves the registration of each child and pays, through
the Charitable Fund, for the wholesale costs of the books and postage, amounting to $31.20 per child per
year. Administration of our local program is done exclusively by volunteers. At the current level, we have a
financial obligation of approximately $40,000. Hence, we are seeking funds from foundations, corporations,
individuals, and local governments such as yourself. El Mirage city dollars would be spent to reopen
registrations and help offset the cost of providing books to each enrolled child that go directly to the homes
of local residents each month.
Describe how this program or project will benefit El Mirage residents directly and the need or gap
in service that it meets. Please include data to support your response.
Recent data from the Arizona Department of Education shows a decline in third grade reading scores, with
only 39% passiing statewide tests. Similarly, the National Assessment of Educational Progress notes that
Arizona fourth graders' reading scores have dropped below the national trend with just 26% proficient in
reading, Hence, our Rotary Club's commitment to early childhood literacy. A 2025 study comparing
children enrolled in the DPIL program with those not participateling, done by the international research firm
of Claire Melanie Anita Galea of Macquarie University found that Dolly Parton's Imagination Library (1)
Closes Literacy Gap with children Four (4) Times more likely to demonstate stronger emerging literacy
skills -- such as vocabulary and phonological awareness; (2) Strengthens Home Literacy Environments
with Children Nine (9) Times more likely to read Four (4) or More Days a Week; (3) Inspires tthe Love of
Reading with Children Nine (9) times more likely to be interested in books; and finally (4) Builds Positive
Family Reading Habits with Children Seven (7) Times more likely to describe images. The DPIL program
builds bonds between parents/caregivers and children, while instilling a life-long love for reading and
learning. Children in El Mirage deserve that opportunity.
Is this a new or continuing program?
Continuing
If you selected "Other" above, please specify:
Section B: Scope & Timeline

What are the program or project dates? 
This is an ongoing program with no ending date planned.
Total number of persons expected to be served by this program or project during the funded year.
1,500
Total number of El Mirage residents you expect to be served by this program or project during the
funded year.
400
How soon will the program or project be implemented after funds are received, if awarded? (If not
applicable, write “N/A.”) 
Currently operating. Reopen online registrations immediately.
Section C: Accessibility and Resource Needs 
Does your program or project take place in the City of El Mirage? * 
Yes
Where will your project or program be located, and how does this location support your ability to
serve El Mirage residents effectively?
The program coordinator/adminstrator resides in Surprise. Most registrations and enrollments are done
online and sent in for verification of address and approval. The administrator also responds to parents'
inquiries and directly communicates to The Dollywood Foundation about issues that arrise. The Rotary
Club also has volunteers that enter mail-in registrations and do outreach.
Describe how your program or project will be open to the public and ensure accessibility for
persons with disabilities, including specific accommodations.
Enrollment is not restricted except for the age requirement of being ages 0 to 5 and residing within one of
the El Mirage or Surprise zip codes.
Will the implementation of this activity require space, staffing, grants management, or in-kind
contributions from another agency, a school, or another jurisdiction?
No
If you selected "Other" above, please specify (If not applicable, write “N/A.”):
N/A
Section D: Collaboration and Outreach 
Are you currently partnered with, or have you ever partnered with, the City of El Mirage?
No
Describe how you will collaborate with the City of El Mirage to coordinate outreach promoting the
program or project to the residents of El Mirage.
We would expect to expand our marketing to daycare centers within the commnity of El Mirage, the Dysart
Community Center, the local elementary schools, and the City's own newsletter (EL MIRAGE CONNECT).
In addition, we would provide regular status reports to the City Council and make presentations to local
organizations and groups that may be identiified by city staff.
How will you work with other local partners to maximize impact and ensure residents are aware of
and engaged with your services?
The local school district staff will surely be consulted as well as churches that have a presence in El

Mirage. Word-of-mouth is the most effective tool. This may include our sending an email to those El Mirage
residents currently enrolled.
Part 3: Program or Project Goals and Outcomes
Please provide up to three goals of the program or project and describe how progress will be
measured to ensure success in providing health and human services to the residents of El
Mirage. It is important to ensure that your goals correspond with the proposed number of residents to
be served within the program year. Explain how you will collect and report data and measure the
impact for each stated goal. 
Example Goal: Of the 80 persons served by the project, 40% (32 persons) will find employment within
three months of entering the program. This will be measured by follow-up contact with each program
participant. 
Measurable Goal No. 1
With added funding, we will be able to reopen online registrations and have 250 children from El Mirage
enrolled and receiving books by Decenber of 2026.
Measurable Goal No. 2
With increased marketing and outreach in El Mirage, we will have 400 El Mirage children enrolled and
receiving books by June of 2027.
Measurable Goal No. 3
Leverage El Mirage grant funds with additional financial support from the Charitable Fund, new grants,
amd private donations by the June 2027 allowing the DPIL program to grow without pausing enrollment.
Part 4: Funding Request
Total Community Partnership Grant Funding Requested
7,500.00
Minimum Community Partnership Grant Funding Requested
5,000.00
Is program or project implementation contingent upon receiving the full award?
Yes. Without community support, marketing and outreach will not occur and the DPIL program in El Mirage
will be limited.
If approved for an amount less than 100% of your request, how will you address the shortfall?  
Our Rotary Club continues to seek additonal funding and conducting fundraisers to keep the program
running.
Part 5: Program or Project Budget
Section A: Total Program or Project Budget 
Total Cost of the Program or Project Operations
47,000.00

Total Program or Project Funding from Other Funding Sources
42,000.00
What other funding sources presently support this program or project? 
Surprise & Sun City West Rotary Charitable Fund, The Burton Family Foundation, Sun City Rotary
Foundation, Kellam Foundation, West Valley Lutheran Thrift Shop, Desert Diamond Casino, and individual
Rotarians, parents, and friends.
Section B: Total Budget for Program or Project – Grant Award
Only 
Grant Award Budget Narrative 
Wages/Salaries
Employee-Related Expenses (ERE)
Professional Services & Outside Services
Training
Materials & Supplies
General Office Supplies
Administrative Cost (not to exceed $1,000 or
10% of grant request)
Program/Project Incentives (gift cards, food,
certificates of achievement)
Marketing/Outreach
Other
5,000.00
If you selected "Other" to the previous question,
please explain.
Payments to The Dollywood Foundtion for books
and postage billed monthly to the Charitablle Fund.
Explain how grant funds will be utilized to support administrative costs for your project.
All administrative costs are absorbed by the Rotary Club, which is operated by volunteers.
Section C: Program or Project Funding Sustainability 
How will your organization generate or secure additional funding to sustain services for the
continued operation of this program or project? 
We will continue to search for outside funding plus mantain close ties with all of the existing funding
partners, expecting them to renew and/or increase their funding support.
If the program receives less than the requested amount of funding, what adjustments, if any, would
be made to the program and services provided to El Mirage residents?
We would reduce our marketing and outreach enrollment efforts and, if necessay, pause registrations of
additional children.
Part 6: Operational and Financial Status

Please upload the following required attachments: 
Applicant organization's last two IRS Form 990 filings.   
If your organization is not required to file a 990, upload a brief explanation. 
Please upload attachment (1). 
2024 990.jpg
Please upload attachment (2). 
2023 990.jpg
If your organization does not have either document available, please explain below.
Authorized Representative Signature