Customized Sponsor Recognition Options

EyeSpy 20/20’s on-report sponsorship recognition IMPORTANT - DO NOT DISCARD !

provides schools the opportunity to dramatically VISION SCREENING REPORT PREPARED EXCLUSIVELY FOR

fkas Aslkd - Age 6 - DOB 05/05/2005

reduce or eliminate the cost of vision screening
their students while raising additional funds for their Teacher: Hecker - Grade: 1

school. Provided 04:19:10 PM - Thursday, March 22, 2012 by

VisionQuest 20/20 (www.visionquest2020.org)

The designated sponsor recognition area in partnership with
measures 7.5” long x 1.4” wide. It can be VisionQuest 20/20 Demonstration School
customized and divided in various ways to allow for OVERALL VISION EVALUATION (without glasses)
up to 3 sponsor advertisements. These can include This vision screening suggests your child may have a vision problem.

graphics, text, logos, web-links, and even coupons.
*The messaging must be approved by the school.
Equal Monetary Donations
A. ! 1 sponsor 7.5” long x 1.4” wide
If your child is not currently under the care of an eye doctor,
a professional eye examination is recommended.
Eye Professional Use Only
VISUAL ACUITY (Patching w/ LEA) Does this child have normal vision without glasses? Y / N
Both Eyes Open: PASS (20/35 or better)
Does this child have normal vision with glasses? Y / N
Were glasses prescribed? Y / N
Right Eye: FAIL (unable to see 20/35)
Left Eye: Not tested
Does child have serious vision impairment, even with glasses,
which would interfere with school performance? Y / N

B. ! 2 sponsors 3.75” x 1.4” each Would this child benefit from vision services at school? Y / N
Follow up appointment: ____wks ____mos ____yrs ____PRN
C. !3 sponsors 2.5” x 1.4” each Printed Doctor's Name: ________________________________

____________________________________________________

Multiple Sponsors with Differing % of Sign & Date above & fax to ______________________________

Advertising Space This vision screening was provided thanks to the generous support of...

D.! % of Donation = % of Advertising Space

For example, If a school raises a total of $5000 in
sponsorship, they may have one sponsor providing
$3,000, a second providing $1500, and a third with For more information please contact Elizabeth Reich @ 602-903-3099
Version 4.67 - U.S. Patent No. 6,808,267 LEA Symbols® used under license from GOOD-LITE®
$500. The advertising space would be divided as © 2013 VisionQuest 20/20 www.visionquest2020.org TDS: 53 SE: N/A STN

follows:

$3000 Sponsor $1500 Sponsor $500

60% of total $5000 sponsorship 30% of $5000 10%
60% of 7.5” length = 4.5” 30% of 7.5” length = 2.25” 0.75”

Multiple Sponsors with % of Reporting Advertisement

E. % of Donation = % of Vision Screening Reports with Sponsor Advertisement
If each sponsor wants to use the full area (7.5” x 1.4”), their advertisement will appear in the appropriate
percentage of screening reports. Example below of 600 total reports, split among 3 sponsors.

360 Reports

180 Reports
60 Reports

$3000 Sponsor $1500 Sponsor $500 Sponsor