Collins C. Diboll Private Foundation

Grant Application

General Information

Project title:

Organization:

Contact person: Title:

Address:

Phone: Fax:

E-mail: Web site:

Request INFORMATION

Application Date: Amount requested: $

Type of Support:

qProject qGeneral Operating qCapacity Building qEmergency qOther:

What geographic area will be served?

Approx. number of people served? ______Time period covered by grant?

Approximate % of grant funds used to pay administrative expenses? ______

Organizational Information

What is the organization’s EIN?

When was the organization founded?

# paid staff - full time ____ part time ____ # board members: ____ # volunteers ____

Financial Information

Total expenses budgeted for the project: $

Amount raised for the project so far: $

Total income of organization (most recent fiscal year): $

Total expenses of organization (most recent fiscal year): $

Please attach:

q  A proposal, in 6 pages or less, that includes the following:

o  Your mission and an overview of the organization’s programs

o  A description of the project you are seeking funding for, including:

§  Overview,

§  How this project fits your mission and the Foundation’s mission,

§  Grant goals (short-, intermediate-, and long-term),

§  Implementation plan to achieve the goals,

§  Expected impact on the community (what will change as a result of the project?), and

§  How you will document and measure (evaluate) whatever change occurs.

o  Community partners working on the same issues and how you are coordinating with them.

o  The plan for securing future funding beyond the grant period.

q  List of principal staff that will be working on the program/project and their qualifications;

q  List of other funding sources for this project, showing anticipated amounts funded.

q  Financial statements, to include:

o  Your organization’s current operating budget,

o  The project’s budget,

o  Most recent income and expense sheet,

o  Most recent balance sheet, and

o  Most recent Form 990.

q  List of board members and their professional/business affiliations

q  A copy of the IRS letter determining 501(c)(3) nonprofit status (only required if this is your first application to the Foundation); and

q  An affirmative statement that the organization’s exempt status has not been revoked.

You will be notified once the Foundation receives your grant application. Applications are considered quarterly and you will be notified in writing of the outcome. If you have not received notice that your application was received 30 days after submission, please contact the Administrator to discuss.

The Foundation’s annual calendar follows. Please note that applications are accepted throughout the year but we strongly encourage applicants to send grant applications well in advance of the considerations deadlines. Failure to submit a completed grant application before the consideration deadline will result in delayed consideration.

For applications received (not postmarked!) after: / Grant decision meetings are held in the month of: / Notice of grant award or declination will be sent by:
December 15 / March / April 15
March 15 / June / July 15
June 15 / September / October 15
September 15 / December / January 15

CONTACT INFORMATION

Please send letters of inquiry/applications to:

Katie Walston, Administrator

Collins C. Diboll Private Foundation

201 St. Charles Ave, Floor 51

New Orleans, LA 70170

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