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COLLIh~ C. DIBOLL PRIVATE FOUNDA1* jN
Grant Application
Date
Organization Name ________________________________
Address
Street	City	State	Zip
Contact _________________________________________
Name	Title	Telephone
Amount Requested $_______________
1.	How long has your organization been in existence?
2.	List the members of your Board of Directors and their business or professional affiliations.
3.	What is the principal need or problem your organization addresses?
4.	List other funding sources your organization has approached or which have committed funding.
5.	What other organizations address the same or similar problems? How do you coordinate?
6.	What percent of grant money is spent on administration?
7.	How do you plan to fund your work in the future?
8.	How will you evaluate the success of the service to which funding will be committed?
Application must be accompanied by a copy of your budget and a copy of the organization's IRS determination letter as evidence of 501 (c)3 tax-exempt status. Please return this form to Donald W. Diboll; P. O. Box 2010; Bay St. Louis, MS 39521.