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Home
Events
- 2024 Conference Photos
- Media
About
Black Community Development Framework
- Conscious Community Development Principles
- Mastermind Conscious Community Development
Black Coopnomics Academy
Membership Matters
Contact
Donate

Cooperative Academy Interest Application

Baltimore Spring

DC Spring

DC Fall

Baltimore Summer

DC Summer

1User Information

2TELL US ABOUT YOUR BUSINESS

3A FEW LAST THINGS ABOUT YOU

Your Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Email Address *

Other Members

What is your gender identity *

Female
Male
Transgender
Gender Neutral
Other

Age *

<25
26-40
41-65
>65

Ethnicity *

African American Descendant
Indigenous
Asian
Caucasian
Latinx
Other

Highest level of education *

Less than High School
High School or GED
Some College
College Degree
Graduate Degree
PhD
Other

How many people in your household *

Total Annual Household Income *

<$30,000
$30,000-$50,000
>$50,000

Do you currently receive the following benefits? Select All That Apply *

Food Stamps
Medicaid
Section 8
Public Housing
HABC Resident
N/A

Have you personally EVER owned, started, or tried to start a business?

Describe the cooperative business you plan to create

Name of Business

How did you learn about the Cooperative Baltimore Academy?

What do you expect to gain as a result of your participation in this program?

Why is establishing your business as a cooperative important to you?

Why do you want to be part of a cooperatively owned business?

Will you be needing Childcare?

1User Information

2TELL US ABOUT YOUR BUSINESS

3A FEW LAST THINGS ABOUT YOU

Your Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Email Address *

Other Members

What is your gender identity *

Female
Male
Transgender
Gender Neutral
Other

Age *

<25
26-40
41-65
>65

Ethnicity *

African American Descendant
Indigenous
Asian
Caucasian
Latinx
Other

Highest level of education *

Less than High School
High School or GED
Some College
College Degree
Graduate Degree
PhD
Other

How many people in your household *

Total Annual Household Income *

<$30,000
$30,000-$50,000
>$50,000

Do you currently receive the following benefits? Select All That Apply *

Food Stamps
Medicaid
Section 8
Public Housing
HABC Resident
N/A

Have you personally EVER owned, started, or tried to start a business?

Describe the cooperative business you plan to create

Name of Business

How did you learn about the Cooperative Baltimore Academy?

What do you expect to gain as a result of your participation in this program?

Why is establishing your business as a cooperative important to you?

Why do you want to be part of a cooperatively owned business?

Will you be needing Childcare?

1User Information

2TELL US ABOUT YOUR BUSINESS

3A FEW LAST THINGS ABOUT YOU

Your Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Email Address *

Other Members

What is your gender identity *

Female
Male
Transgender
Gender Neutral
Other

Age *

<25
26-40
41-65
>65

Ethnicity *

African American Descendant
Indigenous
Asian
Caucasian
Latinx
Other

Highest level of education *

Less than High School
High School or GED
Some College
College Degree
Graduate Degree
PhD
Other

How many people in your household *

Total Annual Household Income *

<$30,000
$30,000-$50,000
>$50,000

Do you currently receive the following benefits? Select All That Apply *

Food Stamps
Medicaid
Section 8
Public Housing
HABC Resident
N/A

Have you personally EVER owned, started, or tried to start a business?

Describe the cooperative business you plan to create

Name of Business

How did you learn about the Cooperative Baltimore Academy?

What do you expect to gain as a result of your participation in this program?

Why is establishing your business as a cooperative important to you?

Why do you want to be part of a cooperatively owned business?

Will you be needing Childcare?

1User Information

2TELL US ABOUT YOUR BUSINESS

3A FEW LAST THINGS ABOUT YOU

Your Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Email Address *

Other Members

What is your gender identity *

Female
Male
Transgender
Gender Neutral
Other

Age *

<25
26-40
41-65
>65

Ethnicity *

African American Descendant
Indigenous
Asian
Caucasian
Latinx
Other

Highest level of education *

Less than High School
High School or GED
Some College
College Degree
Graduate Degree
PhD
Other

How many people in your household *

Total Annual Household Income *

<$30,000
$30,000-$50,000
>$50,000

Do you currently receive the following benefits? Select All That Apply *

Food Stamps
Medicaid
Section 8
Public Housing
HABC Resident
N/A

Have you personally EVER owned, started, or tried to start a business?

Describe the cooperative business you plan to create

Name of Business

How did you learn about the Cooperative Baltimore Academy?

What do you expect to gain as a result of your participation in this program?

Why is establishing your business as a cooperative important to you?

Why do you want to be part of a cooperatively owned business?

Will you be needing Childcare?

1User Information

2TELL US ABOUT YOUR BUSINESS

3A FEW LAST THINGS ABOUT YOU

Your Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Email Address *

Other Members

What is your gender identity *

Female
Male
Transgender
Gender Neutral
Other

Age *

<25
26-40
41-65
>65

Ethnicity *

African American Descendant
Indigenous
Asian
Caucasian
Latinx
Other

Highest level of education *

Less than High School
High School or GED
Some College
College Degree
Graduate Degree
PhD
Other

How many people in your household *

Total Annual Household Income *

<$30,000
$30,000-$50,000
>$50,000

Do you currently receive the following benefits? Select All That Apply *

Food Stamps
Medicaid
Section 8
Public Housing
HABC Resident
N/A

Have you personally EVER owned, started, or tried to start a business?

Describe the cooperative business you plan to create

Name of Business

How did you learn about the Cooperative Baltimore Academy?

What do you expect to gain as a result of your participation in this program?

Why is establishing your business as a cooperative important to you?

Why do you want to be part of a cooperatively owned business?

Will you be needing Childcare?

1User Information

2TELL US ABOUT YOUR BUSINESS

3A FEW LAST THINGS ABOUT YOU

Your Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Email Address *

Other Members

What is your gender identity *

Female
Male
Transgender
Gender Neutral
Other

Age *

<25
26-40
41-65
>65

Ethnicity *

African American Descendant
Indigenous
Asian
Caucasian
Latinx
Other

Highest level of education *

Less than High School
High School or GED
Some College
College Degree
Graduate Degree
PhD
Other

How many people in your household *

Total Annual Household Income *

<$30,000
$30,000-$50,000
>$50,000

Do you currently receive the following benefits? Select All That Apply *

Food Stamps
Medicaid
Section 8
Public Housing
HABC Resident
N/A

Have you personally EVER owned, started, or tried to start a business?

Describe the cooperative business you plan to create

Name of Business

How did you learn about the Cooperative Baltimore Academy?

What do you expect to gain as a result of your participation in this program?

Why is establishing your business as a cooperative important to you?

Why do you want to be part of a cooperatively owned business?

Will you be needing Childcare?

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