2017 Cooperative Leadership Institute Application
The Philadelphia Area Cooperative Alliance is pleased to request applications for the inaugural Cooperative Leadership Institute. All Philadelphia area cooperators are eligible to apply. For detailed information about the program, visit www.philadelphia.coop/CLI.

All applicants must commit to attending ALL program dates:
July 21-23
August 17
September 9-10
October 7-8
November 2

The application deadline to apply for the 2017 Cooperative Leadership Institute (CLI) is Monday, May 22, 2017, 11:59 pm.

If you have any questions, contact:
Jamila Medley | jamila@philadelphia.coop | 732-328-8970
Information about your cooperative:
Cooperative name: *
Your answer
Year cooperative was founded: *
Your answer
Website address: *
Your answer
Mailing address: *
Your answer
Annual sales: *
Your answer
Total # of staff: *
Your answer
Total # of full-time equivalent jobs: *
Your answer
What is your cooperative’s mission? *
Your answer
Which area best describes the focus of your cooperative’s mission: *
Select the state that most closely describes your organization’s lifecycle: *
Of the following management practices, please select those that most closely describe your cooperative: *
Information about you:
Name: *
Your answer
Title: *
Your answer
Email address: *
Your answer
Phone number: *
Your answer
In which month and year did you begin working at your cooperative: *
Your answer
As of April 2017, how long have you been in your current position: *
Your answer
To whom do you report to (title): *
Your answer
How many people report to you? *
Your answer
Demographic information about you:
The demographic information requested below is not mandatory, but is helpful to us for internal use.
Current level of education:
If applicable, in what area of study did you receive your degree?
Your answer
How do you identify? (Check all that apply, elaborate in the “other” section)
Preferred pronoun
What language(s) do you speak? *
Your answer
Is there anything else you would like to share with us about how you many add to the diversity of the cohort?
Your answer
Essay section
We are excited to learn about the life experiences that brought you to this point. What is your background working in cooperatives, how did you become a cooperative leader, and why is it important to you? (500 words maximum)
Your answer
Why are you interested in participating in the CLI? In what ways do you anticipate the CLI benefiting your work and your co-op? What do you hope to get out of the program? Please be specific and detailed in your answers. (500 words maximum) *
Your answer
What strengths do you and your cooperative possess that might be enhanced by the CLI? (200 words maximum) *
Your answer
What particular challenges do you and your cooperative currently face that the CLI might help to address? (200 words maximum) *
Your answer
Are there any additional comments that you would like to share with the selection committee?
Your answer
The CLI Selection Committee is looking for applicants who are able to attend ALL of the dates listed below. Consistent attendance will build a stronger cohort of participants over the six month period.
Indicate the following dates when you are available to attend: *
The content of this application is true to the best of my knowledge and if selected I am committed to fully participating in this program. *
As part of the selection process we will be contacting your supervisor to discuss your application and how they can support you to reach your learning goals. May we contact them? *
Please share your supervisor's name, phone number and email. *
Your answer
Are you a Principle Six Club member? (for more information go to https://www.philadelphia.coop/principlesixclub/) *
Program cost and scholarship opportunities
Participation in the CLI 2017 cohort will cost $1000 per participant. We have a small amount of scholarship money raised. We strongly encourage participants coming from food cooperatives to apply for the Howard Bowers Fund, and all others, regardless of industry, the Ralph K. Morris Fund. We do not want to turn anyone away due to financial need, and we will do our best to think creatively with you and your cooperative in how to cover the cost of the CLI.

--> Howard Bowers Fund (http://www.cdf.coop/bowersfund/) - Grants for training and education of food co-op staff, managers, and board members, $1000 – $3000. The application deadline is March 15! HURRY!

--> Ralph K. Morris Fund (http://www.ralphkmorrisfoundation.org/morris_app_guide.asp) - Scholarships may be available through the Ralph K. Morris Foundation Cooperative Leadership Fund. These scholarships may be used for travel expenses and registration costs. Preference is given to applications received at least 30 days prior to training date (training starts May 19).
Do you need financial assistance to attend this program? *
Are you considered low-income? (in Philadelphia low-income is calculated as: a family of 1 making $28,400 or less; a family of 2 $32,450 or less; a family of 3 making $36,500 or less; a family of 4 making $40,550 or less.) *
Scholarships opportunities provided by:
The CLI is generously supported by CHS, the Democracy at Work Institute, and The Cooperative Foundation.
Thank you
Thank you very much for taking the time to fill out this application. The selection committee will notify you by June 5, 2017. If you have any questions, please contact Jamila Medley at 732-328-8970.
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