CDL9 2017
Welcome to the CDL9 2017 application form.

By completing this form you are submitting an application to participate in a small group leadership development program for cooperatives leaders. This program will be meeting for three weekends in Gray Maine.

After you complete the form, we will contact you to set up an interview and process your registration.

Thank you for applying!
Rachel Lyn Rumson & Kate Wallace, Registration Coordinators

Contact Information
Who should we contact about your application? If you are applying as a group who will be the point of contact for you?
First Name *
Your answer
Last Name *
Your answer
Application Date *
MM
/
DD
/
YYYY
Phone Number
Your answer
Email
Your answer
Mailing Address
Your answer
What is the best way to reach you? *
Project, Business or Organizational Name
In the earliest stages of cooperative development we call it a project. If you're in an early stage you might make up a project name here. Some people find their business name quickly and use that. Others are entering the program sponsored but another entity and that name would be the one to share here.
Your answer
Limited Scholarships are available. Would you require assistance to attend this program?
Participant Group
Please identify yourself as ONE of the following participant groups: *
Please make sure that your team knows which participant group you have selected.
Learning Considerations
1. What is most exciting you about cooperatives and why do you most want to learn? *
Your answer
2. What are your goals for this year? *
Your answer
3. What parts of your cooperative are you most confident about? *
Your answer
4. What is the community need that your cooperative is serving? *
Your answer
5. Do you have any physical considerations that we should be aware of? If so, what are they?
In finding spaces to hold our classes, we want to make sure that we accommodate all of our participants needs.
Your answer
6. Will any members of your team be unable to participate effectively in Design Lab classes if the classes are conducted in English?
If so, what is the primary language of those team members?
Your answer
About Your Cooperative
Please fill out as many of the following questions as you can.
1. What product, service, or benefit is your cooperative providing (or aiming to provide) for members?
Your answer
2. Is your group legally incorporated?
3. If your organization is incorporated, please provide year of incorporation and legal structure, as well as info on members, jobs, and revenue.
a) year of incorporation b) corporate structure (e.g. co-op, LLC, nonprofit, etc.) c) # of jobs d) most recent annual sales revenue
Your answer
4. If not incorporated, what needs to happen in order for members to commit?
6. Who are your members or potential members? Check all that apply.
check all that apply
7. If possible please provide demographic information (age, gender, ethnicity, national origin, average income, etc.).
Your answer
8. How do is your co-op funded?
Your answer
Connections
How did you hear about Cooperative Design Lab?
Your answer
One of our sponsors, is offering a scholarship for low-income participants in CDL. Would you like to apply for it?
If you say yes, we will send you an link to their application. They will process your application separately.
Submit
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