Basic Intake Form: Cooperation New Orleans Loan Fund
Thanks so much for your interest in working with Cooperation New Orleans! Please fill out the fields below to the best of your ability. We will reach out to you with in 2 weeks of you submitting the intake form.
Primary Contact Name *
Primary Contact Email *
Primary Contact Phone Number *
Secondary Contact Name
Secondary Contact Email
Secondary Contact Phone Number
Where in Greater New Orleans are you located? *
If your project is not place-based, please put N/A.
Name of cooperative, collective, project, or business *
Your role in cooperative/business, etc. *
Is the business legally formalized? If so, what is the legal entity type and what year was it incorporated? *
Describe your business model. What kind of products or services does your business provide? *
Please select the services you are seeking from CNO Loan Fund (check all that apply)
How many people are actively involved in decision making for this project?
Clear selection
What stage is your Co-op in? *
If operational, what is your annual revenue? *
If your business is not yet operational, please write N/A.
Do you have any of the following documents? Check all that apply. *
Required
Have you read our website? https://www.coopnola.org/ *
On a scale of 1-5, how closely do you feel your project aligns with each of our values? *
Full description of our values can be found here: https://www.coopnola.org/our-values. Please rate, 1 = NOT AT ALL, 2 = NOT REALLY, 3=SOMEWHAT, 4=MOSTLY ALIGNED, 5 = IN TOTAL ALIGNMENT N/A = I DON'T UNDERSTAND WHAT THIS VALUE MEANS
1
2
3
4
5
N/A
ALTERNATIVE TO RACIAL CAPITALISM
CULTURE
BUILDING POWER
SOLIDARITY
DECOLONIZATION
What are some goals you hope to achieve through working with CNO Loan Fund?
Does your co-op or organization have a budget for technical assistance? *
Are there other technical service providers you are currently working with, or have plans to work with in the immediate future? *
If you stated 'Yes' to the previous question, please share who you are already working with.
How did you find out about us? *
Required
If someone specific recommended you reach out to us, please include their name here.
Is there anything else you would like to share?
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