2021 Social Impact Cohort Application
The Social Impact Cohort competition is sponsored by StartingBlock, American Family Insurance, and Associated Bank. Entries are accepted through January 31, 2021. Entries will be judged by a panel selected by the sponsors. The odds of winning depend on the number and quality of entries received. No purchase necessary to enter. Void where prohibited. For more information and full rules, visit
Applicant Name (First and Last)
Contact Information (please list email address and phone number):
How did you hear about the Social Impact Cohort?
I saw it on Social Media
I saw it on the StartingBlock website
I was reffered by an entrepreneurial organization
I saw it in the StartingBlock newsletter
Type of Organization
Not yet incorporated
If a for-profit company, are you a:
Certified B Corporation?
What stage best describes your company/organization?
Early (0-3 years, we're fairly new)
Established (we've been around 3+ years and are in a growth phase)
Mature (we're 10+ years old and have a stable source of revenue/funding)
What is the main problem, challenge or issue that you company/organization is trying to solve–and how do you do it?
Who will benefit from your work? (In describing your target audience/community, consider: Who are they? How big is the market? Where are they located?)
Describe how your company/organization values and measures beneficial societal impact in Wisconsin.
What is your company/organization's primary source of funding? Check all that apply.
Briefly outline your business model, including how you plan to measure and achieve financial sustainability.
Identify three key milestones that you have achieved in the past three years? If a newly launched company/organization, what are three milestones you hope to achieve?
Why do you want to be part for the StartingBlock community, and how would access benefit your organization?
Name one specific need your organization currently has that you’re looking for assistance on.
If accepted, would you or your team want to have access to the StartingBlock space?
If yes, how many hours would you anticipate being at StartingBlock each week?
How many team members would you anticipate spending time at StartingBlock?
More than 5
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