Knoxville Area Urban League · CO.STARTERS application

Instructions:

Please fill out this entire form to the best of your ability. If there are questions that you do not have answers for, please just place a N/A or none in the field.

Contact Information

Name

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Prefix

First Name

Last Name

Suffix

Email

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Verify Email

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Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Gender

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Phone Number (Best to contact you with)

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Birthday

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(mm/dd/yyyy)

County?

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Enter 'other' county here:

Which of the following describes your age group?

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How many people live in your household?

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Race:

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African American / Black: Origins in any of the Black racial groups of Africa

Alaska Native / Native American: Origins in any of the original peoples of North, South, and Central America

Asian: Origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent

Caucasian / White: Origins in any of the original peoples of Europe, the Middle East, or North Africa

Hawaiian / Pacific Islander: Origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands

Two or More Races: A person identifying with more than one specified racial category

Prefer not to say: Choose not to disclose their racial identity

Have you ever served in the military?

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If yes, which branch?

Employment Status?

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If other, specify here:

Which of the following describes your annual household?

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Which of the following best describes your venture?

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Business: a venture that exists to provide a product or service that people are willing to buy

Cause: a venture that exists to provide sustainable, impactful solutions to social, cultural, or environmental problems

Which of the following best describes the way you plan on working within/on your venture?

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It will be my full-time job. (Full time = 35 hours or more per week)

It will be my part-time job. (Part-time = Less than 35 hours per week)

It will be my "side-gig" to add extra income.

It will be my passion project and my primary goal is not to make money for it.

I don't know yet.

Other

Please specify other here:

Which best describes the current state of your venture?

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Concept stage: I have an idea and I would like help moving forward?

Startup Stage: I am in the beginning stages of my business, and I am trying different things, but still need work making it sustainable

Business Stage: My business is operating and I am trying to expand/build on it

What is the name of your existing venture or idea?

Tell us more about your business:

How long have you been in business?

Who are your target customers?

How many employees do you have?

What are your expectations of this program?

How did you find out about this program?

Commitments Required

Do you agree to the following?

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To get the most out of CO.STARTERS, you will need to participate in all three-hour sessions, engage regularly with the CO.STARTERS materials, share insights and connections with your peers, and complete targeted "fieldwork" activities weekly between group sessions. You will need to be dedicated during the program and give an adequate amount of time to it. Are you ready to commit your time and attention to make significant progress for your venture through CO.STARTERS?

There is a $250 fee for participating in this program. Please select all of the following that apply to you.

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I am able to pay now and secure my seat in the class.

I would like information about payment plans.

I would like to know how I can sponsor another entrepreneur's participation.

Have you previously completed any relevant training that will help you in launching your venture? If so, please name the training. (Previous training is not required!)

Consent and Agreements

CO.STARTERS is a venture too! As such, we have to follow our own advice (which you'll hear in Week 5!) and ask you to enter into a little business agreement with us. The statements below were crafted by keen legal minds ... and read that way. If you have any questions about the dense legalese, please let us know.

PLEASE READ THE FOLLOWING CAREFULLY:

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I understand that neither Knoxville Area Urban League nor CO.STARTERS guarantees that I will be successful in my venture. Furthermore, the benefits gained from participating in CO.STARTERS are a result of time, energy, and dedication to the program, and thus are not based solely on the completion of the coursework. I further understand and authorize CO.STARTERS to provide applicable information to the assigned management counselor(s). I understand that any information released is to be held in strict confidence by him/her. No person will be excluded from participation in or otherwise subjected to discrimination in regard to services, programs, and employment provided by the KAUL and CO.STARTERS based on race, sex, color, national origin, sexual orientation, disability, age, religion, or any other characteristic protected by applicable law or ordinance

PLEASE READ THE FOLLOWING CAREFULLY:

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I understand that the facilitators of Knoxville Area Urban League and CO.STARTERS rely upon the active participation and assistance of local volunteers in order to effectively operate the program. These volunteers include, but are not limited to, mentors and speakers. I further understand that CO.STARTERS is most effective when participants are willing to freely share experiences and advice with one another during the course of the program. In order to encourage these vital contributions, as well as those of program staff and facilitators, I hereby release, discharge, and hold harmless the KAUL, CO.STARTERS, program staff, facilitators, volunteers, and fellow participants from any and all claims, demands, or causes of action that I may hereafter have based upon the advice provided during the program and I understand that I am entirely responsible for the results of the decisions I make involving my venture during and as the result of my participation in CO.STARTERS.

PLEASE READ THE FOLLOWING:

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I do hereby give permission to Knoxville Area Urban League and CO.STARTERS, its agents, and others working under its authority, full and free use of video/photographs containing my image/likeness. I understand these images may be used for promotional, news, research, and/or educational purposes. I hereby release, discharge, and hold harmless CO.STARTERS and its agents from any and all claims, demands, or causes of action that I may hereafter have by reason of anything contained in the photographs or video. I do further certify that I am either of legal age, or possess full legal capacity to execute the foregoing authorization and release.