2021 ICCC Application Form

Thank you for your interest in ICCC! Please fill out the below application for the 2021 ICCC program. Once you submit the application, it will direct you to a website where you can select a time for a phone interview with an ICCC representative. We look forward to speaking with you!

Please note that all the following cohorts and their respective schedules will be hosted virtually. If you do not see your city listed, select either the cohort closest to you or the cohort for which you’re available. For example, if you are from St. Louis, you can either select the Chicago cohort or another cohort whose dates work for you.

ICCC Cohort	Opening Seminar Dates
Boston	May 18 & May 20
Chicago	May 25 & May 27
Portland	June 8 & June 10
Philadelphia	June 15 & June 17
Memphis	June 22 & June 24
Southern California 1	June 29 & July 1
Northern California 1	July 13 & July 15
Western MA	July 20 & July 22
Baltimore	July 27 & July 29
Southern California 2	August 10 & August 12
Hawai'i	August 17 & August 19
Detroit	August 24 & August 26
Northern California 2	August 30 & September 1
Denver	September 14 & September 16
Washington, DC	September 28 & September 30
Atlanta	October 4 & October 6
Northern VA	October 19 & October 21
Hartford	November 2 & November 4
Seattle	November 9 & November 11

CEO Information
Please have either the CEO or highest executive complete the application.

1. CEO's First Name *This question is required.

2. CEO's Last Name *This question is required.

3. CEO's Pronouns of Choice: *This question is required.

Other: Write-in Pronouns of Choice: *This question is required.

4. CEO's Gender Identity *This question is required.

5. CEO's Race/Ethnicity: *This question is required.

6. CEO's Email Address *This question is required. This question requires a valid email address.

7. CEO's Phone Number *This question is required. Please type your phone number in the following format: (617) 238-3019.

9. How did you hear about the ICCC program? Please indicate the organization and/or contact name. *This question is required.

Company Information

10. Company Name *This question is required.

11. Company Description *This question is required. Please write 2-3 sentences explaining what your company does.

12. Physical Address *This question is required. If you no longer have a physical address and are working remotely, please use the address of your remote office.

13. City *This question is required.

15. Zip Code *This question is required. This question requires a valid number format.

16. Company Website *This question is required. If you do not have a company website, please feel free to enter your company's Facebook page. If you do not have either, please enter "N/A."

17. Please select all that apply to your business. *This question is required.

Not-for-profit
ESOP (Employee Stock Ownership Plan)
Co-op
B-Corp (certified by the nonprofit B Lab to meet rigorous standards of social and environmental performance accountability and transparency)
Stated social/environmental mission
None of the above

18. Please select all that apply to your business. *This question is required.

Please select all certifications that your company has obtained through federal, state, or local government or private third-party. *This question is required.

Minority Business Enterprise (MBE)
Woman Business Enterprise (WBE)
Veteran's Business Enterprise (VBE)
Service-Disabled Veteran's Business Enterprise (SDVBE)
LGBT Business Enterprise (LGBTBE)
Disability-Owned Business Enterprise (DOBE)
None of the above

19. Industry *This question is required.

Please indicate your industry:

20. Do you sell or provide cannabis/CBD products? *This question is required.Businesses who sell or provide cannabis/CBD products are permitted to participate in select ICCC cohorts. A member from the team will follow up on which cohorts you can attend.

21. Year Founded *This question is required. This question requires a valid number format.

Company Employment, Revenue, and Capital Needs Information

22. Current # of Full-Time Employees *This question is required. This question requires a valid number format.

23. Current # of Part-Time Employees *This question is required. This includes any 1099 employees. This question requires a valid number format.

24. # of Full-Time Employees at the end of 2019 (pre-COVID) *This question is required. This question requires a valid number format.

25. # of Part-Time Employees at the end of 2019 (pre-COVID) *This question is required. This includes any 1099 employees. This question requires a valid number format.

26. Do you expect to hire/rehire employees in the next 12 months? *This question is required.

How many additional employees do you expect to add? *This question is required. This question requires a valid number format.

27. 2020 Year-End Revenue *This question is required. If you are a non-profit, please list your operational budget.
Please type in only numbers. If you type your revenue with letters, such as $5k or $2M, you will receive an error. This question requires a valid currency format.

28. 2019 Year-End Revenue (pre-COVID) *This question is required. This question requires a valid currency format.

29. Compared to your 2020 year-end revenue, do you expect your 2021 revenue to: *This question is required.

30. Please list the 3 growth goals that you have for the next 3 years: *This question is required. Please use complete sentences.

31. What are the 3 main barriers to growth that your business is facing? *This question is required. Please use complete sentences.

32. Have you received any of the following types of emergency capital since the COVID-19 pandemic began? *This question is required.

Other emergency capital received: *This question is required.

33. Which of the following best describes your interest in capital? *This question is required.

Please indicate what you are seeking emergency capital for: *This question is required.

34. Do we have your permission to share your contact information with fellow participants prior to the Opening Seminar? *This question is required.This includes your email address and contact first and last name.

PROTECTION AND USE OF APPLICATION DATA POLICY

This application asks for confidential business information, which we use to evaluate your application. Confidential and proprietary financial information and business plans will be fully protected and access to them will be strictly limited to ICIC personnel. This application also asks for personal information such as the applicant’s name and contact information. We use your personal information for contact purposes and to evaluate your application. This personal information may be shared with ICIC program sponsors, nominating partners, and other program participants. You can opt out of having your personal information shared. If you would like to opt out, please email iccc@icic.org or call us at (617) 238-3019.

Additional information about how we use your personal information, and your rights regarding your personal information, can be found in ICIC’s complete privacy policy, which is available here. You should review ICIC’s complete privacy policy before submitting this application. By submitting this application, you consent to the terms of ICIC’s complete privacy policy and to the terms of this Protection and Use of Application Data Policy.