Rebuild Scholarship Application

Scholarship Application | Summer 2020

Thank you for your interest in Rebuild! Small businesses like yours are the heart and soul of communities that thrive. We wish we could help everyone, but we only have a limited amount of scholarship funding available. Please fill out this application and let us know how Rebuild would help your venture. Once you submit, a member of our team will be in touch to let you know next steps.

First Name

Last Name

Email Address

Phone Number

Street Address

City

State

Zip

What is the name of your business?

What is your business website?

Please tell us a little bit why you are requesting a scholarship for Rebuild.

We invest in people who invest in others. Please tell us a little more about how you are involved in or give back to your community.

Which of the following CO.STARTERS programs or workshops have you participated in in the past?

CO.STARTERS Get Started Workshop Refocus Workshop 30/60/90 Roadmap I have not previously participated in a CO.STARTERS program

Which of the following best describes your total annual household income?

Including yourself, how many people live in your household?

Which of the following best describes the impact of COVID-19 on your business revenue?

Decreased by 20% or less 20%-30% decrease 30%-40% decrease Decreased by more than 40%

Which of the following best describes the impact of COVID-19 on your business operations?

My business is fully open My business is partially open (e.g., operating at a reduced patron capacity, takeout/delivery only, solely online when other options were previously available, etc.) My business is closed

Have you laid off or furloughed any employees because of COVID-19?*

Yes No

If you begin the Rebuild program and stop before the program ends, are you willing to pay the full program value as an incompletion fee?

Yes No

I am interested in...

Yes No

We require all program participants to pay for some portion of their experience as an investment in themselves and their venture. Please let us know the maximum amount you can pay to participate in Rebuild at this time.

If you were referred to Rebuild by an organization or person, please enter their name below. We want to be sure to tell them thanks!

We respect your privacy, and will only use your personal information to provide the products and services you requested from us. If you would like to receive offers and other content from CO.STARTERS that may be of interest to you, please approve below: