California Micro Grant Program
CA Employment Training Panel 2023 SEED Grant Application Form
Thank you for your interest in the grant program! The purpose of the grant program is to assist
groups forming a cooperative, or existing
cooperatives planning on growth. Awards range up
. For details
on the program, please visit CCCD’s website at:
Worker Co-op Microgrants | California Center for Cooperative Development (cccd.coop)
Your Contact Information
1. First Name
2. Last Name
3. Title/ Position
4. Email Address
5. Phone #
6. Additional Phone #
Status of your Cooperative / Group
7. Are you an existing cooperative or organizing a worker-cooperative?
Organizing a Worker Cooperative
8. If Other, please identify
9. How long have you been a cooperative or in how many years or months do you expect to be a cooperative?
Your Cooperative's / Organization's Information
10. Business / Organization Name
11. Business / Organization Email
12. Business / Organization Phone #
13. Business/ Organization Website
14. Street Address
15. Address 2
18. Zip Code
19. Please indicate the industry of your cooperative/ organizing group
20. Approximately how much are you requesting from the grant program?
21. What do you plan to use the grant funds for?
Cooperative / Group Member
22. How many members are in your cooperative / organizing group?
23. Please indicate the primary language(s) spoken by the members of your cooperative / organizing group.
24. Please indicate how many members in your cooperative / organizing group belong to the following racial categories. Please enter a number or '0' for each option.
American Indian or Alaska Native
Black or African American
Latino or Latinx
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White or Caucasian
25. Please indicate how many members in your cooperative / organizing group are in each gender group. Please enter a number or '0' for each option.
Transgender, female to male
Transgender, male to female
Transgender, gender non-conforming
Genderqueer, gender non-conforming
Prefer not to state
26. Please indicate how many members in your cooperative / organizing group belong to each age group. Please enter a number or '0' for each option.
18 - 34 years old
35 - 64 years old
65 years old or older
The answers given in this application are true
to the best of my knowledge