VMCC Bootcamp Application

VMCC Bootcamp Application
The Bootcamp program is intended to support those most impacted by the prohibition of cannabis. The current definitions of social equity stem from past cannabis conviction status, income levels, and permanent living address etc. Therefore, it’s important that you answer each question honestly. There aren't any wrong answers. Prior life issues do not disqualify you from participating in the bootcamp program. These questions help ensure our bootcamp serves social equity applicants by removing as many barriers to entry in the cannabsi economy.
Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Mobile Phone Number:*
E-mail Address:*
example@example.com
LinkedIn URL:
Current Employer:
What do you currently do for a living?*
Please be as detailed as possible
What do you want to get out of the boot camp experience?*
Upload Resume:

Cancelof
References

Please list three (2) references that are familiar with your work life.
Reference 1
Name:*

First NameLast Name
Phone Number*
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 2
Name:*

First NameLast Name
Phone Number*
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name:*

First NameLast Name
Phone Number*
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cannabis Industry Intersts
What part of the Cannabis industry are you MOST interested in? (Choose one)*

Cultivation/ Farming/ GrowingEdibles/ Product manufacturingDispensary/ RetailSocial consumptionI need help decidingOther
Demographic Data
Race/Ethnicity*
Are you a U.S. citizen?*
Birth Date*

MonthDayYear
Disabilities:
Yes or No, if yes please explain
Are you a U.S. military veteran?
Military discharge date:
Social Equity Qualifications
How long have you lived in the state of Virginia?*
What is your highest level of education?*
Have you, or a parent, child, or spouse been arrested or convicted of cannabis- related offenses eligible for expungement, including possession, cannabis related arrest and/or conviction?*

YesNo
Was your 2021 personal income tax filing less than $32,000?*

YesNo
How many years of the last five years has your personal income exceeded $19,000?*
Did you graduate from a HBCU located Maryland, D.C., Virginia, or North Carolina?*

YesNo
Has it been more than 10 years since you attended four year university, but you currently have more than $25,000 in outstanding student loan debt?*

YesNoDoes not apply to me
Technology Support Needs
The support our program provides includes academic support, business coaching, mentoring and the other resources necessary for empowering our members. Our program utilizes the internet, smartphones and laptops to complete assignment and participate in live discussions. Please answer the following questions so that we have an accurate assessment of needs of our bootcamp members.
Do you personally own a laptop computer? (This does not include smartphones, tablets or a kindle)?*

YesNo
Do you have dependable around the clock internet access at home?*

YesNo
Mobile phone compatibility – Which type of phone do you have*

Apple iPhoneAndroidOther
Have you ever personally participated in a live Zoom video call?*

YesNo
Current Skills & Training
Training or Certifications:
How were you referred to us?*

Promo PosterYouTube VideoWord of mouthFacebookTwitterInstagramOther (please specify)
Which Boot Camp format are you interested in attending?*
Tuition is not paid now but must be paid after your VMCC interview and cohort assignment in order to receive your course activation link by the start date.
Signature

Clear
Date Completed

MonthDayYear
Date
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