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 Name Last Name

Address: *

Street Address

Street Address Line 2

City State

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:

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References

Please list three (2) references that are familiar with your work life.

Reference 1

Name: *

First Name Last Name

Phone Number *

Years Known: *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Reference 2

Name: *

First Name Last Name

Phone Number *

Years Known: *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Name: *

First Name Last Name

Phone Number *

Years Known: *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Cannabis Industry Intersts

What part of the Cannabis industry are you MOST interested in? (Choose one) *

Cultivation/ Farming/ Growing Edibles/ Product manufacturing Dispensary/ Retail Social consumption I need help deciding Other

Demographic Data

Race/Ethnicity *

Are you a U.S. citizen? *

Birth Date *

Month Day Year

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? *

Yes No

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

Yes No

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? *

Yes No

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? *

Yes No Does 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)? *

Yes No

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

Yes No

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

Apple iPhone Android Other

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

Yes No

Current Skills & Training

Training or Certifications:

How were you referred to us? *

Promo Poster YouTube Video Word of mouth Facebook Twitter Instagram Other (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

Date