USA Co-ops Community Impact Story by NCBA CLUSA

Year of Co-ops Storytelling Campaign

presented by NCBA CLUSA

Thank you for participating in NCBA CLUSA’s video storytelling campaign! We are excited to hear about the amazing work your co-op is doing in the community.
About the Co-op Storyteller
Name*

First NameLast Name
Email*
example@example.com
Job Title*
Staff title, Board Director, worker/owner
Organization*
Website*
Please list your company's website (e.g. https://ncbaclusa.coop/)
Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Which co-op sector are you representing?*

AgricultureAssociation of Co-opsBank/CDFICo-op DeveloperConsumerCredit UnionGroceryHealthcareHousingInsurancePlatformProducerPurchasingUtilitiesWorkerOther
Were you referred by someone? If yes, please type their full name.
Are you interested in membership with NCBA CLUSA?*

YesNoI'm already a member
Twitter/X social media handle
Instagram social media handle
LinkedIn social media handle
YouTube social media handle
About the Co-op Story
Which co-op story elements are present in the story submission?*

IMPACT on local community and membersPrinciple 6 - cooperation among cooperativesInclusive economiesAdvocacy - engaging with elected officialsPublic awareness - amplifying the co-op business modelOther
Was this video story created specifically for this storytelling campaign or did it already exist? If the video already existed, what year was it published?*
Please share the funding source (government, grant, program, etc.) that supported your co-op and/or funded this specific initiative.
Please share if you received funding for this initiative that was created to empower/support low-income neighbors (an example is SNAP or pricing discounts). The source of the funding can be federal/state/local government or a private entity.

Yes - federal governmentYes - state/local governmentYes - private entityNo - not applicable
The Co-op Story Submission
Submission Category

Social Media ContentShort-form VideoLong-form Content
Video upload*

Cancelof
Additional media (video, photo, document, etc.)

Cancelof
Co-op Storyteller Consent & Waiver
LIABILITY WAIVER: By submitting this video, I acknowledge and agree that NCBA CLUSA shall not be liable for any claims, demands, actions or causes of action arising out of or in connection with the use, editing or broadcasting of the video content. I release NCBA CLUSA from any liability or legal actions as a result of the use, display, distribution or publication of the video content. This waiver extends to my heirs, executors, administrators or assigns.*

I consent
CONSENT AND RELEASE AGREEMENT: By submitting this video, I give NCBA CLUSA permission to use it for advocacy, outreach and/or educational purposes. This includes sharing it on digital, print and social platforms. I confirm I have the rights to share this video, and I understand it may be edited or adapted as needed. NCBA CLUSA will credit me as the creator when possible. I waive the right to review or approve how the video is used and release NCBA CLUSA from any related claims.*

I consent
Should be Empty:

About the Co-op Storyteller

About the Co-op Story

The Co-op Story Submission

Co-op Storyteller Consent & Waiver