Penn-CCP Entrepreneurship Academy

Prior to starting this application, you should have prepared the following items, so you can complete the application in one sitting.

250-word maximum statement.
Why are you interested in the Penn–CCP Entrepreneurship Academy, and what business challenge or growth opportunity do you hope the program will help you address?
250-word maximum, business description
Briefly describe your business, including the products or services you provide.
Proof of address

Applicant and Business Contact Information

Applicant First Name*

Applicant Last Name*

Date of Birth*

Your Title or Role in the Business

Business Name*

Business Website

Business Social Media

Business Email*

Business Phone*

Business Address*

Country

Street

City

Region

Postal Code

Connection to West and/or Southwest Philadelphia*

My business operates in West and/or Southwest Philadelphia

My business is registered in West and/or Southwest Philadelphia

I live in West and/or Southwest Philadelphia

Other: Please describe your connection.

Business Information*

Business Description: Briefly describe your business, including the products or services you provide. (250 words maximum)*

Or, type or copy-and-paste your document here:

Year the Business Was Established (yyyy)*

Number of Years of Operation*

Number of FT Employees (including you)*

Number of PT Employees*

Number of Independent Contractors*

2025 Annual Revenue*

Applicants who advance in the review process may be asked to provide additional business and financial information.

Why are you interested in the Penn–CCP Entrepreneurship Academy, and what business challenge or growth opportunity do you hope the program will help you address? (250 words maximum)*

Or, type or copy-and-paste your document here:

Intake Eligibility Checklist

West and Southwest Philadelphia Verification

This form verifies that the applicant's primary business or residential address is located within the designated West Philadelphia and Southwest Philadelphia service area. Completion of this page is required at intake to confirm program eligibility. Applications submitted without a completed and signed verification will not be processed.

West and Southwest Philadelphia ZIP Codes
An applicant is eligible if the primary business or residential address falls within one of the ZIP codes below:

ZIP CODE	REPRESENTATIVE NEIGHBORHOODS
19104	University City / Mantua / Powelton Village
19131	Wynnefield / Overbrook / Wynnefield Heights
19139	Cobbs Creek / Walnut Hill / Garden Court
19142	Elmwood Park and Paschall
19143	Cedar Park / Kingsessing / Squirrel Hill
19151	Overbrook / Overbrook Park / Morris Park
19153	Eastwick, Penrose, and Philadelphia International Airport

* Primary business or residential address is located within one of the eligible ZIP codes listed above.

* Proof of address is attached (utility bill, lease, mortgage statement, business license, or government-issued ID dated within the last 90 days).

* Applicant name on proof of address matches the name provided on this application.

* If using a business address, the business is currently active and registered in the Commonwealth of Pennsylvania.

* All address fields on the main application have been reviewed for accuracy and consistency with this verification.

Application Certification

I certify, under penalty of perjury under the laws of the Commonwealth of Pennsylvania, that the primary business or residential address provided above is true, current, and falls within one of the eligible West and Southwest Philadelphia ZIP codes (19104, 19131, 19139, 19142, 19143, 19151, or 19153). I understand that providing false, misleading, or inaccurate information may result in immediate disqualification from this program, forfeiture of any benefits received, and may be subject to additional legal or administrative action. I agree to provide supporting documentation upon request.

Click to Sign...