CEG Local Jurisdiction Demographic Questionnaire
This information is being collected at the request of the Governor’s Office of Business and Economic Development (GO-Biz) as part of the annual report for the Cannabis Equity Grants Program for Local Jurisdictions (CEG) Program. All participating jurisdictions must collect and provide demographic data for the jurisdiction's commercial cannabis applicants and licensees, including equity and non-equity applicants and licensees. Please note that responses to this survey will be disclosed to GO-Biz, and may be disclosed to another agency or the public, such as in response to a public records request under California Government Code § 7920.000. 

Participation in this survey is optional.
Sign in to Google to save your progress. Learn more
Email *
Have you been issued a permit by the local jurisdiction or have a pending application for a permit to conduct commercial cannabis activity? (Please check only one)
Clear selection
Please select all the commercial cannabis activities for which you have received a license or have a
pending application. (Select all that apply)
Do you qualify as an equity applicant or equity licensee under the local jurisdiction’s cannabis equity
program? (Please check only one)
Clear selection
Age (Please select the appropriate age range)
Clear selection
Race and Ethnicity (Please check all that apply)
Gender (Please check all that apply)
Disability

A person with a disability is an individual who: has a physical or mental impairment or medical condition that limits one or more life activities, such as walking, speaking, breathing, performing manual tasks, seeing, hearing, learning, caring for oneself or working; has a record or history of such impairment or medical condition; or is regarded as having such an impairment or medical condition.

Please select one of the following:
Clear selection
Income Level

Please select the category that contains your annual income. Applicants and licensees that are business entities, please select the average annual income for all owners.
Clear selection
Education Level

Please select the category that contains your highest level of educational attainment. For business entities with more than one owner, select the category that contains the highest level of educational attainment among all of the owners.
Clear selection
Prior Convictions

For the purposes of this section, “immediate family” refers to first degree family members such as parents, siblings, spouses, and children.

Have you, or any member of your immediate family, been convicted of any cannabis‐related charges? For business entities with more than one owner, have one or more owners been convicted, or have immediate family members that have been convicted, of any cannabis‐related charges?
Clear selection
Prior Convictions

Have you, or any member of your immediate family, been incarcerated for any cannabis‐related charges? For business entities with more than one owner, have one or more owners been incarcerated, or have immediate family members that have been incarcerated, for any cannabis‐related charges?
Clear selection
Prior Convictions

If you answered "Yes" to the question above, how long were you or an member of your immediate family incarcerated for?
Clear selection
Military Service

Are you currently serving or have served in the United States military? For business entities with more than one owner, are one or more owners currently serving or have served in the United States military?
Clear selection
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
reCAPTCHA
PrivacyTerms
This form was created inside of City of Los Angeles. Report Abuse
Google Forms