LEAP Registration Form

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This form is the first step in joining GTI's Social Equity Application Assistance Program. All information provided will be used to verify eligibility for the Cannabis Regulation and Tax Act's social equity licenses.

Email *

Name (First, Last) *

Age (must be 21+ years old to apply) *

Do you or any individual/entity with more than 10% ownership in your business have a total income of $750,000 or more in the previous calendar year? (This applies to any individual and entity with 10% or greater ownership and all parent companies, subsidiaries, and affiliates.) *

Yes

Which type of cannabis business license are you applying for? *

Craft Grow

Infuser

Dispensary

Transporter

Required

Is your business an Illinois resident? *

How do you qualify as a social equity applicant? (Check all that apply). *

I am an an applicant with at least 51% ownership and control by one or more individuals who have resided for at least 5 of the preceding 10 years in a Disproportionately Impacted Area.

I am an an applicant with at least 51% ownership and control by one or more individuals who: a) have been arrested for, convicted of, or adjudicated delinquent for any offense that is eligible for expungement under The Cannabis Regulation & Tax Act, OR b) is a member of an impacted family

I am an applicant with a minimum of 10 full-time employees, with at least 51% of current employees who: (i) currently reside in a Disproportionately Impacted Area; or (ii) have been arrested for, convicted of, or adjudicated delinquent for any offense that is eligible for expungement under this Act or member of an impacted family.

None of the above - I do

Required

A copy of your responses will be emailed to the address you provided.

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