City of Sacramento
Office of Cannabis Management
APPLICANT / PERMIT HOLDER QUESTIONNAIRE
Completion of the below general information and demographic questionnaire is completely voluntary. The data gathered will only be used for reporting purposes as required by Business and Professions Code Section 26244(c) of the California Cannabis Equity Act.
Note on the Demographic Questionnaire: For applicants and permit holders that are business entities with multiple owners, responses to the demographic survey should include all options that represent each owner of the entity. An owner can include individuals with ownership interest such as officers, directors, managing members, or general partners.
GENERAL INFORMATION
For the purposes of this section, “You” and “I” apply to both individual applicants and permit holders as well as applicants and permit holders that are business entities.
1. Have you been issued a Business Operating Permit (BOP) by the Office of Cannabis Management or have a pending application for a permit to conduct commercial cannabis activity?
2. Please select all the commercial cannabis activities for which you have received a permit. (Select all that apply)
3. Please select all the commercial cannabis activities for which you have a pending application. (Select all that apply)
4. Do you qualify as an equity applicant or equity permit holder under the local jurisdiction’s Cannabis Opportunity Reinvestment and Equity (CORE) Program?
DEMOGRAPHIC QUESTIONNAIRE
Note for applicants and permit holders that are business entities with multiple owners: If the applicant or permit holder is a business entity with more than one owner, select all demographic options that represent each owner of the entity.
1. Age (Please select the appropriate age range)
2. Race and Ethnicity (Please check all that apply)
3. Gender (Please check all that apply)
4. Sexual Orientation (Please check all that apply)
5. 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:
6. Income Level
Please select the category that contains your annual income. Applicants and permit holders that are business entities, please select the average annual income for all owners.
7. 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.
8. 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?
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?
9. 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?