National Diversity & Inclusion Cannabis Alliance (NDICA) Incubator Intake Form 

*The 2023 Illinois CRAFT GROW LICENSE and INFUSER LICENSE application window is yet to be announced.*

*Fill out form to receive e-mail updates from Juan Aguirre, BSN, RN, project manager at NDICA*

Fill out this intake form to verify whether or not you qualify for the 2023 Illinois Social Equity Criteria Lottery CRAFT GROW LICENSE and INFUSION LICENSE round. If you qualify, Juan Aguirre will send you a follow up e-mail with instructions on how to submit an application on The Illinois Department of Agriculture's (DOA) website. 

Juan Aguirre is the youngest cannabis dispensary license owner in Illinois and the youngest board member at the National Diversity and Inclusion Cannabis Alliance (NDCIA). NDICA is a 501(c)(3) nonprofit organization that offers free technical assistance to qualifying social equity applicants in addition to hosting criminal record expungement clinics and job fairs funded through the Lieutenant Governor’s Restore, Reinvestment, and Renew (R3) Grant. NDICA is also funded through the Governor's office in California to provide technical assistance to Social Equity applicants pursuing state licensure. In California, NDICA operates a "Legacy to Legal" paid internship program for folks seeking hands on experience in state-licensed facilities.

Nurse Juan Aguirre's incubator will provide the following assistance:

- Introduction to Capital Investors to fund operations if awarded a license

- Assistance with completing the application

- Assistance with legal templates and operating agreements

- Assistance with completing a business plan 

- Assistance with writing Standard operating procedures (SOPs), including security plans, market and supply chain strategy, and more

- Assistance with selecting a properly zoned craft grow or infusion site

- Document review to confirm you qualify as a social equity applicant.

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Email *
E-mail Address *
First Name *
Last Name *
Phone Number *
Age Range *
Gender *
Ethnicity *
Race *
Have you ever witnessed gun violence or been victim of a gun violence?
 *
Are you related to someone that is a victim of gun violence?
 *
Are You Currently Employed? *
Are You Seeking Employment? *
Please select all of the services that you received from NDICA and/or Juan Aguirre in 2023: 
State Guidelines for Meeting Social Equity Qualifications
The social equity criteria, defined here https://idfpr.illinois.gov/profs/adultusecan.asp, dictate that in order to be issued a conditional license pursuant to this application process, an applicant must prove that it is 51% or more owned or controlled by one or more individuals who each meet the combination of at least one of the criteria under Criteria A and one of the criteria under Criteria B.

The information collected after this section is required to help determine if you meet this criteria. YOUR INFORMATION WILL REMAIN CONFIDENTIAL.
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Are you at least 21 years old? *
Have you or an immediate family member (parent, child/dependent, or spouse) been arrested or convicted for possession of 500 grams or less of cannabis? The arrest could have occurred in any state in the country. Federal OR state charges qualify. 

If the arrest of conviction happened OUTSIDE of Illinois, the arrest date does not matter. For example, if you were arrested today in Indiana for possession of under 500 grams, you now qualify.

If the arrest or conviction occurred in Illinois, it must have occurred prior to June 25th, 2019.

Arrest OR conviction must be below 500 grams; If defendant entered a guilty plea which resulted in a conviction for possession of under 500 grams, that conviction qualifies even if the arrest was made for more than 500 grams (pleading to a lesser charge).
 *
Have you or an immediate family member (parent, child/dependent, or spouse) been arrested or convicted for manufacture, delivery, or possession with intent to distribute 30 grams or less of cannabis? The arrest could have occurred in any state in the country. Federal OR state charges qualify.

If the arrest of conviction happened OUTSIDE of Illinois, the arrest date does not matter. For example, if you were arrested today in Indiana for manufacture, delivery, or possession with intent to distribute under 30 grams, you now qualify.

If the arrest or conviction occurred in Illinois, it must have occurred prior to June 25th, 2019.

Arrest OR conviction must be below 30 grams; If defendant entered a guilty plea which resulted in a conviction for manufacture, delivery, or possession with intent to distribute under 30 grams, that conviction qualifies even if the arrest was made for more than 30 grams (pleading to a lesser charge).
 *
Have you been a victim of a firearm injury as evidenced by a police report or medical record?
 *
Has your parent, child/dependent, or spouse been a victim of a firearm injury as evidenced by a police report or medical record? Someone who lived in your household in a relationship with you, at the time of the incident, that is substantially similar to that of a spouse, parent, or child qualifies.
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Have you witnessed a firearm injury as evidenced by a police report or medical record?
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Have you received Medicaid, Supplemental Security Income, Social Security Disability, and/or subsidized housing for at least 5 of the past 10 years?  *
List the addresses you have lived at during the last 10 years, including zip code. This information is critical to determine if the areas you've lived in are eligible for social equity licensing.
 *
Do you have an LLC that is in good standing with the State of Illinois? *

Incubator participants who are awarded a dispensary license will be offered enrollment in NDICA's "Legacy to Legal" internship program. 

If awarded a license, would you be interested in enrolling in the program to gain hands-on experience at state licensed cannabis facilities in Chicago, IL?  


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Any other information you'd like to share?
A copy of your responses will be emailed to the address you provided.
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