What is your name?
What is your phone number?
What is your ZIP code?
Are you at least 21 years old?
Have you lived in one of the following zip codes for 5years or more? 90057, 90037, 90062, 90003, 90061, 90059, 90001, 90011, 90008, 90016, 90013, 90059, 90002, 90021, 90014, 90044, 90043, 90058, 90027, 90033
What is your estimated current income?
Are you receiving government assistance?
Are you currently receiving FAFSA?
Have you ever been arrested or convicted of possession or sales of marijuana? (Please be honest. For the sake of this survey, a conviction may be beneficial.)
What state was your cannabis conviction in?
What was the outcome of your cannabis offense?
Placed on probation
Spent time in jail
Went to Prison
I do not have any cannabis offenses on my record
Was your conviction before or after 11/08/2016?
I do not have a conviction on my record.
Have you been arrested or convicted of any of the following in the last 20 years?
Possession of schedule 1 drugs (other than marijuana)
Possession of a gun
A violent crime
Harm to children
None of the above apply to me
What agency or person referred you to Social Equity Partners?
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Cannabis Advising Partners.
Terms of Service