Qualification Survey
Email address *
What is your name? *
Your answer
What is your phone number? *
Your answer
What is your ZIP code? *
Your answer
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?
Your answer
What was the outcome of your cannabis offense?
Was your conviction before or after 11/08/2016?
Have you been arrested or convicted of any of the following in the last 20 years?
What agency or person referred you to Social Equity Partners?
Your answer
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.