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2026 LEEP Demographic Survey

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The data gathered by this questionnaire will only be used for reporting purposes as required by Business and Professions Code Section 26244(c) of the California Cannabis Equity Act. Your participation in this survey is entirely voluntary, and you may choose to skip any questions that you do not wish to answer.

Note on the Demographic Questionnaire: For applicants and licensees that are business entities with multiple owners, each owner should complete a separate, individual survey. An owner can include individuals with ownership interest such as officers, directors, managing members, or general partners. 

This survey will close Friday, December 11, 2026.


Please correct the fields below:

1
Applicant/Licensee Name (Legal business name if a business entity):
2
Have you been issued a license by Mendocino County or do you have a pending application (under review) for a license to conduct commercial cannabis activity? (Please check only one):
Have you been issued a license by Mendocino County or do you have a pending application (under review) for a license to conduct commercial cannabis activity? (Please check only one):
3
Please select all the commercial cannabis activities for which you have received a license or have submitted a pending application. (Select all that apply): 
Please select all the commercial cannabis activities for which you have received a license or have submitted a pending application. (Select all that apply):
4
Do you qualify as an equity applicant or equity licensee under Mendocino County's cannabis equity program? (Please check only one):
Do you qualify as an equity applicant or equity licensee under Mendocino County's cannabis equity program? (Please check only one):
5
Age (Please select your appropriate age range):
Age (Please select your appropriate age range):
6
Please indicate your race and ethnicity (Please specify if you select "other"):
7
Please indicate your gender:
Please indicate your gender:
8
Please indicate your sexual orientation:
Please indicate your sexual orientation:
9

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:

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:
10
Please select the category that contains your annual income:
Please select the category that contains your annual income:
11
Please select the category that contains your highest level of educational attainment:
Please select the category that contains your highest level of educational attainment:
12

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 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?:
13
Have you, or any member of your immediate family, been incarcerated for any cannabis‐related charges?:
Have you, or any member of your immediate family, been incarcerated for any cannabis‐related charges?:
14
Are you currently serving or have you served in the United States military?:
Are you currently serving or have you served in the United States military?:
  1. To receive a copy of your submission, please fill out your email address below and submit.

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