Your session has timed out.

Please answer the following questions to assist us in determining if in the last year, you lived in a household with an income at or below 150% of the Area Median Income (adjusted for family size) for Santa Clara County.

 Based on the information you provided, you do not meet the income requirement and therefore are unable to continue with the application. 

If you have any questions, please contact us at CannabisEquity@sanjoseca.gov

or by phone at 408-794-1151 or 408-535-8181.

PRIVACY AGREEMENT

Please be advised that any information you enter in the City of San José’s, Police Department Cannabis Equity Business Academy Application will be retained by the City of San José as soon as you save that information. Please note that the City of San José holds all confidential information in the strictest confidence and does not disclose or provide access to confidential information to unauthorized persons unless required by law. The privacy of applicants is very important to us. We take precautions to protect your personal information by using a variety of security measures to reduce the risk of loss, misuse, unauthorized access, disclosure, or modification of your information.

Which of the following apply to you? Please select all that apply.

If providing a self-attestation as proof of self-employment, please use the following format.
You may copy and paste the text into Word or Google Docs to create your document for upload.
 

Self Attesattion of Self-Employment

Self-Employment Attestation 
 
I (insert name), confirm that I operated a cannabis business and identified as 
self-employed starting (insert start date)  and ending (insert end date)  .

I operated my business out of the following address (insert home address at time of self-emplyment).

(insert printed name)

(insert signature)

Employment 1

Employment 2

Employment 3

Employment 4

Employment 5

Employment 6

Employment 7

Employment 8

Employment 9

Employment 10

  Based on the information you provided, you do not meet the experience requirement and therefore are unable to continue with the application.

If you have any questions, please contact us at CannabisEquity@sanjoseca.gov

or by phone at 408-794-1151 or 408-535-8181.

To qualify for application to the Cannabis Equity Business Academy, you must be a current resident of either a Metropolitan Transportation Commission (MTC)'s Equity Priority Community program or a former Strong Neighborhoods Initiative neighborhood in the City of San José (Cannabis Equity Areas).

Please provide your current address below. If your current address meets the program requirements, you will be required to provide proof of residency. Please use the guidelines below when uploading proof of residency. 

Proof of Residency Acceptable Documentation Guidelines

When providing proof of residency, please provide one of the suggested documents below. 

•  Rental/lease agreement with signatures of the owner/landlord and the tenant/resident. 
• Deed/title to residential real property. 
• Mortgage bill.
• Home utility bill (including cellular phones). 
• Any school document issued by a U.S. education institution that either includes the applicant’s date of birth, or if a foreign school document, is sealed by the school and includes a photograph of the applicant at the age the record was issued.
• Medical document.
• Employment document.
• Faith-based document with the name/address of issuing organization.
• Insurance document including medical, dental, vision, life, home, rental, and vehicle.
• Internal Revenue Service (IRS) or California Franchise Tax Board (FTB) return. 
• Any document issued by an entity, office, or authority governing over a country, state, county, city, municipality, district, agency, department, or any other political subdivision of a country or state that is typed and contains the agency name, department name, state seal, or is on official letterhead. 
• California vehicle/vessel Certificate of Title or registration. 
• Change of address confirmation from the U.S. Postal Service (Form CNL107). 
• California property tax bill or statement. 
• Record of any state or national banks, state or federal savings associations, trust companies, industrial loan companies, state or federal credit unions, and any institution or entity that has issued a credit card. 
• Court document that lists the applicant as a resident of California. 
• Letter on letterhead from a homeless shelter, shelter for abused women, nonprofit entity, employer, faith-based organization, or government within the U.S. attesting that the applicant is a resident of California. 
• Voter registration confirmation letter or postcard issued by the California Secretary of State or a local California county elections officer. 
• Proof of payment of resident tuition to a California public institution of higher education. 
• Original copy of an approved Claim for Homeowners’ Property Tax Exemption (BOE-266) form fled with a local California County Assessor. 
• An acceptable No Fee Identification Card Eligibility Verification form DL 933

Your current address is outside of the Cannabis Equity Area.

Current residency in a Cannabis Equity Area is required to move forward with this application. If you have any questions, please contact us at CannabisEquity@sanjoseca.gov or by phone at  408-794-1151 or 408-535-8181.

You have lived at your current address for less than 48 months. Please proceed to the next page and provide the addresses for your prior residencies. Proof of residence, as outlined above, is mandatory for each submitted address. 

Previous Residency Requirement

In addition to being a current resident of either a Metropolitan Transportation Commission (MTC)'s Equity Priority Community program or a former Strong Neighborhoods Initiative neighborhood in the City of San José (Cannabis Equity Areas), you must have lived for at least four years in an MTC Equity Priority Community or a Strong Neighborhoods Initiative neighborhood in the City of San José (Cannabis Equity Areas).

Please note that these do not need to be four years in a row; these can include places where you lived as a child or as an adult. Please enter your previous addresses and date you began and ended residency. You will be required to provide proof of residency for each address. Please use the guidelines below when uploading proof of residency. 

Proof of Residency Acceptable Documentation Guidelines

When providing proof of residency, please provide one of the suggested documents below for each address. 

•  Rental/lease agreement with signatures of the owner/landlord and the tenant/resident. 
• Deed/title to residential real property. 
• Mortgage bill.
• Home utility bill (including cellular phones). 
• Any school document issued by a U.S. education institution that either includes the applicant’s date of birth, or if a foreign school document, is sealed by the school and includes a photograph of the applicant at the age the record was issued.
• Medical document.
• Employment document.
• Faith-based document with the name/address of issuing organization.
• Insurance document including medical, dental, vision, life, home, rental, and vehicle.
• Internal Revenue Service (IRS) or California Franchise Tax Board (FTB) return. 
• Any document issued by an entity, office, or authority governing over a country, state, county, city, municipality, district, agency, department, or any other political subdivision of a country or state that is typed and contains the agency name, department name, state seal, or is on official letterhead. 
• California vehicle/vessel Certificate of Title or registration. 
• Change of address confirmation from the U.S. Postal Service (Form CNL107). 
• California property tax bill or statement. 
• Record of any state or national banks, state or federal savings associations, trust companies, industrial loan companies, state or federal credit unions, and any institution or entity that has issued a credit card. 
• Court document that lists the applicant as a resident of California. 
• Letter on letterhead from a homeless shelter, shelter for abused women, nonprofit entity, employer, faith-based organization, or government within the U.S. attesting that the applicant is a resident of California. 
• Voter registration confirmation letter or postcard issued by the California Secretary of State or a local California county elections officer. 
• Proof of payment of resident tuition to a California public institution of higher education. 
• Original copy of an approved Claim for Homeowners’ Property Tax Exemption (BOE-266) form fled with a local California County Assessor. 
• An acceptable No Fee Identification Card Eligibility Verification form DL 933

After entering an address, please verify it so that the application can check if it meets the requirements for this program. If an address meets the program requirements, you will be asked to provide proof of residency. 

You will be prompted to enter an address until you meet the four-year requirement.

. 

Previous Address 1

Previous Address 2

Previous Address 3

Previous Address 4

Previous Address 5

Previous Address 6

Previous Address 7

Previous Address 8

Previous Address 9

Previous Address 10

Total Qualifying Time at ALL Residencies

SAN JOSÉ POLICE DEPARTMENT

DIVISION OF CANNABIS REGULATION

This application shall be completed in full by each Owner, Manager and Individual participating in the cultivation, processing, manufacturing, transporting or dispensing of cannabis. Missing, incomplete or inaccurate information may disqualify the applicant from participating in the Cannabis Business.

Fingerprinting & Badging

Each Cannabis Business owner, manager and individual participating in the cultivation, processing, manufacturing, transporting or dispensing of cannabis shall:

• Provide complete and accurate applications for the type(s) of badge(s) being sought;
• Provide a current passport style photo and fingerprints via LiveScan;
• Be issued an identification badge by the Police Department prior to performing any work for the Cannabis Business; and
• At all times while engaged in the duties of his or her position for the Cannabis Business wear in plain sight on his or her person and at chest level a valid identification badge issued by the Chief of Police.

Government Issued Identification

Provide a copy of a valid government issued photo identification card or license containing the following information: name, date of birth, and physical description.

• Acceptable forms of government issued identification include: a driver’s license or photo identification card issued by a State Department of Motor Vehicles, a passport issued by the United States government, a United States Military Identification card, or a Permanent Resident card.

Criminal History

If you have been convicted of a crime (other than an infraction traffic violation) or you are currently on probation or parole, provide the information requested below.

Incomplete information may be grounds for the Individual and/or the Cannabis Business being disqualified from the registration process.

Event 1

Event 2

Event 3

Event 4

Event 5

Event 6

Event 7

Event 8

Event 9

Event 10

Thank you for letting us know you have additional events you need to disclose. A City representative will reach out to gather details for these events. 

Individual Affidavit

(To be completed by each Owner, Manager and Employee participating in the cultivation, processing, manufacturing, transporting, or dispensing of Cannabis)

Individual Authorization for Release of Information

(To be completed by each Owner, Manager and Employee participating in the cultivation, processing, manufacturing, transporting, or dispensing of Cannabis)

I, the undersigned, declare that I am an owner or manager for the applicant, or that I am a member of the applicant and I participate in the cultivation, processing, manufacturing, transporting or dispensing of cannabis on behalf of the applicant.

I authorize all persons, institutions, organizations, schools, governmental agencies, employers, references, or any others not specifically included in the preceding characterization, to release to the San José Police Department any files, records, or information of any type pertaining to me.

The information is being requested by the San José Police Department to properly evaluate the applicant’s qualifications for badging and the Cannabis Business’s qualifications for Registration by the City of San José . A copy of this Authorization shall be as valid, and provide the same authorization as, the original.

Owner and Manager Affidavit 

(To be completed by each Owner & Manager)

Questionnaire for Owners & Managers  

(To be completed by each Owner and Manager participating in the cultivation, processing, manufacturing, transporting, distributing, or dispensing of Cannabis)

Next to each question, please answer “Yes” or “No.” If you answer “Yes” to any of the questions, please explain your answer and provide all information necessary for the City to confirm the information you provided, including, but not limited to the jurisdiction where the activity occurred. 
 

A “Yes” answer does not necessarily mean the Cannabis Business will be disqualified from the registration process. Additional documentation may be requested by the City if the information presented is deemed insufficient to complete the investigation

Owner /Manager Consent for Inspection of Location/Premises and Inspection and Copying of Records 

(To be completed by each Owner & Manager)

A copy of this Consent Form shall be as valid as, and provide the same authorization as, the original.

I attest that the information provided in this application is true, correct, and complete as of the date of my signature below. I understand that submission of false or misleading information or the failure to disclose material facts may result in denial of the application, the suspension or revocation of the license, and/or any other penalties allowed by the law.