Categories Take the Next Steps! Help us measure our impact Please complete this survey to help us better understand our community and evaluate our efforts to be as inclusive as possible. All responses will remain anonymous; only aggregate data will be shared. "*" indicates required fields Tell us about yourselfBackground (optional) Economic Empowerment applicant or licensee Social Equity Program participant MA Non-EE/SE cannabis applicant or licensee Licensed dispensary agent Caregiver Ancillary cannabis industry business Healthcare provider Government regulator, elected official, or other public employee Nonprofit leader, community activist, or other advocate LGBTQ+-owned business leader Minority-owned business leader Veteran-owned business leader Women-owned business leader Arrested or convicted of a cannabis crime, or child or someone who was From a community disparartely harmed by prohibition I do NOT have a financial interest in a licensed cannabis business Gender (optional)Please check all that apply. Woman Man Transgender Non-Binary Gender Queer / Gender Non-Conforming Two Spirits Intersex Questioning My gender isn’t listed Prefer not to say Sexual Orientation (optional) Asexual Bisexual Gay Straight Lesbian Pansexual Queer Questioning or unsure Same-gender loving My sexual orientation isn’t listed Prefer not to say Race/Ethnicity (optional)Please check all that apply. American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Preferred Language(s) (optional) American Sign Language Arabic Cambodian/Khmer Cantonese Cape Verdean English French Greek Italian Haitian Creole Mandarin Portugese Russian Spanish Vietnamese Asian: Please specify (optional) Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Aisan Native Hawaiian or Pacific islander: Please specify (optional) Native Hawaiian Guamanian or Chamorro Samoan Other Pacific islander Prefer not to say Hispanic or Latino: Please specify (optional) Latino/a/x Dominican Cuban Mexican, Chicano/a/x Other Hispanic/Latino Prefer not to say Religion (optional)Select the option that best refelcts your beliefesAgnosticAtheistBaptistBuddhistCatholicChristian (no denomination specified)Church of ChristCongregational/United Church of ChristEpiscopalJewishLutheranMethodistMuslimNothing in ParticularPentecostalPresbyterianOtherPrefer not to sayAge*Choose age range16-2425-3435-4445-5455-6465+Birthday (optional) MM slash DD slash YYYY Housing Status (optional)Select the option that best reflects your circumstancesStable – renterStable – ownerStruggling with rentStruggling with mortgageUnstable, insecure, transient, or guest housingHalfway, sober, re-entry, or other transitional housingMilitary housing, veteran housing, or Soldier's HomesNursing home, assisted living, or other treatment centerJail, prison, or other correctional facilityMy housing situation is not listedPrefer not to sayAverage Annual Income (optional)Select annual earning range$0 – $10,000$10,001 – $40,000$40,001 – $90,000$90,001 – $170,000$170,001 – $215,000$215,001 – $540,000$540,001 – $1,000,000$1,000,001 – $3,000,000$3,000,001 – $5,000,000$5,000,001 – $10,000,000$10,000,000+Prefer not to sayCommentsThis field is for validation purposes and should be left unchanged. Δ
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