Social Equity Program

Marijuana Regulatory Agency

P.O. Box 30205 Lansing, MI 48909
Telephone: (517) 284-8599
MRA-SocialEquity@michigan.gov

Social Equity Program

Social Equity Application

PARTICIPANT INFORMATION
Please provide the following information regarding the individual seeking to participate in the social equity program.

______________________________________________________________________________
Participant Name Email Address Phone
______________________________________________________________________________
Date of Birth SSN
______________________________________________________________________________
Mailing Address City State Zip Code
______________________________________________________________________________
Residential Address (if different than mailing) City State Zip Code

Section 8 of the Michigan Regulation and Taxation of Marihuana Act (MRTMA) requires the
Marijuana Regulatory Agency (MRA) to promulgate rules including “a plan to promote and
encourage participation in the marihuana industry by people from communities that have been
disproportionately impacted by marihuana prohibition and enforcement and to positively impact
those communities” (MCL 333.27958, 2018 IL 1).
Please select the municipality where you have lived for the last 5 years:
 Albion, MI  Mount Morris, MI
 Benton Harbor, MI  Mount Pleasant, MI
 Detroit, MI  Muskegon, MI
 East Lansing, MI  Muskegon Heights, MI
 Ecorse, MI  Niles, MI
 Flint, MI  Pontiac, MI
 Hamtramck, MI  River Rouge, MI
 Highland Park, MI  Saginaw, MI
 Inkster, MI  Ypsilanti, MI
 Kalamazoo, MI

Do you plan to operate in the municipality selected above?

 Yes  No
If no, where will you operate?
______________________________________________, MI

MRA (New July-2019) Page 1 of 2

 Social Equity Program
Marijuana Regulatory Agency
P.O. Box 30205 Lansing, MI 48909
Telephone: (517) 284-8599
MRA-SocialEquity@michigan.gov

Social Equity Program

Social Equity Application
Please select all that apply:
 Participant has been a resident of the identified community for the past 5 consecutive
years.
 Participant has a marijuana-related conviction.
 Participant has been registered as a primary caregiver for at least 2 years between 2008
and 2017.
Please attach the following, as applicable.
 To verify proof of residency: W-2 forms, lease or rental agreements, or voter
registration. A combination of these or other documents may be required to verify
residency.
 To verify a marijuana-related conviction: Copy of judgment of sentence.
 To verify 2 years of caregiver experience: Authorization of Release of MMMP
Information form.
Would you be interested in participating in education and outreach sessions in your area?
 Yes  No
Which type of marihuana establishment do you plan to operate?
 Class A Marihuana Grower  Marihuana Processor*
 Class B Marihuana Grower*  Marihuana Retailer*
 Class C Marihuana Grower*  Marihuana Secure Transporter*
 Designated Consumption  Marihuana Safety Compliance
Establishment Facility
 Marihuana Microbusiness  Marihuana Event Organizer
*State operating license under MMFLA required.
Would you like assistance in completing your adult-use application?
 Yes  No

Mail application with all required supporting documents to:

Social Equity Program

Marijuana Regulatory Agency
P.O. Box 30205
Lansing, MI 48909

MRA (New July-2019) Page 2 of 2