The Bronx Cannabis Hub
Thank you for your interest in The Bronx Cannabis Hub. (haga clic aquí para ver el formulario en español). Please fill out this form if you are interested in assistance from The Hub in applying for a Conditional Adult Use Retail Dispensary License issued by New York State's Office of Cannabis Management. A confirmation email will be sent to you shortly after the completion of this form. This form will ask you to provide some basic contact information as well as a series of questions that will help to determine your eligibility. Questions related to prior involvement in the criminal legal system are being asked only because this first round of licenses are reserved for those who were arrested for a cannabis-related offense or have a close family member who was arrested for such offense. All of this information will be kept confidential and is being requested only in order to better assist you in your application.

Contact Details

First Name 

Last Name

Current Mailing Street Address

City

State

Zip

Email

Telephone

Are you interested in applying for the Conditional Adult Use Retail Dispensary License?

YesNo

Are you a New York State Resident?

YesNo

Were you arrested and charged with any cannabis-related crime in New York State before 03/31/2021

Yes

No

 With respect to the arrest in question, the outcome of the case was:

Felony convictionMisdemeanor convictionViolationAdjournment in Contemplation of Dismissal (ACD)DismissalI don't know

Did you have a parent, legal guardian, child, spouse, or dependent who was arrested for a cannabis-related crime in New York State before 03/31/2021?

YesNo

With respect to the arrest in question, the outcome of the case was:

Felony convictionMisdemeanor convictionViolationAdjournment in Contemplation of Dismissal (ACD)DismissalI don't know

Were you a dependent of a person who was arrested for any cannabis-related crime in New York State prior to 03/31/2021?

YesNo

With respect to the arrest in question, the outcome of the case was:

Felony convictionMisdemeanor convictionViolationAdjournment in Contemplation of Dismissal (ACD)DismissalI don't know

Do you have a business with a significant presence in New York State (are you incorporated or organized in New York State or have a principal corporate presence in New York State)?

YesNo

For at least 2 years, have you held at least a 10% interest in ownership and control of, a business that has had net profit for at least two of the years the business was in operation?

YesNo

Please provide your business's legal name. 

Please provide the state in which the business was formed.    

Please provide the year the business was formed.  

Please provide the EIN of the company.  
 

How did you find out about The Hub/who referred you?