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FORM |
REQUIREMENTS |
INFORMATION |
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Background Check Request Form
| - Must be submitted for all persons listed on an application for a medical marijuana dispensary.
- Must be submitted in support of request to
add a new PRD.
- For details, visit the
Background Check page.
| All persons listed on an application for a medical marijuana dispensary registration must complete a background check request form. PRDs must submit separate background check request forms for each dispensary site they propose to serve. |
Electronic Fingerprint Authorization Form
| - After OMMP has received your background check form, you will receive a letter with instructions on how to proceed with fingerprinting.
| For details, visit the Background Check page.
You are not required to submit your fingerprints electronically. If you do, you must use this form.
|
Individual History Form
| - Must be submitted within
30 calendar days of new application payment.
| Required for each person listed on the application. |
School Proximity Affirmation Form
| - Must be submitted within 30 calendar days of new application payment.
| This form attests that the PRD has canvassed the area surrounding the proposed facility in an effort to locate schools that may not appear on the OLCC's School Locator Map (the map is located about half way down the page).
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Notification of Dispensary Readiness Form | - Must be submitted within
60 days of notification from OHA that an application meets initial criteria.
- By 5:00 pm on the prescribed deadline, the form must be received by OMMP by emailing medmj.dispensaries@dhsoha.state.or.us.
- Alternately, form may be mailed, postmarked by the prescribed deadline, to:
Oregon Medical Marijuana Dispensary Program
P.O. Box 14450
Portland, OR 97293
| Do not submit this form prior to notification of meeting initial criteria. |
Extension Request for Dispensary Readiness Form
| - Must be submitted before your 60-day readiness deadline expires.
| The extension request must be for a reason outside your control, and you must provide supporting documents. |
Remove or Change of PRD Form | A PRD
Remove or Change Form must be submitted to remove or change the designation of a PRD or Primary PRD. For details, visit the
PRD page. | Failure to notify the Authority of a change of PRD, or if a PRD has resigned his/her position, may result in revocation of a dispensary registration. |
Add a PRD Form
| A PRD
Add Form must be submitted to add Primary PRD or additional PRDs. For details, visit the
PRD page. | Failure to notify the Authority of any additional PRD’s may result in revocation of a dispensary registration. |
Transfer Authorization Form
| Must be used whenever unused marijuana is transferred by a grower or caregiver to a registered dispensary. | This form authorizes a specific person such a caregiver or grower to transfer unused marijuana on behalf of card holder. |
Transfer Authorization Form - Processor to Processor or Dispensary
| Must be used whenever a medical marijuana processing site transfers cannabinoid concentrate, extract, edible, transdermal patch, or suppository to a registered medical marijuana dispensary or processing site. | This form authorizes a medical marijuana processing site to transfer cannabinoid concentrate, extract, edible, transdermal patch, or suppository to a registered medical marijuana dispensary or processing site. |
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Continuation of Operations by a Secured Party Form | In the event of Foreclosure or Cessation of Operations, a Secured party may continue operations. This form allows you to appoint such secured party. | |
Request to Change Premises Form
| Must be submitted to seek approval from the Authority
before making any physical changes that could substantially alter the premises from plans the Authority originally viewed. | A floor or plot sketch must be attached with this request under OAR 333-008-1040(6)(b). |
Business Change Form
| Must be used whenever a registrant proposes to
change its corporate structure, ownership structure or financial interest with an individual. |
|
Intake Form - Dispensary
| This form is required as the Dispensary Intake Form. It must be used in order to adhere to the intake transfer documentation rule requirements OAR 333-008-1230(4). |
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