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MMJ Certifications and Reimbursements

Medical Marijuana Reimbursement/Certification Form

LinkedIn

This field is for validation purposes and should be left unchanged.

Veteran Status(Required)

I am not a veteran

I am a veteran

Veteran Details

Please share the name, email, and location of the veteran seeking certification and/or reimbursement.

Name(Required)

First Last

Email(Required)

Location(Required)

What city and state do you need a reimbursement/certification for?

Submission Type(Required)

Are you submitting a form for a certification, reimbursement, or both?

Certification

Reimbursement

Certification

Certification Type(Required)

Initial (first time applying)

Renewal

What type of certification is this?

Reimbursement

Reimbursement Type(Required)

Initial (first time applying)

Renewal

What type of reimbursement is this?

Receipt Date(Required)

MM slash DD slash YYYY

What date is on your receipt?

Fee(Required)

What is the total fee that you paid to your state?

Reimbursement Method(Required)

Zelle

Paypal

Store Discount

How would you like to be reimbursed?

Reimbursement Method Details(Required)

Please add the username, email, or phone number associated with the reimbursement method you chose. Incorrect data in this field will delay the reimbursement.

Please upload your receipt(Required)

Max. file size: 100 MB.

Must be dated within 180 days of this application. Reimbursements can only be submitted annually.

Validation

Please upload your proof of veteran status(Required)

Max. file size: 100 MB.

Please upload a copy of your driver license with veteran identifier, VA healthcare care, DD-214 (redacted). If you submit something other than one of the above documents or the resolution is difficult to read, it may take longer than usual to process.

Terms and Conditions(Required)

I understand that:
1) there is no guarantee of reimbursement.
2) reimbursements are sent as funds are available.
3) only veterans may receive this reimbursement.
4) reimbursement is limited to $50 per year.
5) reimbursements may take up to 90 days to receive.

I agree to the terms and conditions

Submission

You can only submit this form if you are a veteran and have included proof of veteran status.

Submission

Please click submit below to submit this form. You may leave a comment to share with the BVN team if you would like.

Comment

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Veteran Resources

EIN: 84-1854742 | Annual Statement | Tax Exempt Organization Search

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MMJ Certifications and Reimbursements

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