2026 Baltimore Life Community Grants Application Survey

General Information

Please answer the following questions. Once you complete the online application, your submission will be sent to the nearest agency for consideration. Following completion, Baltimore Life and any of our agents, agencies, or representatives may contact you. There is no need to follow up with a fax or a hard copy of the completed application. A preview of the questions asked below are shown on this sample application. All completed surveys must be submitted online no later than Friday, October 23, 2026, at 5:00 p.m. (EST).

Note: This program is limited to the participating states of Maryland, Ohio, Pennsylvania, South Carolina, Washington D.C. and West Virginia only.

Organization Name(Required.)

Director’s Name(Required.)

Tax Identification Number(Required.)

Mailing Address(Required.)

Address

City/Town

State/Province

ZIP/Postal Code

Phone Number(Required.)

Fax Number

Contact Name and Title (if not Director) (Required.)

Email Address (Required.)

Current Progress,

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