Individual / Household Membership :: Community Resource Center

Full name

Email

Password

Phone number

Street Address

Date of Birth

Household Size

How many children (age 1-17) live in the household?

Monthly Household Income

Upload a Driver's License, ID or other Photo ID

Select following that apply:

I live in Baltimore City

Someone in the household is elderly (60+)

Someone in the household has disabilities

I have / care for special needs children

I receive SNAP benefits (Food Assistance)

I receive SSI or SSDI Income

I am currently employed

I am receiving mental health services

I am receiving substance use / rehab services

English is not my first language

I am retired

I don't have access to reliable transportation

I am a student

I receive TCA (Temporary Cash Assistance)

I / My family was affected by COVID-19

Individual / Household Membership Application