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Application Form

The primary goal of the Community Investment Program (CIP) is to fund programs benefiting the low-to-moderate income (LMI) community. As such, the organizations that conduct these programs are given special consideration in the ballot selection process.

The CIP Ballot is the portion of the Essex Bank CIP in which our customers vote to allocate donations to qualified 501(c)(3) nonprofits.

To participate in the 2026 ballot, please complete and submit the form below.

For full rules and terms, view the CIP Ballot Statement of Goals and Guidelines.

Format: 99-9999999

Organization Headquarters' Address

Accepts 5 or 9 digits (ZIP+4).

Do you wish to include a separate mailing address?
Primary Contact *
Do you wish to include a second contact?
Account Relationship(s) with (check all that apply)
How does your organization support LMI individuals and/or families? *