(207) 861-3000 / (800) 491-8600
Thank you for your interest in Inland Hospital’s Community Benefit program. Applications for mini-grants of up to $1,000 are being accepted from April 23 – May 14, 2015. Priority is given to applications that address our key community health improvement priorities, which include: access to care, obesity prevention, chronic disease management, poverty and economic opportunity, substance abuse prevention, mental health, homelessness, domestic violence, and transportation.
Requests using this electronic application are preferred. If electronic submission is not possible, please submit a typed copy of this application. Incomplete applications will not be considered. Attachments to this application are not necessary, but may be requested later. Please complete this form and submit electronically or mail to: Laura Howell, Community Relations Assistant, 200 Kennedy Memorial Drive, Waterville, ME 04901, fax to 207-861-3387, or email at firstname.lastname@example.org. For more information, please call 861-3293.
Please note: You cannot save your application. We suggest you save your answers on a Word Document to copy and paste them into the boxes once you are ready to submit your application.
Would you like to Continue working in this session?