(207) 861-3000 / (800) 491-8600
Community Health Needs Assessment | Financial Assistance

Community Outreach Request Form

Thank you for your interest in inviting Inland Hospital to participate in your activity or event.  It is our goal to support local economic, educational, and cultural efforts and to collaborate with local organizations, schools and businesses to help improve the overall health and well-being of our community.

All applications will be carefully considered as we strive for the best way to meet our mission: “to care for and serve our community”. Please fill out the form below and click submit when finished. You may also download a printable Community Outreach Request Form and fax the form to: 1-207-861-3387, or via US mail to: Community Relations, Inland Hospital, 200 Kennedy Memorial Drive, Waterville ME 04901, or scan and email to inlandcr@emhs.org.  If you have any questions please call 1-207-861-3293.


Date and Time of Event/Activity:

Date response needed by: