(207) 861-3000 / (800) 491-8600

Community Benefit Program

$1,000 Mini-Grant Application

Thank you for your interest in Inland Hospital’s Community Benefit program. 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. Applications are being accepted from October 1 – October 31, 2013. Please complete this form and submit electronically or mail to: Tammy Poissonnier, Community Benefit Coordinator, 200 Kennedy Memorial Drive, Waterville, ME 04901 or email at tpoissonnier@emhs.org. For more information call 861-3392. (Tip: Complete responses and save on separate word document prior to submitting application. Once "Submit" has been chosen from the application screen, form clears--leaving a blank form).

Organization Type:

Check the items you can provide upon request. Please do not attach to application.:



Has your organization received funding from Inland in the past?: