The Maine Shared Community Health Needs Assessment is a dynamic public private partnership that compiles data, engages and activates our community to discuss the data, and build plans to address our most pressing health needs. We invite you to join us in this conversation so that together, we can become the healthiest state in the nation.

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* 1. Please tell us about yourself. 

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* 2. Please provide contact information (Optional).

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* 3. We hope you can attend a York County community forum.
Check all that apply

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* 4. Which community sector do you primarily represent?

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* 5. Within the community sector you identified, what is your primary role?

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* 6. I understand that my name, photograph, voice or likeness may be used for all promotional purposes related only to the Community Engagement Forum by any of the Partnering Event Organizers and their sponsors, beneficiaries, licensees, affiliates and employees. I consent to and authorize, in advance, such use and waive all rights of privacy I have in connection therewith. I also understand that I will not be entitled to any payment or other form of compensation from any use thereof.

With support  from the Maine Shared CHNA collaboration partners: Central Maine Healthcare, EMHS, (EMHS to become Northern Light Health October 1), MaineGeneral Health, MaineHealth, and the Maine Center for Disease Control and Prevention.

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