Wellness Champion Application Wellness Champions Application First Name Last Name Email address 1. What Unit/School/Department would you be representing as a Wellness Champion? 2. Where if your Unit/School/Department's physical location/address 3. What is your intra-office mail address? 4. What is your current working situation? Remote only In-office only Hybrid: remote and in-office 5. What is your Department's current working situation? Remote only In-office only Hybrid: remote and in-office 6. Tell us more about why you would like to serve as a Wellness Champion? 7. What HealthyUNCG services do you currently use or are aware of? (Check all that apply) Special Programming (Monthly Workshops and Webinars) Health Coaching Nutrition Counseling Physical activity opportunities such as ActiveU and Fitness Lending Library Events and Challenges such as Employee Field Day, Movement Challenge, etc. Website resources page- EAP, mental wellbeing caretaker support, etc. Newsletters and Emails Social media (Instagram and Facebook) Select All9. How could HealthyUNCG best support you as a champion? 10. Is there anything else you would like the HealthyUNCG team to know? 11. As a HealthyUNCG Wellness Champion, I agree to attend monthly/bi-monthly check-in meetings with Wellness Champions (You will also receive an email with bulleted wellness happenings each month for easy reference.) Yes No 12. As a HealthyUNCG Wellness Champion, I agree to share HealthyUNCG programs and events, along with the HealthyUNCG Newsletter (3-5 times a year) which is prepared in advance by HealthyUNCG staff Yes No 13. As a HealthyUNCG Wellness Champion, I agree to share HealthyUNCG and other campus wellness information with your department and networks (print and share within your department and place on a bulletin board if available within your department or shared PDF versions by email or on website) Yes No 14. As a HealthyUNCG Wellness Champion, I agree to work with HealthyUNCG to plan and implement two to three wellness initiatives annually Yes No 15. As a HealthyUNCG Wellness Champion, I agree to communicate opportunities for partnership or events/programs as related to the mission of HealthyUNCG Yes No 16. As a HealthyUNCG Wellness Champion, I agree to attend Annual/Biannual celebratory events hosted by HealthyUNCG to thank you for your support and commitment to the program Yes No 17. I have discussed my interest in becoming a HealthyUNCG Wellness Champion with my supervisor and have gained approval to serve in this role for my department/office. Yes No 18. I will attend one of the following HealthyUNCG Wellness Champions Orientation/Trainings: August 17th from 11 - 1 in person (lunch) August 18th from 11:30 - 1 via Zoom Δ Join the HealthyUNCG ListServ Email Δ Stay up to date with HealthyUNCG Workshops, Classes & Events! Click to view or add HealthyUNCG Calendar Find Us on Social Media and YouTube!