Grant Application

To be considered for a wellness grant, all sections of the grant application must be completed. Please review the sample application before submitting your application.

1. What is your department name and location?

2. What is your name and title?

3. What is your work e-mail address?

4. How many employees are in your department?

5. Do you have at least one Wellness Champion on your team? (Yes or No)


6. Indicate which type of activity your grant activity will focus on and write a 2-4 sentence goal describing your commitment to promoting wellness habits through realistic, achievable changes.

7. Write 1 to 4 paragraphs describing how your team will accomplish this goal with grant funds.

8. Propose a budget between $200 and $1000. (Goals and activities must align with funds request.)

9. Select your team’s level of wellness practice and knowledge:

Wellness Pioneers (beginners)Wellness Experts (intermediate)Wellness Visionaries (advanced)

10. Which wellness practices does your department already have implemented: (Check all that apply)