Wellness Champion Nomination Form

Your Name (the nominator):

Who would you like to nominate?

A wellness champion is someone who has one or more of the following traits. Please select which of the traits the person you are nominating contains:

Maintains a balance and consistency in one or more aspects of a healthy lifestyle (physical, emotional, financial, social, environmental, spiritual, occupational, intellectual)

Someone who sets an example within their department of incorporating healthy habits in or outside of the workplace

Someone who has set and accomplished a personal improvement goal related to health

Someone who has improved their biometrics markers (A1c, blood pressure, etc.) through working with the health and wellness staff and participating in the PHP

Someone who is heavily involved with the wellness center and participates in what they offer

Describe how the nominee has demonstrated the behaviors selected above & why they're deserving of this nomination:

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Wellness Champion Nomination Form

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