Worksite Wellness Awards Application

Please fill out the application below for the Mayor's Healthy Hometown Movement Worksite Wellness Awards.  The Awards will be announced at the GLI annual banquet on March 10.
Organization being nominated: (You may nominate your own company)
Program/Project Name: *
Address Line 1: *
Address Line 2:
City: *
State: *
Zip Code: *
Phone: ext:*
Fax: *
Website:
Contact Person: *
Email: *
Business Size:
*
Nomination being submitted by:
Name: *
Title: *
Organization: *
Address Line 1: *
Address Line 2:
City: *
State: *
Zip Code: *
Phone: ext:*
Fax:
Email: *
Relationship to Nominee: *
How long have you had a worksite wellness program in place?
*
What made you decide to start a worksite wellness program at your company?
*
How many employees have participated in your program on an annual basis?
*
How many of those participants have achieved company or personal goals through participation in your company program?
*
In 300 words or less, describe your worksite wellness program. Why is your program outstanding or innovative? Discuss how your program has impacted the culture within your organization, any policies that have resulted from its implementation, and why it has been successful. Include stories of any employees meeting or exceeding personal goals, anecdotal successes, and applicable methods of evaluation.
 
You may also submit nominations to:

Mayor's Healthy Hometown Movement
Attn: Marigny Bostock
400 East Gray Street
Louisville, KY 40202

Submissions must be received no later than February 10, 2009.