2022 / 2023 WellPATH Service Request Form WellPATH Service Request Form Question Title * 1. Contact Information First Name Last Name Department/Title Phone Number Email Address Question Title * 2. Please select your school or department. Elementary Schools Middle Schools High Schools Departments If your site is not listed, please include your location below. Addams Addicott Anthony Ayer Aynesworth Bakman Balderas Birney Burroughs Calwa Centennial Columbia Del Mar Easterby Eaton Ericson Ewing Figarden Forkner Fremont Gibson Greenberg Heaton Hidalgo Holland Homan Jackson Jefferson King Kirk Kratt Lane Lawless K-6 Leavenworth Lincoln Lowell Malloch Manchester GATE Mayfair McCardle Muir Norseman Olmos Phoenix Elementary Academy Powers-Ginsburg Pyle Robinson Roeding Rowell Slater Southeast Starr Storey Sunset Thomas Turner Vang Pao Viking Vinland Webster Williams Wilson Winchell Wishon Wolters Yokomi If your site is not listed, please include your location below. Elementary Schools menu Ahwahnee Baird Bullard Talent K-8 Carver Academy Computech Cooper Academy Gaston Fort Miller Hamilton K-8 Kings Canyon Rata Scandinavian Sequoia Tehipite Tenaya Terronez Tioga Wawona Yosemite If your site is not listed, please include your location below. Middle Schools menu Bullard Cambridge CART Design Science DeWolf Duncan Edison Fresno Hoover McLane Phoenix Secondary Roosevelt Sunnyside If your site is not listed, please include your location below. High Schools menu Cesar Chavez Adult School Administrative Services Adult Education After School Program Athletics Benefits Campus Culture Career Readiness Career Technical Education Center for Professional Development Character Education Communications Constituent Services Counseling Services Curriculum and Professional Learning District and School Accountability and Improvement Early Learning Electronics Shop English Learner Services Facilities Management & Planning Fiscal Services Food Services Gifted and Talented Education (GATE) Graduation Task Force Grants Office Graphic Communications Health Services History/Social Science Home Hospital Instruction Services/District 504 Human Resources/Labor Relations Information Technology Instructional Media Center (IMC) Instructional Technology and Innovation (ITI) International Baccalaureate Leadership Development Maintenance & Operations Migrant Education Operational Services Parent University Physical Education Prevention & Intervention Professional Learning Project ACCESS/Passport to Life Purchasing Research, Evaluation, & Assessment Risk Management Safety and Security Department School Leadership Science Social Emotional Support Special Education Office State & Federal Programs Summer School Superintendent's Office Teacher Development Telecommunications Transfers Office Transportation Visual and Performing Arts Warehouse/Distribution Center Workers Compensation If your site is not listed, please include your location below. Departments menu Other (please specify) Question Title * 3. Number of employees at your site: Less than 25 25 - 50 50 - 75 75 - 100 100 + Question Title * 4. What type of WellPATH onsite event are you requesting today?All WellPATH-sponsored activities are open to active employees, spouses, domestic partners, dependent children age 18+, early retirees, and Medicare-eligible retirees covered under the District’s health benefit plan. Flu Shot Clinic (typically held September-November) Wellness Screening (available year round- must be 10+months since your site last held a wellness screening) Group Fitness Class Other (please specify) Next