Worksite Wellness Mini-Grant Application

Worksite Wellness Mini-Grant funding is available from PEHP anytime throughout the year depending on fiscal year budget on a first-come, first-serve basis to start or refresh a Wellness Council (inactive for over a year).

To be eligible to qualify for a Mini-Grant, please fill out the application completely, attach a letter of support from management, and a W-9 form. If you haven't completed the PEHP Worksite Wellness Scorecard within the past 12 months, please do so by clicking the link in Question 12.

If you have any questions about the application process or the status of your Mini-Grant, please email Jody Treu at jody.treu@pehp.org. Thanks!

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* 1. Please enter the following contact information:

Name of Primary Contact

Organization

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Number of employees who will benefit from this funding?

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* 3. Does your group have a dedicated budget for Employee Wellness? (Do not include any funding received from PEHP.)

Yes

If yes, enter the amount budgeted.

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* 4. Does your group have an established Wellness Council or Committee and if so, how long has it been in place?

Months/Years