Please complete the following application to participate in the Cerro Gordo County Department of Public Health's Workplace Wellness Award & Recognition Program for 2017. We look forward to recognizing local business wellness efforts and we thank you for taking the time in applying for the award on behalf of your organization.

* 1. Name of Organization:

* 2. Organization Street Address:

* 3. City:

* 4. Nature of Business or Industry:

* 5. Does the organization have multiple sites that benefit from the wellness program:

* 6. Number of employees: (Including Full-Time, Part-Time, and Contracted Employees)

* 7. How many years has your worksite wellness program been in place?

* 8. Is your business a designated Blue Zones worksite?