WellPATH Champion Pledge Form

WHAT IS A WELLNESS CHAMPION?

A Wellness Champion is an on-site ambassador for the WellPATH program who is committed to creating a workplace culture of health and wellness. The Wellness Champion shares wellness-related information with coworkers and helps them connect with wellness programs and activities offered by WellPATH, the district’s employee wellness program. Having a Wellness Champion as a point of contact at each worksite helps to increase program awareness and participation.

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* 1. Contact Information

First Name

Last Name

Department/Title

Email Address

Work Phone Number

T-Shirt Size

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* 2. Please select your school or department.

Elementary Schools	Middle Schools	High Schools	Departments
If your school or department is not listed, please select other.
If your school or department is not listed, please select other. Elementary Schools menu	If your school or department is not listed, please select other. Middle Schools menu	If your school or department is not listed, please select other. High Schools menu	If your school or department is not listed, please select other. Departments menu

Other (please specify)

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* 3. Number of employees at your site:

Less than 25

25 - 50

50 - 75

75 - 100

100 +