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WellPath Event Nomination Form

WellPath Endorsed Events are considered and approved based on the following criteria: accessibility, benevolence, and health benefits. Please answer all questions or provide specific information about the event you are nominating. The event must have a website with registration and/or information to be endorsed. All WellPath Endorsed Events will be approved for 10 WellPath points.
1.Name:
2.Employee ID:
3.Email Address:
Please answer the following questions about the event/activity you are nominating:
4.Event Name:
5.Start Date:
Date / Time
6.End Date:
Date / Time
7.Is this event accessible by all or a majority of employees?
8.Is the registration and information for this event on the web?
9.Does a portion of their proceeds go to a non-profit cause?
10.Is this event sponsored by an alcohol or tobacco product?
11.Will alcohol or tobacco be provided?
12.Comments:
Thank you for your event nomination. WellPath will review your submission and provide you a response via email. For questions, please email us at Wellness@SRPMIC-nsn.gov.