This survey will serve as your application for hosting an employer-sponsored activity for the Well Wisconsin program. Please complete the questions below requesting the details of your activity for consideration. Well Wisconsin program managers will review your application and reach out directly with any questions. If you have any questions in the meantime please email WellWI-employersupport@webmd.net.

Question Title

* 1. Employer Name

Question Title

* 2. Provide the following contact information. This information will be used by the Well Wisconsin team to contact you regarding future details related to this well-being activity.

Question Title

* 3. What is the name or title of the employer-sponsored activity?

Question Title

* 4. Select the option below that best describes your employer-sponsored activity. Participants will select this description when self-reporting the well-being activity at webmdhealth.com/wellwisconsin. Download our how-to guide for reporting employer-sponsored activities to easily communicate this step to participants.

Question Title

* 5. What are the start and end dates of this activity?

Date
Date

Question Title

* 6. Provide a detailed description of the activity, including any names and credentials of any expert you may bring in for the activity.

Question Title

* 7. Describe how this activity provides health education or promotes healthy behaviors.

Question Title

* 8. Describe the steps participants will take to complete the activity (ex: sign in for event, submit a tracking sheet, etc.).

Question Title

* 9. How many participants do you anticipate completing this activity?

Question Title

* 10. Describe how the activity will be promoted to participants.

Thank you for your support of the Well Wisconsin program.
If you have questions related to this or other well-being activities, please contact us at WellWI-employersupport@webmd.net.
( Privacy & Cookie Notice

T