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 and submit at least 30 days before the activity. The WebMD team 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.

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* 1. Employer Name

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

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

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* 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.

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

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Date

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

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

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

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

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* 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.
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