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Tri Wellness at Work Interest Form

If any assistance is needed, please contact us:
  • Kristy Heying: kristy.heying@co.sherburne.mn.us or 763-765-4106
  • Mariah Klein: mklein@co.benton.mn.us or 320-968-5250
  • Melissa Godwin: melissa.godwin@stearnscountymn.gov or 320-656-6141

Expectations for Tri Wellness at Work Participants:
  • The 6-8 month learning phase typically begins in fall/winter.
  • Typically, meetings are held monthly and in-person and are approximately 2 hours long.
  • One employee from each organization must attend every monthly meeting (if the main contact cannot attend, the organization must provide a back up person). It is highly recommended to have two contacts from each organization.
  • Complete assessments, workplan, and evaluation, gain leadership support, and create a wellness committee. Technical assistance from SHIP staff will be available.
1.Organization Name(Required.)
2.Organization's Main Physical Address (street address, city/town, state, zipcode)(Required.)
3.Select the type of industry that best describes your organization (select one):(Required.)
4.Total Number of Employees(Required.)
5.Do any of the following apply to your organization? (select all that apply)(Required.)
6.Primary Contact Information(Required.)
7.Does your organization currently have a work site wellness or employee wellness program?(Required.)
8.How did you learn about SHIP Tri Wellness at Work?
9.Please list any questions/comments you have for us or other information you would like us to know about your work site:
Current Progress,
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