2021 Holiday Trimmings HONU Pre-program

The information below is being used to help HONU evaluate who is participating in the program, what sort of changes participants experience in the program, and how we can better improve programs for the community. You will be asked if it is okay to share your name with your employer if they use Holiday Trimmings as part of their worksite wellness program. No other individual information will be released. Any reporting of results will contain only summary information. By completing this survey you are voluntarily consenting to allow the HONU program to include your data in the evaluation of the Holiday Trimmings program. A follow up survey will also be conducted at the conclusion of the program. Participants who complete BOTH surveys will be entered in a drawing for $50 in Chamber Bucks that can be used at any Chamber member organization.

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* 1. Contact information:

Name:

Address:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

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* 2. How did you learn about the Holiday Trimmings program?

From a friend or co-worker

Employer promoted it

New Um Journal

HONU Newsletter

E-mail promotion

Social Media

Springfield Newspaper

Other (please specify)

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* 3. Who is your employer? (If employed within Brown County, otherwise N/A)

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* 4. Please think about your overall well-being: physical health, mental health, and social well-being. Select the response below that best aligns with your current level of well-being.

Very positive

Somewhat positive

Neutral

Somewhat negative

Very negative

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* 5. Have you participated in the Holiday Trimmings program before?

Yes

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* 6. I agree to allow the release of my name to my employer as a participant in the Holiday Trimmings program.

Yes