To receive credit towards the 2021-22 Healthy Actions Medical Plan. Please complete this form and upload your certificate awarded to you for completing the Wellness Webinar.

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* 1. First Name

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* 2. Last Name

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* 3. Date of Completed Training

Date

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* 4. Employee ID Payroll Number

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* 6. E-mail Address

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* 9. Increasing well being can... (Select all the apply.)

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* 10. Which of the following are ways to stay active at home? (Select all that apply.)

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* 11. TRUE or FALSE: Barriers to staying active can include: no time, no motivation, finding exercising boring and being tired.

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* 12. Please upload the certificate of attendance you received via e-mail from the Cigna Employee Assistance Program (EAP). Only PDF, DOC, DOCX, PNG, JPG, JPEG, GIF files are supported.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File
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