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. TRUE or FALSE: Saying 'no' and making your own choices are small steps towards self-giving.

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* 10. What are consequences of not making time for yourself? Select all that apply.

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* 11. TRUE or FALSE: Decreased stress, improved attitude and immune system, increased energy and self-esteem are all benefits of self-giving.

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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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