Please provide a response to each of the questions below and attach documentation where requested. Each wellness council may submit one application in this annual awards cycle. Applications will be accepted through May 6, 2026 and should describe one wellness activity or initiative implemented from May 5, 2025 - May 1, 2026.

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* 1. Organization Name

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* 2. Name of Your Wellness Council (If your council has a name)

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* 3. Number of employees at your worksite served by your wellness council or wellness efforts

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* 4. Name of person completing this application (contact person)

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* 5. Contact person's job title

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* 6. Contact person's email address

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* 7. Contact person's business phone number

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* 8. Organization's physical address

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* 9. How long has your wellness council been in place?

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* 10. Applicants are required to complete the Worksite Wellness Scorecard at least once every 2 years. What date did you most recently complete the Worksite Wellness Scorecard?

Date

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* 11. Name the Wellness Activity or Initiative you are describing in this application

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* 12. The wellness activity or initiative described in this application addresses the following area(s) of well-being (you may select more than one area):

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* 13. Please specify who an award check should be written to: Must include the organization's name, but may also include individual's name if desired. (for example: <Organization Name> OR <Individual Name>) *Total characters, including spaces, cannot exceed 44. Otherwise, you will get an error and the application can't be submitted.

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* 14. To what address should a check be sent?

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* 15. Is your organization or wellness council able to accept funds via Electronic Funds Transfer?

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* 16. In 1-3 paragraphs, describe the activity and how it was implemented. (For example, how did you decide to conduct this activity? What was the goal? How did you promote it? What was the timeline for planning and implementation? What resources were required?)

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* 17. Describe at least two positive outcomes that were a result of the activity or initiative (2-3 sentences)

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* 18. What lessons were learned that could help you as you plan future activities? (2-3 sentences)

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* 19. How did you evaluate the success of your activity? Include data or feedback that will demonstrate the impact or success of this activity (Number of participants, positive remarks, survey responses, etc.) (2-3 sentences)

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* 20. Provide documentation of your activity with attachments such as photos, flyers, promotional materials, email communication, etc. Please submit this in one PDF document and upload it here (maximum of 10 pages can be submitted).

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

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* 21. Please provide the name, title and email address of a senior manager at your organization that is aware of and supports your application.

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* 22. Would you be willing to share your wellness council's achievements at the 2026 PEHP Wellness Council Conference? (This would be in a roundtable format with smaller groups.)

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