Wellness Champion Nomination Application

The Hidalgo County Wellness Program encourages all Hidalgo County employees, Department Heads, and Elected Officials to nominate a colleague who models a healthy lifestyle, has made significant changes in their health behaviors, or helps to motivate others into making healthy lifestyle improvements. Each month, one Wellness Champion will be featured on the Hidalgo County Wellness Beat monthly newsletter. All Hidalgo County employees are eligible nominees.

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* 1. Nominator's full name:

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* 2. Nominator's E-mail Address:

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* 3. Nominator's Phone Number or Work Extension:

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* 4. Nominator's current department:

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* 5. Nominee's full name:

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* 6. Nominee's E-mail Address:

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* 7. Nominee's Phone Number or Work Extension:

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* 8. Nominee's current department:

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* 9. Nominee's job title:

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* 10. Please explain why you have nominated this employee below:

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* 11. To your knowledge, is the Nominee currently active in the Hidalgo County Wellness Program by attending any of the following wellness events: Virtual Health Talks, Wellness Webinars, Fitness Classes, Health Fairs, Wellness Challenges, additional departmental specific Wellness Program Events.

Yes