Mini Grant Application Let us know which wellness opportunity would be most meaningful to your team! Question Title * 1. Department Question Title * 2. Facility Question Title * 3. Pick a Fun Team Name for your department grant! Question Title * 4. Wellness Ambassador Lead: Name * Email * Phone Number Question Title * 5. Wellness Ambassador Co-Lead (if applicable): Name * Email * Phone Number Question Title * 6. Approving Manager: Name * Email * Phone Number Question Title * 7. Wellness menu item requested Beyond KP Department Series - offered by LWBW staff Care Packages Create YOUR own Adventure Cues to Wellness Action - Items for YOUR environment Department Snack Cart Fitness Class - Interval Training & Bootcamp Fitness Class - Kickboxing Fitness Class - POUND Fitness Class - Spin Class Fitness Class - World Dance Fitness Class - Yoga Fitness Class - Zumba Fitness Corner Fitness Recess Heart Math Wellness Station Host a Department Picnic Host a Gratitude Letter Making Table Host a Preventative Screening Day for Employees Host an Affirmation Art Station KP Adult Day Camp Meditation Corner Mindful Meditation/Gratitude - offered by LWBW staff Resilience Lunch & Learn Webinar Stretch & Strength Sessions Virtual - 30 Day Active Living Challenge Virtual - 30 Day Walk/Run Challenge Workshop - A Balanced Life Workshop - Empathy Workshop - Find Your Zest Workshop - Holistic Nutrition 101 Workshop - Let Go of Sugar Workshop - Mindful Eating Workshop - Stick it to Stress Workshop - Strength Based Leadership Workshop - Superfoods Workshop - Sustainable Nutrition Question Title * 8. Wellness Alignment ( select all that apply ): Healthy Workplace Nutrition Fitness Community Prevention Emotional Health & Wellness Cross Cutting Question Title * 9. Wellness grant $ amount requested: Question Title * 10. What would be purchased with grant funds? Question Title * 11. Preferred date of event: Question Title * 12. Alternative date of event: Question Title * 13. Preferred time of event: Question Title * 14. Location of wellness activity: Question Title * 15. Number of estimated participants: Question Title * 16. Total number of staff and physicians in department: Question Title * 17. How will you promote the event to employees? Question Title * 18. Purpose of request (what is the purpose of the request and how will it impact employee wellness?): Question Title * 19. Any expected wellness or health related outcomes as a result of your project? Question Title * 20. By checking the boxes below, I attest that the following steps will be completed if grant is funded: My department is responsible for organizing and implementing the event/project requested Manager approval of grant My team is interested in activity selected The estimate number of participants reflects true interest in the department Upon acceptance of grant I will commit to a 15-minute planning call with lwbw I will arrange the space, such as book conference rooms or identify location, (if applicable) upon acceptance of grant I will promote the event details to staff via email and other appropriate methods (i.e. huddles) I will be point person for vendor upon arrival (if applicable) I will provide staff the participation sign in sheet at event and email to lwbw at conclusion of event I will send in any approved OneLink expense reports with receipts or invoices I will send photos of my implemented event or project to lwbw I will send all participants a post-event SurveyMonkey via email for feedback Done
