2024-2025 Staff Wellness Challenges Request Form

Please complete the form below to submit your request for all staff wellness challenges.

Organize a minimum of 10 staff participants.
Choose a level (length of time challenge will take place).
Choose an activity or email us to check if your activity applies.

*Each school may participate in an unlimited amount of staff challenges from any of the three levels. However, schools will be limited to one incentive at each level (ie. $25 gift card at Level 1, $50 gift card at Level 2, $100 gift card or AtlantiCare LifeCenter 3 Month Membership at Level 3). For example, you can participate in as many Level 1 activities as you would like, but are only eligible to receive one $25 gift card for the school year.

After the final week of each challenge please share a short summary of activities, highlights, and participation to healthyschools@atlanticare.org

All requests due by May 9, 2025

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* 1. School Name:

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* 2. School Address:

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* 3. Name of Person Completing Form:

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* 4. Email of Person Completing Form:

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* 5. Alternate Contact Name:

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* 6. Alternate Contact Email:

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* 7. Participation:

By checking this box, we confirm we have a group of at least 10 staff members who will participate in the challenge.

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* 8. Staff Challenge Level:
*Only 1 challenge per form

Level 1 - 1 Week+ long staff challenge / $25 gift card support

Level 2 - 4 Week+ long staff challenge / $50 gift card support

Level 3 - 8 Week+ long staff challenge / $100 gift card support or AtlantiCare Life Center 3 Month Membership

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* 9. Planned Start Date of Challenge:
*For Believe to Achieve, please submit requests at least 3 weeks in advance to schedule a team member for Tanita weigh-ins

Date / Time

Date

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* 10. Planned End Date of Challenge:

Date / Time

Date

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* 11. Staff Challenge Type:
*Only 1 challenge per form

Holiday Tag! You're It - Organize a staff compliment/pay-it-forward challenge, centered around a holiday or theme. Ex: Back to School Apples, Halloween Ghosts, Valentine Hearts, Lucky Shamrocks. Staff who earns the most compliments wins a prize.

Morning/Afternoon Staff Fitness - Weekly staff walks, yoga classes, or fitness classes that take place before or after the school day.

Believe to Achieve - A fitness challenge, accompanied by weekly newsletters with exercise challenges, healthy recipes and other wellbeing resources. A Healthy Schools team member will visit your school during the first and final week to administer a body composition analysis with a Tanita scale.
*Please submit requests for Believe to Achieve at least 3 weeks in advance of planned start date

Staff Cookbook/Wellness Book - Create a compilation of staff recipes or mindfulness activities.

Staff Buddy - Organize a staff buddy exchange where staff members are randomly assigned another staff member for exchange multiple times throughout the year. Minimum of three exchanges to be eligible for this level.

Fruit and Veggie Challenge - A nutrition challenge where staff will track their daily fruit and vegetable intake accompanied by weekly newsletters with exercise challenges, healthy recipes and other wellbeing resources.

Hydration - Track daily water intake accompanied by a tracking document based on amount of weeks.

Walking Challenge - Track daily steps accompanied by a tracking document based on amount of weeks.

Create Your Own! - Please email us at healthyschools@atlanticare.org with your proposal

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* 12. Description/Plan for Staff Wellness Challenge:

Once request is received, a Healthy Schools Team member will confirm receipt within 72 hours. If you do not receive a confirmation, please email a team member at healthyschools@atlanticare.org.

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* 1. School Name:

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* 2. School Address:

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* 3. Name of Person Completing Form:

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* 4. Email of Person Completing Form:

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* 5. Alternate Contact Name:

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* 6. Alternate Contact Email:

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* 7. Participation:

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* 8. Staff Challenge Level:*Only 1 challenge per form

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* 9. Planned Start Date of Challenge:*For Believe to Achieve, please submit requests at least 3 weeks in advance to schedule a team member for Tanita weigh-ins

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* 10. Planned End Date of Challenge:

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* 11. Staff Challenge Type:*Only 1 challenge per form

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* 12. Description/Plan for Staff Wellness Challenge:

* 8. Staff Challenge Level:
*Only 1 challenge per form

* 9. Planned Start Date of Challenge:
*For Believe to Achieve, please submit requests at least 3 weeks in advance to schedule a team member for Tanita weigh-ins

* 11. Staff Challenge Type:
*Only 1 challenge per form