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Workplace Wellness Grant Program Application
F-01634 (03/2017)


The information provided on this form serves as an application for the Workplace Wellness Grant Program created in accordance with 2013 WI Act 137.

There are two steps needed to complete the Workplace Wellness Grant Program Application.
1. Complete this online application and submit it to the department.
2. Follow-up submission of the application by sending the required form(s) listed at the end of the application.
Survey Tips:
  • The required questions are highlighted by an asterisk (*) and must be answered to receive grant funds. Optional questions about wellness program components will provide information that may be helpful for future funding, and in providing technical assistance to worksites.
  • Use the navigation buttons at the bottom of the page instead of your internet browser's navigation.  
  • Select "Save and continue later" at the top of the page if you are unable to complete it in one sitting.  You will be sent an email from SurveyGizmo with the link you need to continue. You will need to use the emailed link if you wish to return to the application and automatically retrieve your earlier responses.
  • You will not be able to return to any saved responses once “Submit” is selected on the last page.