Cities For Workforce Health: Grant Application for 2020 Wellness Program Seed Grant

General Information

Application DUE DATE: July 19, 2019

Please complete this application to the best of your ability. It should take you about 30 minutes to do so and you must complete the application in one session. Be sure to hit "Submit" once you have completed all answers.

This application is built with survey logic so that you get questions that are most appropriate to your city based on the answers that you provide. Be sure to hit "Submit" once you have completed all answers.

1. Please provide the following: *This question is required.

Name of city that is applying for the grant:
First & Last Name (who we will contact for anything related to this grant):
Title:
Email address:
Phone:

2. Geographic region (select one): *This question is required.

3. Number of full-time employees: *This question is required.

4. Number of part-time employees: *This question is required.

5. Has your city joined the Healthy Eating Active Living Cities Campaign (http://www.healcitiescampaign.org/) *This question is required.