Wellness Champion Registration Form Become a Wellness Champion Sign up to be a Wellness Champion to represent your department by taking a lead on health and wellness programming Name*TitleE-mail*DepartmentDepartment or Campus unit you are representing? Department Size*How many people are in the department / office/ campus unit that you represent. Position TypeFacultyStaff (Non-Exempt)Staff (Professional)Staff (Executive)Campus PhoneCampus Mailing AddressDepartment, Building, Room #What reasons motivated you to sign up to become a Wellness Champion?*What health and wellness programs do you think are most needed in your department?*Be Well's philosophy is simple: Small steps can lead to big change. But we also recognize that different departments will face different challenges. So what ideas do you have?Please read the the following description of the responsibilities of a Wellness Champion before submitting your application. Wellness Champion objective: Be Well Seeks to improve the health and wellness of UT Knoxville employees through health education and wellness programming that support positive lifestyle choices. Wellness Champions serve as ambassadors for wellness between Be Well and their department. Champions will share Be Well updates, information about programs, events and resources to their departments. Sometimes Champions will be given tool-kits to assist in leading or organizing events for the represented area if they choose to participate. Wellness champions will also play an important role in shaping the wellness culture and programs offered by providing constructive feedback to the Be Well Coordinator regarding campus and specific area needs. Attributes of a Successful Wellness Champion: - Passion for personal health and wellness - Desire to help others - Enthusiasm for wellness programming Responsibilities: - Attend one wellness champion orientation meeting - Lead by example through practicing healthy behaviors and participating in Be Well programming when possible - Assist in communicating Be Well Program by sharing provided emails with respective departments and posting provided materials (poster, flyers, etc..) - Strive to build a culture of wellness within the office/department/building - Identify potential employee success stories and share them with the Be Well Coordinator - Serve as a trusted source for collecting feedback and input from Be Well program participants The Wellness Champion role is an additional, volunteer duty and should not interfere with primary job duties. Volunteers should maintain communication with supervisors regarding activities related to the Be Well Program. A reasonable amount of time involved with responsibilities listed above should be no more than two (2) hours per month* I understand and agree to all expectations of a Wellness Champion NameThis field is for validation purposes and should be left unchanged.