POWER UP Employee Wellness                                     Well-being Activator Application
Thank you for your interest in becoming a POWER UP wellness champion! UH faculty/staff "Well-being Activators" support employee health and well-being by promoting POWER UP and encouraging engagement in wellness opportunities on campus.
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Email *
Last Name, First Name *
What is your work phone number? *
Which department/college do you work in: *
Your position/title: *
Which colleges/departments or areas would you be able to represent and serve? *
What is your building name (or number), and your office/room number?
What is your mail code? *
Are you able to fulfill the role of a Well-being Activator? *
Well-being Activators: "COMMUNICATE" and spread the word about wellness programs and resources!  They share ideas and provide feedback. They "ENGAGE" and encourage participation in wellness opportunities, "COLLABORATE" and advocate for employee health and well-being, and "COMMIT" to focusing on their own personal health and well-being, to self-care and to having FUN!  Well-being Activators must have the support of their supervisor to participate.  Members will attend an initial orientation and 1 hour monthly meetings.  They will contribute 2-3 hours a month to the program (1 of which is the meeting), and agree to a two year term of service.
Which of the following attributes of a Well-being Activator apply to you? *
Required
Why would you like to become a Well-being Activator? *
What two goals  do you have to improve health and well-being within your college, department or area? *
Are there any specific times or days of the week that absolutely do not work for you to meet?
What is your preferred T-Shirt size?     *
Will your supervisor support your contribution to the campus community in this role? *
Supervisor Last Name, First Name: *
Supervisor email: *
Supervisor phone number: *
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