Application: Discovering Wellness

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This program for individual participants consists of a one-day retreat on Sat, Jan 30th, and then 4 half-day sessions on Friday mornings: 2/12, 3/12, 4/16, & 5/14.

PLEASE NOTE THAT THE APPLICATION DEADLINE HAS BEEN EXTENDED TO MONDAY, JAN 11th.

Name *

Email address *

Address *

Employer *

Job Title *

What do you consider to be your Park County community or neighborhood ? *

Where did you hear about the Discovering Wellness program? *

Discovering Wellness meets for a half day during the work week each month from February through March 2021. We recommend discussing the program commitment with your employer before applying. Although not required, our hope is that participants receive support from their employer in the form of paid leave and/or assistance with the program fee of $125. If selected into the program, which of the following will describe your situation? *

I am self-employed, this does not apply

Full employer support, with paid tuition and leave

Employer support, paid tuition only

Employer support, paid leave only

My employer knows I want to participate, but I need to cover my own program fee and figure out how to make up any work comittments I'll be missing during the monthly sessions

Other:

If the answer to the above question is "other", please explain: *

Please briefly describe your day to day work responsibilities. This will help us select a group of participants with both diverse and complimentary experiences. *

Please let us know your personal aspirations for wanting to participate in this program. *

If selected to participate in Discovering Wellness, how do you anticipate employing what you learn for the benefit of the community? *

By submitting this application, I understand that If I am chosen as a participant, I am expected to make a commitment to attend each program session. *

Yes, I understand and agree.

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