Date *

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Your Name *

First Name

Last Name

Person your Nominating *

First Name

Last Name

Date of Birth

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Address

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7 Dimensions of Wellness Category *

Please choose one category per nominee

Physical Wellness: Physical wellness is achieved through optimal nutrition and exercise, building flexibility, strength, and endurance, while accessing necessary education and services to prevent and treat illness.

Emotional Wellness: Emotional wellness is achieved through the ability to manage one’s negative and positive feelings, cope with stress, and check limitations with assistance from friends and family

Spiritual Wellness: An individual's Spiritual Wellness is determined by his or her connection to something larger than himself or herself, as well as the values, principles, morals, and beliefs that provide meaning and purpose to their lives, and how they apply those principles to their actions.

Environmental Wellness: Defined by the livability of your surroundings and maintaining and replenishing the resources we need to support current and future life is the goal

Intellectual Wellness: Our minds need to be continually inspired and exercised just as our bodies do. People who possess a high level of intellectual wellness have an active mind and continue to learn.

Occupational Wellness: Achieving optimal occupational wellness allows you to maintain a positive attitude and experience satisfaction/pleasure in your employment.

Social Wellness: This means learning good communication skills, developing intimacy with others, and creating a support network of friends and family members.

Are you nominating yourself? *

Yes

No