TriCounty Worksite Wellness Initiative
Mini-Grant Program
Designed to promote wellness in the workplace.
Background
With people spending more and more time at the workplace and research demonstrating the health risks of prolonged sitting, worksite wellness is rapidly becoming a new norm. Obesity and its health complications are an epidemic in our country, and much of that is attributed to poor food choices and sedentary behavior. People have less time than ever to devote to taking good care of their health, and over 44% of Americans have at least one chronic health condition. The TriCounty Worksite Wellness Initiative was assembled to promote wellness in the workplace. Through this grant, we can assist you to have healthier, more productive employees. This mini-grant program is designed as a one-time reimbursement grant, for the purchase of items such as biometric screenings, supplies, speaker fees, yoga mats, pedometers, etc.
Eligibility
Applicant organization must be a current member of the Tri-County Chamber of Commerce, and previously accepted into the TriCounty Chamber of Commerce Worksite Wellness Program.
Applicant organization must track outcomes and measurements of proposed project.
Non-profit organizations may use this template. For-profit organizations should contact the TriCounty Area Chamber of Commerce Foundation for information.
Grant Terms
Please allow 6 weeks for approval process. If approved, signed contract should be returned immediately.
Grant term is a six month period.
One-time grant award per organization.
Grant award will not exceed $5,000.
A Final Report must be submitted by the end of the grant term for reimbursement.
A Final Project Budget, with cost documentation is required for reimbursement, (receipts, paid invoices, etc.). Please allow 4-6 weeks for reimbursement.
The Pottstown Area Health & Wellness Foundation will reimburse eligible organizations.
Applicant organization must agree to offer biometric screenings at months one and six, which will be supported by grant funds.
To Apply
Please submit completed Application to
Contact
Attn: Dr. Laurie Betts, Program Officer
Pottstown Area Health & Wellness Foundation
152 E. High Street, Suite 500, Pottstown, PA 19464.
Phone: 610-323-2006, x25 -- Email:
TriCounty Worksite Wellness Initiative Mini-Grant ProgramPROJECT INFORMATION
Grantee Name:
Person Requesting:
Contact Phone Number:
Project Type:
(Check all that apply) / Biometrics / Materials/Programming
Amount Requested:
Project Title:
Project Start Date:
Project End Date:
Organization Address and Locations:
Number of Employees:
Company’s Insurance Provider:
Project Description
Short description of theproject (approximately50 words)
CRITERIA QUESTIONS
Please demonstrate why the Worksite Wellness program will succeed at your company/organization (i.e. leadership buy-in, steering committee, employee enthusiasm, or other components that contribute to a successful culture change.)
PROJECT SCOPE
Explain what programs and activities you plan to fund with this grant.
PROJECT TIMELINE & BUDGET
Dates of your 6-month program (list activities)
Task / Dates of your Program / PAHWF Requested Funds / Organization Budgeted Funds
Biometrics 1
Biometrics 2
List of Other Activities
TOTAL
BUDGET INFORMATION
Grant Request
Biometric Results / $200 + (# of participatingemployees x $25) / Biometric 1
Pre $ / Biometric 2
Post $
Materials/Programming Costs (food, pedometers, yoga mats, lunch & learn fees, etc.) / $
Projected Total Project Cost / $
PROJECT OUTCOMES
Use list below to indicate measurable goals and outcomes. Please choose from the prompts below for your particular organization as applicable.
Biometrics Results
Absenteeism
Employees enrolled (part-time/full-time)
Employee evaluation results
Employee Morale
Pre-Employee Survey
Post-Employee Survey
Other
IMPORTANT NOTE All projects and project related cost and expenses must conform to the guidelines and limitationsoutlined in by PAHWF’s grant terms.
Name (print) Title Signature Date
Name (print) Title Signature Date
REQUIRED DOCUMENTATION TO RECEIVE FUNDING ONCE APPROVED (Allow 2 weeks for payment)
Signed Contract (return immediately)
Biometrics (pre) Invoice
Materials invoice(s) – if applicable
Biometrics (post) Invoice
Final Report
Terms and Conditions and Publicity Notices: This grant is subject to compliance to the Grants Terms & Conditions and Publicity Policy listed on the Foundation’s website:
Worksite Wellness Mini-Grant Procedures
Grant Term: 6 months
Application Deadline: Rolling acceptance (Please allow 4-6 weeks to respond to your request)
Maximum request amount: $5,000 (one-time grant)
Eligibility:Allow six weeks for approval
Compliance: Final report due at the end of 6 months
Please return application electronically to:
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