Rising Star Application

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Important Notes The activities described in your application should have taken place within the last 12 months.

Activities may be repeated for up to two (2) topics/requirements only.

Policies may be used for multiple topics/requirements.

Please do not submit any private or identifying information such as photos or names of employees who participated in activities, without proof of their consent (it may therefore be necessary to redact some of the information contained in evidence)

You can save and continue your application by clicking on the Save & Continue button at the bottom of the form. You will receive a link that is valid FOR 30 DAYS ONLY. Please enter your email to have the link sent to you – we cannot retrieve any partial entries on your behalf.

BUSINESS INFORMATION

Business Name(Required)

**Note: Workplaces may only apply for the Rising Star award level for up to two years.

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Person(Required)

Phone(Required)

Email(Required)

Website

Healthy Workplace Information

1. Choose ONE (1) wellness topic that you have focused on throughout the year.(Required)

2. Based on your wellness topic, provide evidence of the following health promotion strategies:

Promotion / Awareness Raising Activity(Required)

Education and/or Skill Building Activity(Required)

Environmental/Administrative Support Activity(Required)

Wellness Topic Evidence Submission(Required)

Please provide evidence demonstrating your organization’s implementation of EACH of the health promotion strategies discussed above.

Drop files here or

Accepted file types: pdf, jpg, doc, png, Max. file size: 300 MB.

3. WELLNESS STATEMENT SUBMISSION(Required)

ONE statement of employer’s commitment to wellness.