Health Promotion and Wellness Services



Health Promotion and Wellness ServicesApplication for Program SupportOrganization Name: _______________________________________________________Contact Person: __________________________________________________________Address: ________________________________________________________________Phone: _________________________________________________________________Email: __________________________________________________________________Title of Program, Project, or Initiative: _________________________________________Intended Date: ___________________________________________________________Intended Audience:________________________________________________________Please describe your proposed project, including: Projected Budget/ExpensesGoals of ProjectContent Overview/DescriptionAnticipated Outcomes and Measurement of OutcomesHealth and Wellness FocusType of Support Requested (check all that apply) Financial – Amount requested: $________________ Publicity/Marketing Resources – Specify: _______________________________________________ Logistical Support – Specify: __________________________________________ Other – Specify: ____________________________________________________Outreach Plan-Are you partnering with other organizations? If so, who?-Have you applied for funding from other services? If yes, from where did you receive funding and how much?Statement of PurposeThe Department of Health Promotion and Wellness Services (HPWS) provides high-quality, compassionate, and culturally-competent programs and initiatives to enhance the lives of students and promote social, personal, and academic growth. We seek programs that support this mission through engaging student learning opportunities. In the space provided, please describe how your program supports the mission of HPWS. GuidelinesCompleted forms should be submitted to HPWS no less than two weeks prior to your program if possible. The staff will determine whether we can provide the requested support. Once a decision has been made, a member of our staff will contact you. Decisions will be made based on available resources and demonstration of how the proposed project matches HPWS’ mission and focus. If accepted, you must list Health Promotion and Wellness Services in all promotional and marketing materials as a co-sponsor.Return completed application to: hpws@auburn.edu ................
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