What is the name of your organization? Phone Number What is your email address? How do you prefer to communicate? How do you prefer to communicate? Text Phone Call Email Does your organization have Social Media accounts? If so, give handle: Does your organization have Social Media accounts? If so, give handle: Instagram Facebook LinkedIn Do you have an existing health and wellness program? Do you have an existing health and wellness program? Yes No If yes, have you been able to establish a fundraiser with your health and wellness program? If yes, have you been able to establish a fundraiser with your health and wellness program? Yes No If no, are you interested in creating and supporting your community with bettering wellness through a fundraiser program? If no, are you interested in creating and supporting your community with bettering wellness through a fundraiser program? Yes (please continue) No. Thank you for taking a look at our program, you can close the window. 5 + 9 = Submit Detailed your current Health and Wellness program in your organization Do you have an existing health and wellness program? Do you have an existing health and wellness program? Yes No How would you describe your current health and wellness program? How would you describe your current health and wellness program? Diabetes Prevention Program Wellness Coach and/or healthcare professional on staff Heart Health Program Monthly health programs Weekly health programs Once a year health fair Farmers Market Food Bank Never had a health program How would you describe your program? How would you describe your program? Very Successful Moderately Successful Not Successful and want to get people engaged When was your last health event? When was your last health event? Less than a month ago 2 - 6 months ago 6 months + Does your organization have administration on board with having a wellness program, I.e., leadership, management? Does your organization have administration on board with having a wellness program, I.e., leadership, management? Yes No Have your participants seen success within the program? Have your participants seen success within the program? Yes No Are you currently in the National Diabetes Prevention Program (NDPP) as an organization? Are you currently in the National Diabetes Prevention Program (NDPP) as an organization? Yes No Are you interested in the NDPP? Are you interested in the NDPP? Yes No What are your top priorities or concerns for you organization? What days are best for a Zoom Call if you are interested in our Health and Wellness Fundraiser? What days are best for a Zoom Call if you are interested in our Health and Wellness Fundraiser? Monday Tuesday Wednesday Thursday Friday Sunday What time zone is your organization? What time zone is your organization? Eastern Central Mountain Pacific Hawaiian GMT What timeframe is best for your Zoom? What timeframe is best for your Zoom? Mornings (10a - 12p) Afternoon (12p - 4p) Evening (4p - 7p) Is there anything else you’d like for us to know before our Zoom? 1 + 13 = Submit
