Wellness Grant Exit Survey

  • Date Format: MM slash DD slash YYYY
  • Please rank the following statements.

  • As outlined in the terms and conditions of the grant application, the following elements needed to be met in order to be eligible for the next grant cycle. Please check the appropriate box if you believe you have satisfied these requirements.

  • If you'd like to provide a testimonial to the benefits of this grant or any photos that can be used to support the program, please feel free to do so in the space provided below.