Faces of Wellness application form

Self nomination

Full name

Enter your full name.

We’ll send a confirmation message to this email once the application form is submitted.

Enter a valid email address.

Phone number

Enter a phone number including the area code.

Ext.

City

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Province

Postal code

Enter a valid postal code.

1. What does wellness mean to you and how do you integrate it into your life in ways that go beyond your personal benefit?

Wellness can include physical, mental or social wellbeing. Share how you define it. Also, how your daily choices, routines or advocacy extend that definition to support others, challenge stigma or create healthier environments.

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Tell us what wellness means to you and how you integrate it into your life.

2. How do you support wellness in your community and/or workplace in lasting, meaningful ways?

Tell us about specific actions you’ve taken, such as volunteer work, mentorship, advocacy, or creative initiatives that promote wellness.

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Tell us how you support wellness in your community and/or workplace.

3. What are the kind of challenges you have faced and how did you find the courage to overcome them?

Wellness isn’t always a smooth path. Share your story and how you found strength in the face of adversity. Sharing your experience might help someone see themselves in your journey and feel less alone.

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Tell us about a challenge you have faced and how you found the courage to overcome it.

5. Where did you hear about Faces of Wellness?

Tell us how you heard about Faces of Wellness.

Upload attachments (optional) The total maximum file size is 21 MB.

You can upload supporting documents or photos to help illustrate your nominee’s wellness story and impact.

Drag and drop files or

We accept images and documents.

Declaration

Required: I confirm the information provided is truthful to the best of my knowledge. I understand that Alberta Blue Cross^® may contact me about my application.

Check the box to confirm the information is truthful and that you understand Alberta Blue Cross® may contact you.

Optional: Email me about any future grant opportunities from Alberta Blue Cross^®.

Full name

Enter your full name as your signature.

Submission date

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