CCS Wellness Programming Request Form

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Use this form to request CCS Wellness Programming. Our Wellness Initiative hosts programming for staff events on days including, but not limited to: Professional Development days, Records days, staff meetings, and afterschool. NOTE: Vendors require at least a 4- 6 week timeframe to ensure proper staffing for your event. Please contact syerramilli@columbus.k12.oh.us if you have any questions.

Click each item below to add your answer.

General Information

Name of CCS location hosting Wellness Programming *

CCS location front office phone number *

Street address of CCS location hosting Wellness Programming *

Zip code of CCS location *

Region of CCS location *

Contact Information

First & last name of person requesting the Wellness Programming *

CCS email address of person requesting the Wellness Programming *

Work phone number or direct extension number of person requesting the Wellness Programming *

Preferred method of contact for person requesting the Wellness Programming *

CCS email address

Work phone number or direct extension number

Administrative Approval

CCS location administrator's first & last name *

Name of Principal or Supervisor

Has the CCS location administrator approved the request? *

Yes

Wellness Programming Information

The Wellness Programming will be held during: *

Professional Development Day

Records Day

Staff Meeting

Afterschool

Other:

The Wellness Programming will be held: *

Virtually

In-Person

Location of Wellness Programming: *

Include building name and room #. Type N/A if it will be held virtually.

Program Topics

Please select topic that you would like the CCS Wellness Team to present to your group. See examples for subjects relating to the program topic. NOTE: Vendors require at least a 4- 6 week timeframe to ensure proper staffing for your event.

Type of Programming requested *

Please check all that apply.

Chair massages (chair massages provided by established vendor of staff wellness initiative)

Financial Literacy (managing money, invest and use credit, money saving tips, financial wellness)

Leadership (personal and professional leadership)

Mindfulness and Movement (program with aromatherapy, gentle movements, postures, mindfulness, and breathing exercises)

Nutrition (healthy eating during your busy day, eating better on a budget, mindful eating, packing a healthy lunch)

Personal Empowerment (finding your purpose, resiliency, positive thinking, prioritizing your life)

Physical Activity (fitting fitness into your busy day, exercising at home, stretching, weight management )

Self-Reflection (diversity & inclusion practices using art, critical thinking, and storytelling to support creative learning)

Staff Wellness Initiative Offerings (learn about everything our CCS Wellness Initiative offers)

Stress Prevention (managing stress, resiliency, developing work/life balance, goal- setting)

Team Building (restorative practices, conflict resolution, motivation, customer service)

Wellbeing (wellness in the workplace, lifestyle changes, developing your personal wellness plan)

Yoga/Mindfulness (staff mindfulness & self care, incorporating mindful moments and yoga breaks in classrooms)

Required

Programming Details

Date of the Wellness Programming *

YYYY

Start Time of the Wellness Programming *

Time

Duration of the Wellness Programming *

30 minutes

1 hour

2 hours

3 hours

I have included a special time request in the comments box

Type of staff attending the Wellness Programming *

Please specify the audience (ex: teachers, principals, secretaries, transportation staff etc.)

Number of staff members attending the Wellness Programming *

Please provide your best estimate on the number of staff attending the program.

Additional Information

To gain a better understanding of the specific wellness needs of the audience, please respond the the following questions.

Describe some everyday challenges that the staff members attending the Wellness Programming, may encounter in their work life.

What outcomes are you looking to achieve with this Wellness Programming?

What are a few things that would make this Wellness Programming successful for your staff?

Comments

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