Be:Well Member Application

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Thank you for your interest in the ESD 112 Be:Well Committee! We invite you to discuss your interest with your supervisor and answer a few questions below. Members are asked to attend monthly meetings which are currently held via Zoom.

This committee represents all ESD 112 departments (with employees of varying years of experience, and a range of job titles and responsibilities).

If you would like to support this work but cannot make a full-time commitment to the committee, there are opportunities to get involved in select projects or initiatives. Contact us at bewell@esd112.org for more information.

Email *

What is your name? *

What is the program/department you work in? For example: Specialized Student Services Early Intervention Birth-3 *

What are you hoping to learn or do, through this the committee? What perspectives or goals will you bring to the Be:Well committee? What do you hope to take back to your department? *

Are you currently a member of another ESD 112 committee? If yes, please list which one. *

Is there anything else that you would like for us to know? *

How did you hear about the committee? *

I have talked to my supervisor about my interest and have my supervisor's approval. *

YES

Send me a copy of my responses.

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