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This form is used to enroll a company in the CBIA Healthy Connections wellness program and designate a Wellness Champion.
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How to fill out wellness program enrollmentchange form
How to fill out Wellness Program Enrollment/Change Form
01
Obtain the Wellness Program Enrollment/Change Form from the appropriate department or website.
02
Fill out your personal information, including your name, address, and contact details.
03
Indicate whether you are enrolling in the wellness program or making changes to your current enrollment.
04
If enrolling, select the specific wellness programs you wish to participate in.
05
If making changes, clearly outline the changes you wish to make.
06
Review all information for accuracy and completeness.
07
Sign and date the form.
08
Submit the completed form to the designated office or individual as indicated in the instructions.
Who needs Wellness Program Enrollment/Change Form?
01
Employees who want to join the wellness program.
02
Individuals who are already enrolled and need to make changes to their participation.
03
HR representatives managing wellness program enrollment.
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What is Wellness Program Enrollment/Change Form?
The Wellness Program Enrollment/Change Form is a document that allows individuals to enroll in or modify their participation in a wellness program offered by an employer or organization.
Who is required to file Wellness Program Enrollment/Change Form?
Employees who wish to participate in the wellness program or make changes to their existing enrollment are required to file the Wellness Program Enrollment/Change Form.
How to fill out Wellness Program Enrollment/Change Form?
To fill out the Wellness Program Enrollment/Change Form, individuals should provide their personal information, indicate their enrollment status, specify any changes required, and sign the form to confirm their participation.
What is the purpose of Wellness Program Enrollment/Change Form?
The purpose of the Wellness Program Enrollment/Change Form is to facilitate the registration or modification process for employees participating in wellness initiatives, ensuring that all necessary information is collected for program management.
What information must be reported on Wellness Program Enrollment/Change Form?
The information that must be reported on the Wellness Program Enrollment/Change Form typically includes the participant's name, contact details, employee identification number, current enrollment status, and any specific changes being requested.
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