Wellness Passport Program
East Carolina University
Campus Recreation and Wellness
2015-2016 Program Application
What is the Wellness Passport Program?
The Wellness Passport program is a required assignment for all students enrolled in HLTH 1000, HLTH 2500, and some
sections of COAD 1000. This assignment provides students with an added opportunity to experience a variety of health
and wellness activities, services, and programs at ECU. Although any ECU department or registered student organization
may submit a passport event application, approval is not guaranteed. The primary goal and needs of the Passport program
will determine which proposals are accepted.
Criteria – in order to be considered for Wellness Passport approval, programs must:
1. Address at least one of the dimensions of wellness (see below for descriptions of each);
2. Be educational in nature;
3. Be free for students;
4. Be submitted at least 2 weeks prior to the program/event date; AND
5. Include an assessment plan (for premier programs/events only).
What Are The Dimensions of Wellness?
Physical –Maintenance of a healthy body. Examples include maintaining proper nutrition, engaging in adequate physical
exercise, and avoidance of harmful habits such as alcohol abuse, drug use, tobacco use, and practicing unsafe sex.
Emotional –Awareness and acceptance of feelings and emotions. Examples include relationships with friends/family,
optimism, trust, self-esteem, self-acceptance, self-control, and coping with stress.
Intellectual –Openness to new concepts and ideas. Examples include critical thinking, being curious, questioning
concepts, and solving problems.
Social – Ability to perform social roles effectively, comfortably, and without harming others. Examples include
establishing and maintaining personal friendships, learning good communication skills, having loving or intimate
relationships, establishing a support network, and participating in the enrichment of one’s community, country, and world.
Spiritual – Meaning and purpose of human existence. Examples include becoming involved in a religious affiliation,
experiencing peace with nature, meditating, and developing skills in yoga or the martial arts.
Environmental – Recognition of interdependence with nature. Examples include: recycling, ultraviolet radiation,
pollution, air quality, lead paint, and second hand tobacco smoke.
Occupational – Ability to enjoy a chosen career and/or contribute to society through volunteer activities. Examples
include volunteering, workplace safety, and choosing a satisfying career/profession.
Financial – Ability to manage one’s financial resources. Examples include budget management, purposeful spending, and
saving.
Types of Wellness Passport Programs/Events
Regular – Programs and events that are smaller in nature. Examples include classroom lectures/discussions and tabling
events.
Premier – Larger scale programs that feature a guest speaker or movie showing. These events usually draw large crowds
and are typically held in Hendrix Theater or Wright Auditorium.
Assessment Plan – For Premier Programs/Events Only
You MUST assess the participants’ knowledge based on your learning outcomes. Many times, an assessment question can
be asked by restating your learning outcome. This can be facilitated through a survey at the end of the program, a text
messaging system during the event such as Poll Everywhere, or a Qualtrics survey sent to participants within 12 hours of
the program. Please describe the method you will utilize to assess your program. Include the assessment questions you
plan to ask. Once the assessment information has been collected, you must share the results of the assessment with
Campus Wellness. This will help us determine what programs will be accepted for the calendar in the future. If you have
any questions on how to develop your assessment plan, please feel free to contact us at 252.328.5771.
Wellness Passport Program Application (Only one program per application please)
Contact Information
Your Name:
Phone Number:
Email:
Sponsoring Dept./Organization:
Program Information
Name of Program:
Date and Time of Program:
Location of Program:
(please provide the room reservation confirmation for your location)
Brief Description of Program:
Which dimension(s) of wellness does this program cover (physical, social, emotional, intellectual, environmental,
spiritual, occupational, financial)? How does your program address this dimension as it relates to student
development/student success?
Would you like your program/event to be considered for premier passport status?
☐ Yes
☐
No
Learning Outcomes (What do you want students to know/understand/do as a result of attending your program?)
Example: As a result of attending this program, students will be able to identify ways to cope with stress.
As a result of attending this program, students will be able to:
1.
2.
For Premier Programs/Events Only: Assessment Plan
Please describe the method you will utilize to assess your program (pre/post-test, survey, Poll Everywhere, etc). Include
the assessment questions you plan to ask.
Sample Questions:
What are two methods you learned today that you will use in the future to help you cope with stress?
Do you intend to make any behavior changes as a result of attending this program? If yes, what changes will you make?
Method:
Questions:
Please return completed applications and room reservation confirmation to Ainsley Worrell via email (worrella15@ecu.edu), fax
(252.328.6562), or in person (208 Student Recreation Center). For questions or concerns, please call 252.328.5770. If your program is
approved, you will receive an email within 3-5 days about procedures for obtaining a verification stamp on the day of your event and
stamping passports. Please do not advertise your event as a Wellness Passport event until you receive an email stating that your
program is approved.