Agency Interest Form

Agency Interest Form

Thank you for your interest in the Joyce Dudley POST Organizational Wellness Program. This program is designed to support and enhance the organizational wellness strategies within law enforcement agencies to help their sworn and professional staff thrive in their personal and professional lives.

The purpose of this interest form is twofold:

1) Submission of this form will add your agency and wellness team to the contact list shared between POST and UC San Diego Centers for Integrative Health for updates on upcoming events and training opportunities and,

2) helps POST and UCSD begin to learn about existing wellness strategies at your agency and goals to further enhance wellness and resiliency building among your sworn and professional staff.

A member of the POST staff and UCSD team will reach out to the individuals listed on your submitted agency interest form as soon as possible.

POST Privacy Policy
Agency Information
Agency Name
Agency Address
Street Address
City, State / Province
Postal / ZipCode
Country
Agency or Department Head
Agency or Department Head Email
County
Applicant Contact Information
Agency Point of Contact Name
Rank/Title
Phone
Phone Number
Email
Short Answer Questions
Please describe any efforts that have been made in the past that have been successful or unsuccessful in achieving wellness outcomes. (100-500 words)
Please describe any internal infrastructure or resources that are or will be dedicated to enhancing wellness for the sworn and professional staff.
Participants
Total number of sworn personnel
Total number of dispatchers
Total number of professional staff
This optional section allows you to list individuals who have expressed interest in participating, or taking a leadership role in implementing this program at your agency. Please list their name, rank/classification, email address, phone number, and how they would like to be involved.
Attestation

I am applying for participation in the Joyce Dudley POST Organizational Wellness Program. By checking the boxes below, I attest to the following:

I agree to participate fully in a needs assessment process to customize wellness and resilience resources to fit my agency needs. Best practices will be identified during my agency’s participation in the Joyce Dudley POST Organizational Wellness Program.

My agency agrees to participate in developing and implementing a wellness maintenance program that supports the long-term sustainability of the program and builds upon the methodologies learned during participation in the Joyce Dudley POST Organizational Wellness Program.

The agency head agrees to support personnel time whenever possible to participate in wellness program activities.

The agency head is aware of the submission of this interest form and supports developing organizational wellness strategies within the agency.

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Agency Interest Form

Agency Information

Applicant Contact Information

Short Answer Questions

Participants

Attestation