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Application for Workplace Wellness Grant (SH-27)


Employers wanting to improve the health and wellness of their workers can benefit this program which provides funding to assist employers in establishing training and programs to reduce health risk factors specific to their employees. To learn more about eligibility and program requirements, go to the Program overview page.

Additional information

As a grant recipient, the state considers you a state supplier. This means you must obtain a supplier ID number and complete a Request for Taxpayer Identification Number & Certification (W-9) and Authorization Agreement for Direct Deposit of EFT Payments (OBM-4310-Rev.11/1/2011). Both forms are available through the supplier ID number website.
Note: The information you provide on these forms must match the information you provided under your BWC policy. If your BWC policy information is outdated, you must update it to receive your grant funds.

Contract agreement
We will not approve your application without the submission of the signed legal agreement. Download the agreement, sign, and mail the document to the following address:
Workplace Wellness Grant Program
13430 Yarmouth Drive
Pickerington, OH 43147-8310

All signatures must be original.

Required information

  • Policy number, federal tax ID or Social Security number
  • Whether you currently have a wellness program with a health-risk appraisal and biometric assessment
  • Whether you have a wellness program with healthy promotion and activities designed to address heath risk factors
  • Program contact name, phone number, email address and title


  • Budget- Type of service(s) and Estimated cost(s)
  • Narrative - Current wellness situation
  • Proposed program - Number of employees interested, wellness culture, timeline for implementation

IMPORTANT: Be sure you have all required information and additional documentation before you begin. Once you start completing the grant application, the system will automatically time out after 20 minutes of inactivity . If this occurs, you will have to start over.

If you have all the required information on hand, simply click the start button to begin.