Get Commitment Agreement Sfn 58643 - State Of North Dakota - Nd

Filling out the Commitment Agreement SFN 58643 is a critical step in supporting the worksite wellness program in North Dakota. This guide provides clear, step-by-step instructions to help users efficiently complete the form online.

Follow the steps to successfully complete the Commitment Agreement SFN 58643.

1. Click ‘Get Form’ button to access the Commitment Agreement SFN 58643. This will allow you to open the document for online completion.
2. In Part A, fill in the employer information. Enter the organization name, organization ID, name of the organization's head or contracting authority, mailing address, city, state, and zip code. Ensure accuracy in this section to avoid any delays.
3. In Part B, read the Commitment Agreement carefully. After understanding the commitment towards promoting a worksite wellness program, sign the form in the designated space, filling in the date as well.
4. Navigate to Part C and input the contact information for the appointed wellness coordinator. Provide their name, telephone number, email address, mailing address, city, state, and zip code. This information is essential for facilitating communication regarding the wellness program.
5. Review all sections of the form to ensure that all fields are complete and accurate. Make any necessary corrections before finalizing your submission.
6. Once you have confirmed all information is correct, save your changes. You may also choose to download, print, or share the completed form as needed.

Start filling out the Commitment Agreement SFN 58643 online today to support workplace wellness.