Get involved

Patient and Family Advisor Application Form

Application form

This brief application form will help us learn more about you and how you might want to contribute as a member of the PFAC.

Person wearing glasses sits at a desk using a laptop, resting their chin on one hand, with office supplies and a softly lit workspace in the background.
Curriculum vitae attached?
Preferred contact (please check):

The following questions will help us get to know you better

1. Are you a...
4. Which campus(es) provided care for you or your family member: (check all that apply)
5. We recognize that our patient and family advisors have busy lives. How much time are you able to commit to being a patient and family advisor? (Check one)
6. Please specify times when you are available to attend meetings:
7. Are you available to serve as an advisor for at least 1 to 2 years? (You can still be an advisor if you answer “no.”)
8. How do you want to help? I want to: (Check all your interest areas)

Please tell us about yourself

CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.