Family Advisory Council Application


The Family Advisory Council at All Children's Hospital welcomes applications for new members.

Our Family Advisory Council is a group of parents and teen patients who meet with hospital staff to help promote patient- and family-centered care. The Council provides positive and constructive feedback on the patient experience. Council members also help support sensitivity to the emotional, cultural and spiritual needs of our families and patients.

Members include parents and teen patients (age 13-18) who have experience with a variety of children's health conditions and the inpatient and/or outpatient areas at All Children's Hospital.  

The Council has 9 dinner meetings a year, held Tuesday evenings from 6 to 8 p.m. at the Hospital. There are no meetings in December, July and August. Members serve a two-year term. Sometimes there are additional events (such as a panel discussion during Nurses Week) that Council members are invited to attend. We welcome applications throughout the year.

Membership Requirements

Members are expected to attend the 9 monthly meetings, be an advocate for positive change, actively participate and listen to others, and attend a mandatory new member training session.

If you are interested in becoming a member please submit the application below:

Applying for * 
2014-2016 Family Advisory Council 
Teen Virtual Advisory Council 
First Name * 
Last Name * 
Email Address * 
Phone * 
Address 
Address 2 
City 
State 
Zip 
Language(s) You Speak 
Contact Sharing  Will you allow your contact information to be shared with other committee/advisory council members?
Yes 
No 
I am * 
Family Member of an ACH patient 
Patient's First Name 
Patient's Last Name 
Care Type  My child's care provided at All Children's Hospital was primarily:
Hospitalization (Inpatient) 
Clinic Visit (outpatient) 
Both inpatient and outpatient 
Emergency Center Care 
Other Programs 
Care Dates  Dates of my child's care at All Children's Hospital:
2009 to Current 
2004-2008 
Why would you like to serve as an advisor? 
Experience  If you have served as an advisor, been an active volunteer committee member, or done public speaking for other programs or organizations, please breifly describe this experience:
Priorities  If asked to talk to a group of health care professionals, please give us an example of the three most important pieces of insight you would like them to take away from your presentation:
Reference  Is there a health care professional with whom you would feel comfortable asking to support your nomination?
Yes 
No 
If yes, may we contact them? 
Name 
Phone Number 
Validation *  Please enter in this field. This is required in order to reduce spam.
* Required

Confidentiality

All information contained in this form is considered to be confidential and is intended for use by the All Children's Hospital Family Advisory Council Membership Committee. The Committee will maintain appropriate and confidential handling of personal information as stated in HIPPA guidelines and is presented in volunteer training. Qualified applicants will be selected to participate in a face-to-face interview. If selected, all Family Advisory Council applicants must complete volunteer service requirements as assigned by All Children's Hospital.