RUSH Oak Park Hospital Community Engagement Council Application

Please complete and submit the below application if you are interested in serving as a member on the Community Engagement Council (CEC). The CEC will provide feedback to RUSH Oak Park and the Office of Community Health Equity and Engagement on issues of interest to the RUSH Oak Park community. Topics may be introduced by RUSH Oak Park staff members, as well as Council members.

The CEC will meet as a group with various hospital staff approximately monthly for the first 3-6 months, then quarterly thereafter. CEC Members will serve a two-year term.

Preferred Method of Contact
Best Time to Reach You
Age
Languages Spoken
Which of the following best describes you?
Highest Level of Education
Have you ever served on an advisory council or committee?
Have you been a patient at RUSH Oak Park Hospital in the last 3 years?
Has someone close to you/in your care been a patient at RUSH Oak Park Hospital in the last three years?
Are you able to make a commitment to participate in most monthly in-person meetings?
Are you able to attend meetings virtually if necessary?

Conditions of Volunteer Services (Please read before submitting):

We will contact you by phone or email if you are selected for an interview to learn more about your interests and discuss the opportunity to become a member of the Community Engagement Council.

In order to participate, you must meet our volunteer requirements. You will be required to pass a background check and sign a confidentiality agreement. If you are unable to fulfill these requirements, you will not be eligible to serve on the Community Engagement Council.

I certify that the statements made in this application are true and correct and have been given voluntarily. I understand that I will not be paid for my services as a volunteer member of the Community Engagement Council. I agree to abide by the guidelines of Volunteer Services, to respect patient confidentiality, and to uphold the standards of RUSH Oak Park Hospital. All information contained on this form is considered confidential and is intended for use only by RUSH Oak Park Hospital.
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