RUSH University Children’s Hospital Family Advisory Council Application

Please complete and submit the application below if you are interested in serving on the Family Advisory Council (FAC). The FAC will provide hospital administrators, clinicians and staff with suggestions and constructive feedback on a variety of patient and family issues concerning patient care at RUSH University Children’s Hospital and clinics. Topics may be introduced by RUSH staff members, as well as Council members.

The FAC will meet as a group approximately four times each year with various hospital staff. Members will serve a two-year term.

Please note that the FAC strives to represent the diversity of the RUSH Children’s Hospital community. Therefore, we do not discriminate against applicants based on race, color, ancestry, national origin, religious creed, physical disability, medical condition, marital status, sexual orientation, gender, or age. All are welcome and encouraged to apply.

Do you have another pediatric patient to add?
First Name Last Name Pronouns Age
Preferred Method of Contact
Languages Spoken
Which of the following best describes you?
Which of the following best describes the patient(s)?
Have you ever served on an advisory council or committee?
Has your family member (child) been a patient at RUSH Children’s Hospital in the last 3 years?
Are you able to make a commitment to participate in most (at least 3 out of 4) quarterly 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 Family Advisory Council.

Families who are chosen to be a part of the Family Advisory Council will complete an onboarding process through the RUSH volunteer services department. This includes a background check, health clearance and online training modules. If you are unable to fulfill these requirements, you will not be eligible to serve on the Family Advisory 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 Family Advisory Council. I agree to abide by the guidelines of Volunteer Services, to respect patient confidentiality, and to uphold the standards of RUSH Children’s Hospital. All information contained on this form is considered confidential and is intended for use only by RUSH Children’s Hospital.
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