Patient Family-Centered Care Volunteer Application: Finding your Fit!

Asterisk (*) indicates a required field.

Contact Information

First Name*

Last Name*

Patient Family-Centered Care Areas of Interest

Which of the following areas interest you?

Availability

Are you available:*

On-site (in person, at St. Jude) Off-site (away from St. Jude, by email, phone, etc.) Both on-site and/or off-site as needed

How often will you be available? (Daily, Weekly, Monthly, etc.)

What days and hours would you most likely be available to attend onsite meetings?

Skills

Please let us know if you have any special skills you would like to share.

Do you speak a foreign language?

No Yes

Level of Fluency

Native language Fluent Somewhat fluent Just learning

Other Skills*Examples include: business experience, church or other leadership experience, committee participation, project administration, administrative skills, public speaking knowledge, prior volunteer experience with ALSAC or St. Jude. (Limited to 500 characters.)

Demographics

The following information is optional, and will help us ensure we have broad family participation in our Family-Centered Care program.

Marital Status

Married Single Divorced Widowed

References

Please provide the names and contact info of two individuals who would be willing to give a character reference. A preferred reference is someone who has known you more than three years and is not a relative.

Reference 1

First Name*

Last Name*

Phone Number*

Alternate Phone Number

Email Address

Reference 2

First Name

Last Name

Phone Number

Alternate Phone Number

Email Address

Getting to Know You

Responses limited to 500 characters.

1. Please discuss the strengths you feel you will bring to the PFCC program.*

2. Do you enjoy leadership roles or do you prefer assisting the person in charge?*

3. In your opinion, what would present the toughest challenge in your role as a PFCC volunteer?*

4. Please describe how flexible you feel you can be while serving as a PFCC advisor.*

5. Please ask us any questions, discuss concerns, or make comments

I agree to share this information with St. Jude*
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