Patient Family Advisory Council Project Request

Please complete the form below. A member of the PFCC Staff will then contact you regarding your request. If you have any questions or need immediate attention, please call (901) 595-7560 or email [email protected]

Asterisk (*) indicates a required field.

Contact Information

First Name*

Last Name*

Email Address*

Project Information

Suggested Project Title*

What are you trying to improve that is not being done now?*(250-word limit)

What is the overall goal? How would the idea serve patients and/or families?*(600-word limit)

Your idea may require new or additional resources at St. Jude. What type of resources do you foresee the idea needing (staff, supplies, construction, etc.)? What departments or areas would need to be involved?*(250-word limit)

Upon project completion, what would success look like? What is your desired outcome? What kind of measures would be tracked to understand the impact it has on St. Jude patients and/or families? *(250-word limit)

If the project is approved, how involved would you like to be with planning and implementation? How much time can you commit?*(250-word limit)

I agree to share this information with St. Jude*
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