Patient and Family Advisor Program

Patient and Family Advisor Application

Thank you for your interest in volunteering at Cedars-Sinai. Kindly take a moment to complete your online application to become a Patient and Family Advisor Volunteer. If you experience any problems while submitting this application, please email us immediately at Adult Volunteer Program.

If you have previously volunteered or submitted a volunteer application at Cedars-Sinai, please call out office at 310-423-8044 before submitting a new application.

If you have applied or are currently participating in any research or internship opportunities at Cedars-Sinai, please call our office at 310-423-8044 before submitting an application.

New User Details

User ID

User ID (verify)

Password

Password (verify)

Please be sure to answer ALL questions before submitting.

Please upload a picture of your valid, government-issued identification (e.g., driver's license, REAL ID, passport, etc).

* Identification Verification:

Please input your name as it appears on your legal documentation.

* First Name

Middle Name

* Last Name

Alternate first name

* Date of Birth (MM/DD/YYYY)

* Home Address

* City

State

* Zip Code

Best Way to Contact

* E-mail Address

Home Phone

* Cell Phone

Work Phone

Pronouns

What is your gender identity?

If self-describing gender identity, please specify:

EMERGENCY CONTACT

In case of an emergency, whom do you wish to notify:

* Name of Emergency Contact

* Relationship

* Mobile Phone

Home Phone

PERSONAL INFORMATION

* Can you furnish proof of identity and that you are a U.S. Citizen or otherwise legally permitted to take a volunteer position in the United States?

* Social Security Number (000-00-0000) or F1 Visa Number:

If you have neither Social Security Number nor F1 Visa Number, please place zeroes in the blank above and email adultvolunteerprogram@cshs.org to describe your details.

Please list any additional languages that you speak other than English:

How would you identify your race, ethnic, or family origin?

If self-describing race/ethnicity/family origin, please specify:

What is your sexual orientation?

If self-describing sexual orientation, please specify:

Do you have any friends and/or relatives employed or volunteering at Cedars-Sinai:

Name:

Relationship:

Department:

Name:

Relationship:

Department:

EMPLOYMENT INFORMATION

Do any of the categories below apply to you?

Are you currently employed? Name of Company of N/A if not currently employed.

Business Address:

City/State/Postal:

Describe Job Duties:

EXPERIENCE AT CEDARS-SINAI

You are a? Please choose all that apply.

If a family member, you are the patient's:

Other Relationship:

Where have you or your family member received care? Please choose all that apply.

Have you or your family member been seen at Cedars-Sinai in the past year?

* As best you can recall, what department(s) provided care for you or your family member?

BACKGROUND AND INTERESTS

Please check which group(s) you would like to be involved in:

What is the best time for you to attend meetings (if necessary)? Choose all that apply.

Do you need any special accommodations to be able to attend and participate in meetings?

* Do you have any previous experience volunteering or as a patient advocate?

* Please share with us, in a few sentences, why you would like to serve as a Patient and Family Advisor at Cedars-Sinai.

* Is there an area of care at the hospital that is of special interest to you? For example, Neonatal Intensive Care, Oncology, Room Design, Process Improvement, etc.

Cedars-Sinai believes in the richness of human diversity and knows that when we have different perspectives at the table it enables us to achieve our mission of quality care and research for all, by all. To ensure we are inclusive of all backgrounds and experiences, please share how you self-identify (example: African American/Black, Latinx, Korean, Filipino, LGBTQIA+, etc.).

How did you learn about the Cedars-Sinai PFA Program?

Other:

Are you pursuing or exploring a career in healthcare?

Please check off your motivations or interests in volunteering (check all that apply):

If Other, please elaborate on your motivations:

* I hereby affirm that the information provided on this application is true and complete to the best of my knowledge, and agree to have any of the statements checked by the organization. I understand that providing any false or misleading information or any omissions may disqualify me from further consideration as a volunteer and may result in my immediate termination, even if discovered at a later date.

* I authorize representatives of Cedars-Sinai to conduct a thorough investigation of all my activities. I agree to cooperate in such investigation, and release from all liability or responsibility of the organization, all persons and entities acting on its behalf, and all persons and entities requesting or supplying such information.  