Patient and Family Advisor Program

Patient and Family Advisor Application

Thank you for your interest in volunteering at Cedars-Sinai. If you experience any problems while submitting this application, please email us at Adult Volunteer Program to help.

If you have previously submitted an application or previously volunteered at Cedars-Sinai, please call our office at 310-423-8044 before submitting an application to simplify your process.

New User Details

User ID

User ID (verify)

Password

Password (verify)

* Fields marked with a red asterisk are required. Since the system doesn't save partial applications, please set aside 3-10 minutes to complete and submit in one go.

CONTACT INFORMATION

Please input your name as it appears on your official photo ID (e.g., driver's license, REAL ID, passport, etc.).

* First Name

Middle Name

* Last Name

Preferred Name

* Date of Birth (MM/DD/YYYY)

* Home Address - include apt./suite # here

* 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

* 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 Visa Number:

If you have neither Social Security Number nor Visa Number, please place zeroes in the blank above and email Adult Volunteer Program to describe your details.

What languages do you speak? (Please select all that apply.)

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:

EMPLOYMENT INFORMATION

Are you currently employed?

Employer's Address

Describe Job Duties

Do any of the categories below apply to you?

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:

Please upload a picture of your official photo ID with your name (e.g., driver's license, REAL ID, passport, etc.). If you have difficulty, call us at 310-423-8044.

* Identification Verification - please click 'Choose File' below

Thank you for filling out your Volunteer Application! Please verify the information above:

* I confirm that I've shared true and complete information. I understand a background check is part of the application process. I release the organization, all persons, and entities requesting or supplying this information from liability or responsibility. I also understand that incorrect or missing details could affect my application and may disqualify me from further consideration as a volunteer.

Acknowledgement Date