Please complete this application form if you are interested in becoming a Winship Cancer Institute Patient & Family Advisory (PFA) at Emory Healthcare. Once you complete the form, click the submit button at the bottom.


CONTACT INFORMATION


EMERGENCY CONTACT


DEMOGRAPHIC INFORMATION

Select all the following that applies.



MEDICAL INFORMATION


ADDITIONAL QUESTIONS

Please answer the following questions to the best of your ability.



Question 1

Why are you interested in volunteering as a Patient Family Advisor (PFA) at Winship?



Question 2

What are your expectations as a PFA volunteer in this program?



Question 3

What additional skills can you offer as a PFA that would be valuable to our organization?





EMAIL PREFERENCES

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.



VOLUNTEER COMMITMENT PLEDGE & STATEMENT

I pledge my commitment as a volunteer Patient/Family Advisor at Winship Cancer Institute:

• I shall be conscientious in the fulfillment of my duties and accept supervision graciously.

• I shall conduct myself with dignity, courtesy and consideration.

• I shall endeavor to make my work of the highest quality.

• I shall consider all information that I may hear directly or indirectly concerning those we serve as confidential.

• I shall share any questions, issues or concerns with the Committee Staff Liaisons.

• I shall uphold the traditions and reputation of Winship Cancer Institute and as an ambassador I will interpret them to the community at large.

• I hereby certify that if I qualify, I will need to complete the entire application process. Additionally, I understand that misrepresentation, falsification or omission of information may disqualify me from volunteer service.

• I recognize that inappropriate behavior will result in immediate dismissal from the program.