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Family Partners Program Application
Application date
Group
Parent Information
*
Parent Last Name
*
Parent Legal First Name
Parent Preferred Name (for ID)
*
Preferred E-mail (All communication will be sent here.)
Gender (optional)
Date of Birth (optional)
Child/Patient Information
*
Child/Patient Last Name
*
Child/Patient Legal First Name
*
Child/Patient DOB
*
Team Seen by at UNC Health
*
Treating Doctor's Name
Address
*
Street
*
City
*
State
*
Zip
*
Preferred Phone
Secondary Phone
General Information
*
Current Occupation
*
Employer
Note:
Onboarding requirements are different for UNC Health Employees. Please reach out to Volunteer Services for more details if you are an employee.
Additional languages
Emergency Contact Information
*
Emergency Contact Name
*
Relation to Applicant
*
Phone
How would you like to be involved?:
(Required)
Which team are you interested in serving on?
(Required)
*
What do you hope to gain from this experience?
*
Days and Hours Available?
*
How did you hear about the Family Partners Program?
*
I understand I will recieve an automated confirmation email after applying and must reply to it to inform Family Partners of my submission. Otherwise, I risk not being contacted about next steps.
*
I understand I will need to obtain a criminal background check from a Consumer Reporting Agency (CRA) chosen by UNC Health and I authorize UNC Health access to those results.
*
I understand I will need to sign a confidentialty agreement upon approval as member of Family Partners Program.
*
I understand I am required to log volunteer hours each month using Volunteer Services's designated online form.
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