VSys Web application

Patient Family Advisory Board Application

Please fill out this form if you are interested in joining a Patient Family Advisory Board.

Application date

* Last Name

* Legal First Name

Preferred Name (for ID)

Middle Name

* Preferred E-mail (All communication will be sent here.)

Gender (optional)

Date of Birth (optional)

Group

Address

* Street

* City

* State

* Zip

* Preferred Phone

Secondary Phone

General Information

University/College (must not be undergrad)

Study

Class Standing

Additional languages

* 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.

Emergency Contact Information

* Emergency Contact Name

* Relation to Applicant

* Phone

Patient Family Advisory Board

Board: (Required)

If other please include below:

* Why did you choose the service area listed above?

* What do you hope to gain from this experience?

* Days and Hours Available?

* How did you learn about Volunteer Services?

* I understand that 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 contact volsvcs@unchealth.unc.edu if I do not recieve the automated email reply about my next steps to volunteer in my inbox or spam/junk folder within a day.