Thank you for your interest in joining a Johns Hopkins Hospital Patient and Family Advisory Council! Council members are essential partners in the Hospital's mission to provide excellent patient- and family-centered care.

Please fill out this secure form. If you have any questions, feel free to contact us at

Patient and Family Advisory Council (PFAC) Volunteer Application: Teen and Children's Council
Before completing this form you will need an adult other than your parent or guardian to provide a few sentences about why you are a good candidate for the Youth Advisory Council. You will be asked for that information in the "Adult Recommendation" Section.
Note: *Fields highlighted in yellow are required*
Personal Information
Parent/Guardian Information

(Please ask your parent or guardian to fill out the following fields.)

Adult Recommendation

(Please ask an adult other than your parent or guardian to fill out the following fields.)

Confidentiality Agreement
Final Steps

CONFIDENTIALITY:  All information contained in this form is considered confidential and is intended for use by the Johns Hopkins Childrens Center Teen and Childrens Advisory Council Membership Committee. The Committee will maintain appropriate and confidential handling of personal information as stated in HIPAA guidelines and is presented in volunteer training. Qualified applicants will be selected to participate in a face-to-face interview. If selected, all Teen and Childrens Advisory council applicants must complete volunteer service requirements as assigned by the Volunteer Services department. These volunteer requirements include, but are not limited to the completion of the following: volunteer application, reference and criminal background check, volunteer orientation, HIPAA training and badge identification.

All patients served by the Johns Hopkins Children's Center are welcome to apply for membership as a Teen and Childrens Advisor.

Parent/Guardian Virtual Signature
Applicant Virtual Signature