Welcome to Spectrum Health Kalamazoo Volunteer Services!

PFAC Application

Spectrum Health Volunteer Application
Patient and Family Advisory Council
Please note that this application is for new Patient and Family Advisory Council members that have been pre-identified. If you have not yet talked to anyone about this role, please go back to the home page and fill our the New Volunteer Application.
Council you are joining:
Referred by:

Personal Information

First name
Middle name
Last Name
Preferred Name
Date of Birth
Current Address
Address Line 1
Address Line 2
City
State
Zip/postal
Permanent Address (only if different than current)
Address Line 1
Address Line 2
City
State
Zip/postal
Contact Information
Preferred Email Address
Home phone
Mobile
Work phone
May We Text You? (Check if Yes)
Preferred Phone Number
Emergency Contact Information
Name
Relationship to You
Home Phone
Cell Phone
History
Have you ever been convicted of a crime?
If yes, please explain:
Are you eligible to work in US?
Are you a US Citizen?
If no, documentation may be required at a later time.
Education/Employement
Have you ever been employed by Spectrum Health?
If yes, please list the dates, role, entity, and department you worked in.
Have you ever volunteered at Spectrum Health?
If yes, please list the dates, role, entity, and department you volunteered in.
If you worked or Volunteered at Spectrum Health under a different name (i.e. maiden name), please list it below
Volunteer Interest
Why do you want to volunteer at Spectrum Health?
Additional languages spoken
How did you hear about us?
Agreement and Electronic Signature
I agree that:
  • I am at least 18 years of age

  • I can commit to volutneer for a weekly shift for at least six months
  • To complete all of the necessary paperwork and medical requirements
  • I understand that:
    • My application will not be reviewed until I complete two letters of reference found on Spectrum Health's Volunteer website

  • It may take several weeks to review my file
  • Spectrum Health may not be able to find a role that fits my interests
  • Some roles, such as Child Life, have a waiting list
  • Electronic Signature (type your full name in the box below)
    Thank You for taking the time to fill out an application to volunteer at Spectrum Health!

    Please click "Submit my Application" below. You will receive a confirmation message on your screen, as well as to your email.