Family Advisory Council Application Please avoid using special characters when filling out the form. If you'd like to apply for 2024-2025, please fill out the form below. First Name: Last Name: Address: City: State: County: Daytime Phone Number: Evening Phone Number: Cell Phone Number Email: Name of Spouse (if applicable) Are you an employee at Nationwide Children's Hospital? No Yes Occupation/Employment: Full Time/Part Time: Full-time Part-time Educational Background: Names and ages of children: Nationwide Children's Hospital services used by family: Describe your interest for serving on the Family Advisory Council: How did you hear about the Family Advisory Council? Community involvement/Volunteer Experience: Anything else you would like to share? Every Child We Treat Is Extraordinary. Share Your Nationwide Children's Hospital Story
