Teen Advisory Board | Riley Children's Health

Thank you for your interest in serving on the Riley Teen Advisory Board (TAB). Please complete following application electronically. Submit it via email to Darla Cohen. All information is considered confidential. Applications are accepted on a rolling basis throughout the year and board terms are for one year.

After your application is reviewed, you will be contacted to set up an interview. Please note that those selected to serve on the Riley TAB must complete a Volunteer Orientation and if over 18, a criminal background check. A health screening (TB test and flu shot) may also be required.

If you are nominating yourself for a board position, please submit one letter of reference. If you were asked by a staff member to complete this application, please provide their name:

Staff Member Name

Applicant Information

First Name*

Last Name*

Date of Birth*

Address*

City

State

ZIP Code

Phone*

Email*

Best Contact Method*

What best describes you?*

Do you currently have a relative working for IU Health?*

Name the IU Health hospital(s) where you (or the patient if you are a sibling) received care?*

When was care provided?*

Have you (or your sibling) ever received care at another children’s hospital? *

Application Questions

1. Is this your first application to serve on the Teen Advisory Board?*

2. Are you currently serving on another board or council? *

If yes, please describe

3. Why are you interested in being a member of the Teen Advisory Board (TAB)?*

4. Do you recall which departments or services, including outpatient clinics, served you (or the patient if you are a sibling). *

5. What are some specific things the physicians and staff did to help you and your family?*

6. What are some of the things you would like physicians and staff to do differently to better help you, your family or others receiving care at Riley?*

7. Representing the diversity of our patient population in our councils is important to us. Please share anything about yourself that you think would add to the diversity of our council. You might consider your diversity to be: ethnic, racial, spiritual, economic, educational, geographic, gender, sexual orientation, unique family structure, disability-related, chronic illness, or age.*

8. Is there anything else you would like for us to know about you?*

Applicant Availability

The Teen Advisory Board will meet once per month in the evening and possibly on Saturday. Please tell us the days and times you are available by completing the table below.*

Monday Tuesday Wednesday Thursday Friday Saturday

Monday Time

Tuesday Time

Wednesday Time

Thursday Time

Friday Time

Saturday Time