Family Advisory Board

Membership Application

Thank you for your interest in joining one of Connecticut Children's family advisory boards. Please complete the form below as the first step in the application process. If you have any questions, or for more information, please contact Steve Balcanoff, 860.837.5671.


 Parent
 Grandparent
 Guardian
 Sibling
 Other relative
 Yes
 No
 Yes
 No
 Connecticut Children's FAB
 Cancer
 Cystic Fibrosis
 Diabetes
 Sickle Cell
 Weight Management
 Ethnic
 Racial
 Spiritual
 Social
 Economic
 Educational
 Geographic
 Gender
 Sexual Orientation
 Unique family structure
 Disability-related
 Chronic illness
 Single parent
 Full-time parent
 Other
 

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