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Community Benefit Associate Form


Instructions:


  1. The purpose of this form is to track community activities in which Shawnee Mission Health associates participate. 
  2. Include only those activities conducted during work hours (or evenings if the employee is salaried).
    1. Do not list personal volunteer efforts for churches, Boy or Girl Scouts, PTA, etc.
    2. Do not list activities in which employees donate their own money or goods (food drives, United Way, etc.).
  3. Fill out a separate form for each community "agency". You may add multiple events for each agency on this one form.
  4. Please return forms by the 5th of each month (for the prior month).











List all team members who participated. Include actual and preparation time.

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SHAWNEE MISSION HEALTH LOCATIONS
Shawnee Mission Medical Center
9100 West 74th Street
Shawnee Mission, Kansas 66204
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Main Number
913-676-2000
Prairie Star
23401 Prairie Star Parkway
Lenexa, Kansas 66227
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Main Number
913-676-8500
Overland Park
7820 W. 165th Street
Overland Park, KS 66223
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Main Number
913-373-1100