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FOR OFFICE USE ONLY <br />ETHNIC BACKGROUND: <br />Female v <br />5 -11 -oo <br />P I of 2 <br />RO-6 <br />Bari, kill <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY BOARDS AND COMMISSIONS <br />If you are an Orange County resident, at least 18 years old, and wi tUnn to volunte time and expertise to your community, please complete this applic <br />Orange County Commissioners' Office (( } <br />P.O. Box 8181 ; , Kfif F' w I <br />Hillsborough, NC 27278 <br />Phone WQ) 732 -8181; 688 -7331; 968 -4501; 22 - 1 <br />Ext. 2125, 2129 or 2130 • y�Fax: 19 <br />NAME: YSb i ►�1 �'r Yt r L l �1 <br />HOME ADDRESS:V� Y` <br />CITY: UL Zip Code: 2, W- <br />TELEPHONE: (H)?3,� i lst7 (W) T (�� (Fax) <br />EMAIL: r bar " Q 1 h� I SPY Cb hr, <br />PLACE OF EMPLOYMENT: <br />� h�► JOB TITLE:7oXb&>- <br />IN ORbEIt TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INMA'rL YOUR <br />TOWNSHIP OF RESIDENCE: Bingham Cheeks <br />Hillsborough NI Eno <br />Chapel Hill. Little River <br />Cedar Grove <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF1HE FOLLOWING AREAS: <br />Joint Planning Area Extraterritorial Area Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER <br />AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: <br />Mate <br />ETHNIC BACKGROUND: <br />Female v <br />African American <br />Hispanic - <br />Caucasian -`4 <br />Other. <br />Native American <br />DATE OF BIRTH: <br />PLEASE LIST (1N <br />ORDER OF PREFERENCE) THE BOARDS/COMMISj�ON_ S ON WHICH <br />YOU WOULD BE WILLING TO SER , <br />Adv, <br />��v <br />1. �• W',an <br />Sery i LI.N 7$e <br />155 16 � <br />2. <br />. 3. <br />