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/~ <br />This space for office use only <br />6/7/02 Pace 1 of 1 Beth Ellen Barba <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY BOARDS AND COMIMISSION5 <br />If you are an Orange County resident, at least 18 years old, and willing to volunteer your time and expertise to your <br />community, please complete this application and return to: <br />Orange County Commissioners' Office <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />Phone (919) 245-2125; 688-7331; 227-3031 FX (919) 644-0246 <br />NAME; _-_________________-_________ Beth Ellen Barba <br />HOME ADDRESS: --------------- 6421 Sykes Glen Trail <br />CITY: ---------------------------- Mebane <br />STATE: -------------------------- NC <br />ZIP CODE: --------------------------- 27302 <br />TELEPHONE: (Home) ------------- 919-563-4982 <br />TELEPHONE: (Work) ------------ 336-334-5217 <br />TELEPHONE: (FAX) --------------- 336-334-3628 <br />EMAIL: ---------------------------- bebarba@earthlink.net <br />PLACE OF EMPLOYMENT: ---- UNC at Greensboro School of Nursing, Community Practice Department <br />JOB TITLE: --------______________ Associate Professor <br />TOWNSHIP OF RESIDENCE: --- Bingham <br />ZONE OF RESIDENCE: -------- Does not apply <br />SEX: --------------------------------- Female <br />ETHNIC BACKGROUND: ------ Caucasian <br />DATE OF BIRTH: ------------ 02/26/47 <br />LIST, IN PREFERENCE, THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WILLING TO SERVE: <br />1: ---------------------- Nursing Home Advisory 2. ---------------------- Adult Care Home Community Adv. <br />Please list work, volunteer and educational experience. <br />WORK EXPERIENCE: Teach gerontology in school of nursing past 14 years. Registered nurse in acute care and long <br />term care past 34 yeazs. <br />VOLUNTEER EXPERIENCE: Orange County NC Aging Advisory Board. <br />EDUCATIONAL EXPERIENCE: PhD in Nursing, NYUMA in Nursing, NYUBS in Nursing, Jersey City State College, <br />BA in Health Education, Jersey City State College, Diploma in Nursing, St. Francis Hospital School of Nursing, Jersey <br />City, NJ. <br />OTHER COMMENTS: <br />How did you become awaze of Orange County volunteer opportunities? List all that apply: Current Orange County <br />Volunteer. If other, how? <br />By submitting electronic application, applicant agrees to Ethics Guidelines and agrees to attend three-hour <br />orientation.This form was submitted online, on Fri Jun 7 09:47:32 2002. <br />