Orange County NC Website
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<br />, ' ' ~~ FOR OFFICE USE ONLY r ~ _ <br />~,o F ~ _ Kr~st~n~ ~o~s'~ .~_.__ . <br />.~ I <br />I VOLUNTEER APPLICATION • • <br />;ORANGE COUNTY ADVISQRY BOARDS AND COMMISSIONS ~ _ 4' -_.,3 "' <br />ff you are an Orange County resident, at least 18 years old, and willing to volun ~ ~ {'•~ <br />expertise to your community. please complete this application and return to: <br />Orange County Board of Commissioners' Office . <br />P.O. Box 8181 <br />' Hillsborou~. NC 27276 <br />Phone (919) 245.2125; 245.2129; 245.2130; 73Z-8181 <br />Fax: (919) 644.0246 Email: ncglover~co.orange.nc.us <br />NAME; ~IS~-ih MoDre, <br />HOME <br />CITY: <br />zip coae: x•"75 -'~ _ <br />PHONE: (Day) (q..l~~ a'~~-- 44~ (Eventng/late) ~.~4 2-9.~~k9 (1=ax) <br />EawL: <br />PLACi= OF EAAPLOYMENT: I~IG ~~L(~ 4F~ I~IU-YfYtRG{IOB TITLE: ~r.~.Qe~~ ~b( ~°~d <br />IN ORDER TO AS6URE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: ~ <br />f~ Bingham O Cheeks D Hillsborough O EnoChapel Hill O Little River C7 Cedar Grove <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />O Joint Plann~gjArea O Extraterritorial Area O Transition Area <br />.~ <br />WE ASK YOUR HELP IN ASSURING DIVERSRY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: O Male ~emale <br />ETHNIC BACKGROUND: O Africmn American 'Caucasian O Hispanlo O N tivea merican <br />i O Other DATE OF BIRTH: _,Q~ <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE f30ARDS/COMMISSIONS ON WHICH YOU <br />WOULD BE WB.L+NG TO SERVE. <br />~. Nurrulll~I~ela~i~~is 2. A~c~dable, ~-busir~ a. CiDmwu~;on~rf ~e r~ <br />~ p_sru,m~ (n ~ ~) <br />WORK EXPERIENCE: .~S,Q~~ „~ ISS~~ _~ <br />_ ____~ <br />I <br />VOLUNTEER EXPERIENCE: _„~ __._ <br />.- (~tf ld - <br />