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`~ . <br />FOR OFFICE USE ONLY <br />I of 5 G'aml C ~ M'CJS <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />If you are an Orange County resident, at least 16 years old, and willing to vol <br />expertise to your community, please complete this application and return to: <br />NAME: <br />Orange County Gommissloners' Office <br />P.O. Box 8181 <br />Hillsborough, NC 27276 <br />Phone (919) 245-2125; 245-2129; 245-2130; 732-8181 <br />Fax: (819) 644.0246 Email: npaciga~co.orange.nc.us <br />~, ~~ <br />i.I <br />p~ 10~ ~Ej <br />!~. <br />HOME ADDRESS: „~ ~ Q ~'~'~ ~. c ~/~'f/ ~ <br />CITY: _f '//n /~ r 1 ~~! ,Zip Code:-..? ~7~) L.~ <br />PHONE: (Day) 9l 7- , S' n Ai (Eveningllate) _ f ~~7• . ~^n ~' (Fes) iy ~~ <br />EMAIL: ~/l/> ~' _ f ~ ~ ~°f iA /? T~J ~/~- ~,~_~r' <br />PLACE OF EMPLOYMENT: ~'r'~ /~~ f ~, m~ JOB TITLE: ,; f fc /~ r~;_, ~., ~ <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />O Bingham O Cheeks ~ Hillsborough O Eno cl~ Chapel Mill O Little River O Cedar Grove <br />IN ADDITION, PLEASt: INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />O Joint Planning Area O Extraterritorial Area O Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF A)}EMBERSHiP BY AGE, GENDER AND RACE, <br />BY ANSWERINti THE FOLLOWING QUESTIONS: , {~ Male O Female <br />ETHNIC BACKGROUND: O African American Cir7Caucasian O Hispanic O Native American <br />O Other DATE OF BIRTH: ~~ - 2. ?-`' 9 <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br />WOULD BB WILLING TO SERVE. <br />~ F F-..~i.f~ ~ Q ~ E_ l~.iCli' LL ~~~~c' n - ,v f <br />1. ~c/p ii r ..v !'~(1,Qylj~B~ 2. ~ N _ ./~G'~iyfr ~_ 9._ .s .r .r~ . ~~,j •'~dG <br />WORK EXPERIENCE: <br />VOLUNTEER EXPERIENCE:~,f r- ~ ~,E'J- t,~ .~ <br />Sc c~,c.k- <br />~t( ~~lr/ <br />d~ . ,cc_ digs' <br />