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I1]:L1aI <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />This application is a public document <br />0 <br />If you are an Orange County resident, at least 18 years old, and willing to volunteer your time <br />and expertise to your community, you may complete this application online or download it and mail /fax it <br />to the address /fax number below: <br />Orange County Board of Commissioners' Office <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />Phone (919) 245 -2125 <br />Fax: (919) 644 -0246 • Email: liones(a�orangecountync.gov <br />If an applicant is not selected, their application will remain on file in the Clerk to the Board's office for two <br />(2) years, and will be considered by the Commissioners when reviewing and making appointments. <br />Items in bold are required fields. <br />NAME: <br />HOME ADDRESS: <br />CITY: <br />PHONE: (Day) <br />EMAIL: <br />PLACE OF EMPLOYMENT: <br />(Evening /late) <br />YEAR BECAME ORANGE COUNTY RESIDENT: <br />Zip Code: <br />JOB TITLE: <br />(Cell) <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF <br />RESIDENCE: <br />❑Bingham ❑Cheeks ❑Hillsborough ❑Eno ❑Chapel Hill ❑Little River ❑Cedar Grove <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, BY <br />ANSWERING THE FOLLOWING QUESTIONS: ❑Male ❑Female <br />ETHNIC BACKGROUND: ❑African American ❑Caucasian ❑Hispanic ❑Native American <br />❑Asian American ❑Other <br />ARE YOU AT LEAST 18 YEARS OF ❑ YES ❑ NO <br />AGE? <br />PLEASE LIST YOUR CURRENT COMMUNITY ACTIVITIES /ORGANIZATIONAL MEMBERSHIPS: <br />I. PLEASE LIST THE BOARDS /COMMISSIONS ON WHICH YOU WOULD BE WILLING TO SERVE (maximum <br />