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2 <br /> DRAFT <br /> VOLUNTEER APPLICATION <br /> ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br /> T'llli liu s aIpIplicatian is a public document <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: tfreeman§_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: Zip Code: <br /> PHONE: (Day) (Evening/late) (Cell) <br /> EMAIL: <br /> PLACE OF EMPLOYMENT: JOB TITLE: <br /> YEAR BECAME ORANGE COUNTY RESIDENT: <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 ❑ N O <br /> AGE? <br /> PLEASE LIST YOUR CURRENT COMMUNITY ACTIVITIES/ORGANIZATIONAL MEMBERSHIPS: <br /> 1 <br />