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~V <br />Page 1 of 1 <br />Blake Burklin <br />Volunteer Application <br />Orange County Advisory Boards and Commissions <br />Name: <br />Name Called: <br />Home Address: <br />Phone: (Day) <br />Phone: (Evening) <br />Fax: <br />Email: <br />Place of Employment: <br />Job Title: <br />Mr. Blake Burklin <br />117 Creel St. <br />Chapel Hill NC 27516 <br />919-812-4394 <br />919-812-4394 <br />burklin@email.unc.edu <br />Johnny T Shirt <br />Township of Residence: Chapel Hill <br />Zone of Residence: Chapel Hill Twnsp <br />Sex: Male <br />Ethnic Background: Caucasian <br />Date of Birth: 11/15/1983 <br />Boards/Commissions applied for: <br />Orange County Planning Board <br />Nursing Home Community Advisory Committee <br />Work Experience: <br />Harris Teeter <br />Triangle Sportsplex <br />Johnny T Shirt <br />Volunteer Experience: <br />UNC Hospital <br />Habitat for Humanity <br />Education: <br />B.A. in Sociology from the University of North Carolina at Chapel Hill <br />Other Comments: <br />As an undergraduate sociology major I was able to design and implement IRB approved <br />social research on stigmatized populations confidentially. (believe as a life long resident <br />of the Chapel Hill/ New Hope area, that I will have some insight the Board might find <br />valuable. STAFF COMMENTS: Originally applied for Orange County Planning Board & <br />Nursing Home Community Advisory Committee on 2/3/2008. ADDRESS <br />VERIFICATION: 117 Creel St, Chapel Hill, is Chapel Hill township in CHPL jurisdiction. <br />This application was current on: 2/3/2008 10:53:29 PM Date Printed: 6/9/2008 <br />