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~~ <br />Page 1 of 1 <br />Timothy P. Bukowski <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 />Township of Residence: <br />Zone of Residence: <br />Sex: <br />Ethnic Background: <br />Date of Birth: <br />Mr. Timothy P. Bukowski <br />220 Stratford Drive <br />Chapel Hill NC 27516 <br />919-785-1888 <br />919-6967066 <br />919-932-3181 <br />timothy. bu kowski@att. net <br />Pediatric Urology of NC <br />Physician <br />Chapel Hill <br />Carrboro City Limits <br />Male <br />Caucasian <br />6!27/1961 <br />Boards/Commissions applied for: <br />Sportsplex Community Advisory Committee <br />Work Experience: <br />Physician for 20 years (Pediatric Urology <br />Volunteer Experience: <br />Triangle Youth Hockey 11 years, Boy Scouts 8 years, various professial activities, NC <br />Pediatric Society-Foundation President <br />Education: <br />SUNY-Buffalo School of Medicine 1987, Georgetown University 1983 <br />Other Comments: <br />STAFF COMMENTS: Originally applied for Sportsplex Community Adv. Committee <br />8/17/2006 ADDRESS VERIFICATION: 220 Stratford Drivei n in Chapel Hill township in <br />the Carrboro city limits. <br />This application was current on: 8/17/2006 Date Printed: 6/15/2007 <br />