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Page 1 of 1 <br />Dawn C. Pickett I <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 />Ms. Dawn C. Pickett <br />212 B Simpson Street <br />Carrboro NC 27510 <br />919-929-8965 <br />919-929-8965 <br />pickettdawn@hotmail.com <br />Township of Residence: Chapel Hill <br />Zone of Residence: Carrboro City Limits <br />Sex: Female <br />Ethnic Background: Caucasian <br />Date of Birth: 11/2/1945 <br />Boards/Commissions applied for: <br />Master Aging Plan Taskforce-Steering Committee <br />Work Experience: <br />Medical Review of N.C., Senior Assoc; OVP Projects. <br />Volunteer Experience: <br />Wake County Nursing Home Advisory Committee; N.C. Health Access Coalition (see <br />attached letter) <br />Education: <br />B,A. Industrial Relations, UNC-Chapel Hill, Masters in Public Administration 1993 <br />Other Comments: <br />Reapplied MAP Taskforce 10/06/2005. On 10/23/03, she updated her application with <br />staff at CFE; she is still interested in CFE but primarily in NHCAC, 11/25/02 renewed her <br />app. for Nursing Home Community Adv, Committee, 1 st choice; CFE, 2nd choice. <br />Applied 2/19/02 for Nursing Home Community Advisory Committee; Adult Care Home <br />Community Advisory Committee; Commission for the Environment. ADDRESS <br />VERIFICATION: OLD Address: 107 Jones Street is in C.H. city IimitsNEW Address 212 <br />B Simpson Street Carrboro 27510-Carrboro City Limits„ <br />This application was current on: 10/6/2005 Date Printed: 6/1/2Q06 <br />