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11 <br />Page 1 of 2 <br />Tiketha Collins <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 />Phone (Cell): <br />Email: <br />Place of Employment: <br />Job Title: <br />Year of OC Residence: <br />Township of Residence: <br />Zone of Residence: <br />Sex: <br />Ethnic Background <br />Tiketha Collins <br />600 S. Churton Street <br />Hillsborough NC 27278 <br />9193329917 <br />9193329917 <br />9193329917 <br />tikethacollins @gmail.com <br />Durham Nursing and Rehab <br />Director of Social Services <br />2015 <br />Hillsborough <br />Female <br />African American <br />Community Activities /Organizational Memberships: <br />None at this time. I have a great interest in the aging <br />Past Service on Orange County Advisory Boards: <br />none <br />Boards /Commissions applied for: <br />Advisory Board on Aging <br />Background, education and experience relevant to this board: <br />I have worked with the aging for over 10 years. I have studied gerontology on graduate level. <br />Reasons for wanting to serve on this board: <br />I desire to assist in the programs that directly affect the aging in my community. <br />Conflict of Interest: <br />Adult Care Home Community Advisory Committee <br />Background, education and experience relevant to this board: <br />I have worked with the aging for over 10 years. I have studied gerontology on graduate level. <br />Reasons for wanting to serve on this board: <br />I desire to assist in the programs that directly affect the aging in my community and ensure the <br />well being of those in placement. . <br />Conflict of Interest: <br />