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1,~ <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 />lob Title: <br />Township of Residence: <br />Zone of Residence: <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 />ti moth y. bu kowski @ att. n et <br />Pediatric Urology of NC <br />Physician <br />Chapel Hill <br />Carrboro City Limits <br />Sex: Male <br />Ethnic Background: Caucasian <br />Date of Birth: 6/27/1961 <br />BoardslCommissions applied for: <br />Sportspiex 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 far Sportspiex Community Adv, Committee <br />8/17/2006 ADDRESS VERIFICATION: 220 Stratford Drivei n in Chapel Hill township in <br />the Carrboro city limits, <br />Date Printed: 8/24/2006 <br />This application was current on: 8/17/2006 <br />