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Page 1 of 1 <br />Ann Chamberlin ~N <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 />Ms. Ann Chamberlin <br />2329 Falls Dr, <br />Chapel Hill NC 27514 <br />919-383-8105 <br />919-383-8105 <br />acandcm@earthlink..net <br />La Salle Health Care <br />Physical Therapist <br />Chapel Hill <br />Chapel Hill Twnsp <br />Female <br />Undesignated <br />11 /6/ 1957 <br />Boards/Commissions applied for: <br />Work Experience: <br />La Salle Healthcare Durham, 10/03-present; Durham Reg. Hosp. 10/03 - 12/02; UNC <br />School of Medicine, Project Mgr, Research; 10/96 - 8/00; School of Nursing, UNC 8/95 - <br />9/96 ,Project Mgr,; tJNC Sch, Of Medicine, 4(92- 4/95; 12/86 - 12/91 Program <br />Coordinator, Western Man Hospital, Westfield, MT. <br />Volunteer Experience: <br />New Hope Elem. Sch. Reader, 1995-1997, 2002-2003. IFC Community Shelter, 8/96 - <br />5/97. <br />Education: <br />2002 MPT UNC Sch, Of Medicine, Div, Of Physical Therapy; 1984 UNC Sch. Of Public <br />Health, Dept. of Health, Behavior and Health Education, 1979, B,A, Psychology, SONY <br />@Binghamton, <br />Other Comments: <br />STAFF NOTES: Originally applied 1/5/2004 for CFW, HSAC and HRC, ADDRESS <br />VERIFICATION: On 6/17/04 an address change was received for 4909 Walnut Grove <br />Church Road, Hurdle Mills, NC 27514, <br />2704 Millcreek Road, Mebane is in Cheeks Township( current 1/5/2004). <br />This application was current on: 12/19/2003 Date Printed: 5/23/2005 <br />