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25 <br /> Membership Application for Community Advisory Council <br /> The Community Advisory Council is chartered to keep the Regional Health Council informed about member <br /> and family experiences and community health needs. This group is also intended to allow members and <br /> community stakeholders to take an active role in improving their lives and community. <br /> First Name: Kim Last Name: Wanke <br /> Address: 3815 Kenwood Drive <br /> City: Hillsborough County: Orange <br /> State: NC ZIP: 27278 <br /> Phone: 919-732-0915 Email: kwanke28@gmail.com <br /> How would you like us to contact you? Please check all that apply: <br /> Email <br /> Age Range: <br /> 45-54 <br /> 1 self-identify as: <br /> Female <br /> describe my race or ethnicity as: <br /> White <br /> Race: Other, if applicable: <br /> Which spoken language to you prefer? <br /> English <br /> Do you require an interpreter? <br /> No <br /> Do you require any accommodations (handicap accessibility, space for service animal, etc.)? <br /> No <br /> Do you want written material in your spoken language? <br /> Yes <br /> Work Experience: <br /> Currently a Grants Manager in Pediatrics at Duke University. Previous positions in grant management, <br /> administrative, accounting. <br /> Education (for demographic purposes. No formal education required to participate): <br /> Bachelor's Degree <br /> I am passionate about or have knowledge of(please check ALL that apply): <br /> Housing, Community organizing, Education, Maternal/child health, Children/youth services, Community/public <br /> health, Local government, Veteran's services, Mental health services, Senior services, Other (please describe) <br /> Passionate about: Other, if applicable: <br /> Page 1 of 2 • <br /> rev. 20190926 cardinalinnovations.org <br />