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1~:91 FAX <br />~ ~ « <br /> <br />919 6 8 7110 DCRI <br />I, 0 03 <br />~y <br />CQj 01 <br />FOA OFFICE USE ONLY <br />~. t o y S h ~.r~ i sJ <br />VOLUNTEER APPLICATION <br />ORANGE Ct'K1NTY ADVISORY BOARDS AND COMMISSIONS <br />ff you are an Orange County n ~stdent, at least 18 years old, and willing to valUnteer your time and <br />expertise to your community, ~'~lease complete this applicS~tion end return to: <br />Orange County Board of Commissioners' Offico <br />P.O. Box 8181 <br />Hillsborough, NC x7278 <br />Phone 1919) 245-2125; ?.~tS-2129; 245.2130; 732.6181 <br />Fax: (919) 644D246 • Email: ncglover(a~co.orrnge,nc.us <br />NAME: ~>~! ~^ A Y 1 h <br />HOME ADDRESS:~ ~=',~ l.~~eb rook P/. <br />CITY: ~ ~,~ ~ Zip trade: a 7T ~ b <br />PHONE: (Day) ~~!f ~ (Eveningllate) ~° r ~ ('Fax) <br />EMAIL: Sh a her, -~,~ ~q ~ ~~ ~ C o w~ ~• /` <br />PLACE OF EMPLOYMENT• _ ~~• I~P ,(~(biU. JOB TITUE: ~1 !~`. "~~~ ~~'''~ra~"e e~'' <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />O BinEham O Cheeks O Hillsborough O Eno ~Chapei Hill ^ Little River O Cedar Grove <br />IN AbDITION, PLEASE INDICi~,TE IF YOU UVE IN ONE OF THE FOLLOWING ARFJIS: <br />O Jalnt Plahning Area O Ea~traterritorial Area O Transition Area <br />WE A3K YOUR HELP IN ASSI IRING DIVERSITY OF IiAEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLL0IPIIING QUESTION5: J~lale O Female <br />ETHNIC BACKGROUNb: O African American O Caucasian O HEspanic Nave erican <br />~Cither DATE OF BIRTH: ~a/ f <br />PLEASE LIST (IN ORDER OF II~REFERENCE) THE BOAFi:DS/COMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SERiVE. <br />.•~ <br />7. ~ O~D _ 2. 3. <br />WORK EXPERIENCE: t, ~e a,'ttt~ 7 r* Q'^T <br />VOLUNTEER EXPERIENCE: _, ~eQ ~ ~C~~+.~tit <br />