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~ 13;J1 FAX 919 8 8 72110 <br />DCRI <br />~ 01 <br />T _ FOR OFFICE USE ONLY <br />~~ ~ o~ ~ Shana~_ <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />If you are en Orange County rvsldent, at least 18 years old, and willing to volunteer your time and <br />expertise to your community, please cvmplata this application end reWrn to: <br />Orange County Board of Commissioners' Office <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />Phone (919)245-2125;2a5.2129; 245.2130; 732.6161 <br />CFex: (919) 644•D246 ~ Email: ncglover~co,orenga.nc.us <br />NAME: __ '1~O~NA T th <br />ItpMEADDRESS:_~03_ Lc?H2bY0oK P/• _ <br />aTY: ~p qP 1 ~~11~__.~,~~ Zip Coda: °~7rf' 6 <br />PHONE: (Day) t? 60 "~( ~r~11 (Eveningliato) _~(Fax) <br />EMAIL: .S~aagc~rq ~s GJati~~ • Cow. <br />PLACE OF EMPLOYMENT: DbG.P Ua:u. JOB TITLE: ~J!^. <`n~~ G/"~S'Tapr...[V' <br />IN ORDERTO ASSURE COUNTYWIDE REpRESEN7ATi0N PLEASE INDICATEYOURTOWNSHIP <br />OF RESIDENCE: <br />O Bingham O Cheeks D Hillsborough O Eno ~Chapei Hill O Little River D Cedar Grove <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />D Joinl Planning Area D Extraterritoria- Area O Transition Area <br />WE ASK YOUR HELP IN ASSURING pIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING pUEST10N5:.1~Maie O Female <br />ETHNIC BACKGROUND:O~AfrieanAmericanOCaucasian DHispanic aaAhve6tr7erican <br />Other DATE OF BIRTH: l/ // <br />PLEASE US7 (IN ORDER OF PREFERENCE) THE <br />WOULD BE/ WILLING TO SERVE. <br />ON WHICH YOU <br />3. <br />WORK EXPERIENCE: Ste ~i,'~4c h rtQ~"r <br />VOLUNTEER EXPERIENCE: S"e? ~ claC~F+.a.,";! <br />