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This space for office use only - <br /> 12/10/01 Page 1 of 1 Jaclyn Lipchak <br /> VOLUNTEER APPLICATION <br /> ORANGE COUNTY BOARDS AND COMMISSIONS <br /> If you are an Orange County resident, at least 18 years old, and willing to volunteer your time and expertise to <br /> your community,please complete this application and return to: <br /> Orange County Commissioners' Office <br /> P.O. Box 8181 <br /> Hillsborough,NC 27278 <br /> Phone(919)245-2125; 688-7331;227-3031 FX(919)644-0246 <br /> NAME:---------------------------------Jaclyn Lipchak <br /> HOME ADDRESS:------------------ 114 Melville Loop,Apartment#8 <br /> CITY:-----------------------------------Chapel Hill <br /> STATE:--------------------------------NC <br /> ZIP CODE: ----------------------------27514 <br /> TELEPHONE: (Home)--------------929-8794 <br /> TELEPHONE: (Work)---------------403-9425 ext.30 <br /> TELEPHONE: (FAX)----------------490-9726 <br /> EMAIL:---------------------------------jlipchak @intrex.net <br /> PLACE OF EMPLOYMENT: ------Durham Crisis Response Center <br /> JOB TITLE:---------------------------Crisis Line and Volunteer Coordinator <br /> TOWNSHIP OF RESIDENCE: ----Chapel Hill <br /> ZONE OF RESIDENCE:------------Within C.H.City Limits.✓ <br /> SEX:------------------------------------Female <br /> ETHNIC BACKGROUND:---------Caucasian <br /> DATE OF BIRTH:--------------------08-10-1979 <br /> LIST,IN PREFERENCE,THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WILLING TO SERVE: <br /> 1: ----------------------Advisory Board on Aging 2- ---------------------- Commission for Women <br /> 3- ----------------------Human Relations Commission <br /> Please list work,volunteer and educational experience. <br /> WORK EXPERIENCE: Durham Crisis Response Center, Crisis Line and Volunteer Coordinator,March 2000- <br /> Present; US Attorney's Office, Victim and Witness Advocate Intern,Domestic Violence Unity, Washington D.C., <br /> August 2000-December 2000. <br /> VOLUNTEER EXPERIENCE: A Helping Hand, Chapel Hill-August 2001-Present;DC Coalition for Domestic <br /> Violence-Victim/Witness Advocate Aug. 2000-Dec. 2000;Make-A-Wish Foundation Volunteer 1998-2000; <br /> Family HouseVolunteer 1999; Susan G Komen Breast Cancer Society Volunteer 1998-2000; Jubilee Soup <br /> Kitchen Volunteer 1999,2000. <br /> EDUCATIONAL EXPERIENCE: North Hills High School,Pittsburgh,PA Graduated 6/97;Duquesne <br /> University, Pittsburgh,PA Summa Cum Ladde,BA Psychology, 12/2000;Institute for Experiential Learning, 08/ <br /> 2000-12/2000; Certificate of Completion, Duke University, Graduate School, Master of Liberal Studies. <br /> OTHER COMMENTS: I have lived in Orange County for one year and would like to become more involved in <br /> my community. I feel that I would gain invaluable experience from being a volunteer in this capacity, as well as <br /> offer my own unique life experiences to these areas of involvement. <br /> How did you become aware of Orange County volunteer opportunities? List all that apply: Newspaper. <br /> If other, how?By submitting electronic application, applicant agrees to Ethics Guidelines and agrees to attend <br /> three-hour orientation. This form was submitted online,on Mon Dec 10 11:04:18 2001. <br /> db✓ cc dirs appt <br /> sc✓ cc bks <br /> lk✓ ack <br /> addrs✓mpq np 12/11/01 <br />