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<br />Page 1 of 1 <br />Jerry Ann Gregory <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, Jerry Ann Gregory <br />917 Crestwood Lane <br />Chapel Hill NC 27514 <br />919-933-8481 <br />919-933-8481 <br />919-968-2013 <br />.Jkgregory@mindspring.com <br />O.C, Health Dept; Maxim Health Service <br />Flu Immunization Nurse <br />Chapel Hill <br />ETJ <br />Female <br />Caucasian <br />1/1211945 <br />Boards/Commissions applied for: <br />Adult Care Home Community Advisory Committee <br />Advisory Board on Aging <br />Work Experience: <br />32 Years at Orange County Health Dept, as nurse - retired 1/12/2001. Presently work on <br />contract with Health Dept, and Maxim Health services as Flu Immunization nurse. <br />Volunteer Experience: <br />Meals on Wheels; VA Medial Center - Durham; PTA Thrift shop; Habitat for Humanity; <br />Fund raising for Exchange Club Child Abuse Prevention Foundation in Durham <br />Education: <br />H.S. Diploma; BS, Nursing; Adult Health Assessment certificate-UNC. <br />Other Comments: <br />Renewed application 10/09/03 for ACHCAC and Adv. Bd. on Aging. 6/16/03 for <br />ACHCAC; NHCAC; Adv. Bd. on Aging. Originally applied 9/3/99. Address Verification: <br />917 Crestwood Lane, Chapel Hill, NC 27514 is not in Chapel Hill City Limits; is in Chapel <br />Hill Township. and ETJ. CHPlanning Dept. nag/Clerk's office. <br />This application was current on: 10/3/2003 Date Printed: 1/15/2004