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J <br />Page 1 of 1 <br />Ann Chamberlin <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 />Ms. Ann Chamberlin <br />2329 Falls Dr, <br />Chapel Hill NC 27514 <br />919-383-8105 <br />919-383-8105 <br />acandcm@earthlink.net <br />La Salle Health Care <br />Physical Therapist <br />Township of Residence: Chapel Hill <br />Zone of Residence: Chapel Hill Twnsp <br />Sex: Female <br />Ethnic Background: Undesiqnated <br />Date of Birth: 11/6/1957 <br />Boards/Commissions applied for: <br />Adult Care Home Community Advisory Committee <br />Work Experience: <br />La Salle Healthcare Durham, 10/03-present; Durham Reg. Hosp. 10/03 - 12/02; UNC <br />School of Medicine, Project Mgr. Research; 10/96 - 8/00; School of Nursing, UNC 8/95 - <br />9/96 , Project Mgr.; UNC Sch. Of Medicine, 4/92- 4/95; 12/86 - 12/91 Program <br />Coordinator, Western Man Hospital, Westfield, MT, <br />Volunteer Experience: <br />New Hope Elem. Sch. Reader, 1995-1997, 2002-2003, IFC Community Shelter, 8/96 - <br />5/97. <br />Education: <br />2002 MPT UNC Sch, Of Medicine, Div. Of Physical Therapy; 1984 UNC Sch. Of Public <br />Health, Dept, of Health, Behavior and Health Education, 1979, B,A, Psychology, SUNY <br />@Binghamton, <br />Other Comments: <br />STAFF NOTES: Origninally applied 12/19/03 for Adult Care Home Community Advisory <br />Committee, ADDRESS VERIFICATION: 2329 Falls Drive, Chapel Hill, 27514 is in <br />Chapel Hill Township, Outside City Limits, Not in ETJ. MOAD,ncg, <br />This application was current on: 12/19/2003 Date Printed: 1/1512004