Agenda - 04-13-2004-5b2 - Laserfiche WebLink

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FOR OFFICE USE ONLY ~~~_'~ 6/8/99 P il9 Theresa Nicole 6eaJi--ng-Rai'" ~ VOLUNTEER APPLICATION ORANGE COUNTY BOARDS AND COMMISSIONS If you are an Orange County resident, at least 18 years old, and willing to volunteer your time and expertise to your community, please complete this application. and return to: Orange County Commissioners' Office i) ~ ~ L5 u v P.O. Box 8181 ,V Hillsborough, NC 27278 JUN $ I~ Phone (919) 732-8181; 688.7331; 968-4501; 227-2031 Ext. 2125, 2129 or 2130 • Fax: (919) 644-0246 Via, ~~ NAME: Theresa Nicole~6eedingi~ayr ~r~'`~~'~' ~ ~ ~!^- HOME ADDRESS: 2430 Daisy Lane CITY: Chapel Hiil _ _ _ Zip Code: 27516 TELEPHONE: (H) 919-967-0352 (W}__ _(Fax) , __ EMAIL: coleslaw@emaii.unc.edu PLACE OF EMPLOYMENT: Unemployed-studying for bar exam JOB TITLE: IN ORDER TO ASSURE COUNTYWIDE REPRESENTA~,I,~N PLEASE INDICATE YOUR TOWNSHIP OF RESIDENCE: Bingham X ~, Cheeks _ ~_ Hillsborough 1~ ~ no _~ Chapel Hill ittle River Cedar Grove . ~/h1 IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: Joint Planning Area _ Extraterritorial Area _ Transition Area _ WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: Male ETHNIC BACKGROUND: Female _x African American Hispanic Caucasian „~ ~ Other Native American __.~ DATE OF BIRTH: 12122/72 PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WILLING TO SERVE. 1. Commission for the Environment 2. Orange County Planning Board 3. e~flS