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fY <br />Page 1 of 1 <br />Katina Nichols <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 />Ms. Katina Nichols <br />5656 Preston Loop <br />Mebane INC 27302 <br />919-563-4373 <br />336-266-9993 <br />919-563-9881 <br />nichols@mebtel.net <br />Touching Lives Everyday Home Care, INC <br />Agency Director/Owner <br />Cheeks <br />At-Large <br />Female <br />African American <br />Date of Birth: 2123/1971 <br />Boards/Commissions applied for: <br />Advisory Board on Aging <br />Nursing Home Community Advisory Committee <br />Human Relations Commission <br />Work Experience: <br />Presently owner, Director of Nursing and Agency Direcotr of home care agency, RN for 9 <br />years with experience in renal and nephrology, home care, case management, MDS <br />coordinator at Nursing Home facility, worked as weekend RN supervisor at skilled <br />nursing home facility and RN team leader at Rehabiliation facility. <br />Volunteer Experience: <br />School system and soon the daycare that my baby attends. <br />Education: <br />A.D.N. <br />Other Comments: <br />I am looking forward to giving in the community and helping others. I am a stay-at-home <br />mom/wife who is running a business and wanting to make a difference for our youth and <br />other people. I want better standards for our elderly in long term care facilities. STAFF <br />COMMENTS: Originally applied for Adv, bd on Aging, NHCAC, HRC 7/18/2005, <br />ADDRESS VERIFICATION: 5656 Preston Loop is in Orange County in Cheeks township. <br />This application was current on: 7/18/2005 Date Printed: 8/3/2005