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14 ? <br />FOR OFFICE USE ONLY <br />2^Z 2-0 e IoF2 1?41lh G,S& e <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />If you are an Orange County resident, at least 18 years old, and willing to volunteer your time and <br />expertise to your community, please complete this application and return to: <br />CC?GQ?`r? <br />Orange County Commissioners' Office -- ;? <br />P.O. Box 8181 <br />Hillsborough, NC 27278 FEB 2 2 211 <br />Phone (919) 245-2125; 245-2129; 245-2130; 732-8181 <br />Fax: (919) 644-0246 *.Email: nmarUn@co.omnge.nc. <br />NAME:V T? S-ro Ale <br />HOME ADDRESS: Q Jr XTOAI/ Cr ?T C-I- ?(;(? j???q? d J <br />CITY• l W66 <br />R o G A/ cl_ zip code• a 7a 78 <br />PHONE: (Day) 3 0? 9 3 (Evening1Iate) 5;4^-1- (Fax) <br />EMAIL: <br />PLACE OF EMPLOYMENT: JOB TITLE: <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDI ATE YOUR AWNS 113' <br />OF RESIDE4CE: <br />? Bingham la Cheeks Hillsborough ? Eno ? Chapel Hill ? Little River ? Cedar Groire <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE-FOLLOWING AREAS: <br />? Joint Planning Area ? Extraterritorial Area ? Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: ? Male Female <br />ETHNIC BACKGROUND: ? African American'ACaucaslan ? Hispanic ? Native American <br />? Other DATE OF BIRTH: 1 _ZLQ. <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDSICOMMISSIONS ON WHICH YOU <br />WOULD BE WILLIN TO SERVE. <br />1. 0 C a A &K5- _ 2. 3. <br />&u reyT' ' ?. A <br />WORK EXPERIENCE: r/' I:22 S i es lea <br />Au&d, V a / /ri /;10/p/ (_70M n /YY /'411 a I'Pco' -i-- /1 r <br /> <br />o/)-q/ <br /> <br /> <br />VOLUNTEER EXPERIENCE: -5 r_ i / (10-x -- /111 ,. )-7.' F <br />4, g-l ,S000C-L ?LS < <br />>y Stuff kl en %fh b'2 gm nC_e 1 nf{yr&1 lien pay r?rr, <br />01b <br />s?