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This space for office use only <br />4/29/02 Page 1 of 1 Cherie Rosemond <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY 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 t:o: <br />Orange County Commissioners' Office <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />Phone (919) 245-2125; 688-7331; 227-3031 FX (919) 644-0246 <br />NAME: --------------------------------- Cherie Rosemond <br />HOME ADDRESS: ------------------ 2823 Old NC 10 <br />CITY: ----------------------------------- Chapel Hill <br />STATE: -------------------------------- NC <br />ZIP CODE: ---------------------------- 27514 <br />TELEPHONE: (Home) -------------- 383-5284 <br />TELEPHONE: (Work) --------------- 843-8696 <br />TELEPHONE: (FAX) ---------------- 966-3678 <br />EMAIL: --------------------------------- crosemon@med.unc.edu <br />PLACE OF EMPLOYMENT: ------ UNC <br />JOB TITLE: --------------------------- Clinical Asso. Professor/PhD student <br />TOWNSHIP OF RESIDENCE: ---- - <br />ZONE OF RESIDENCE: ------------ - <br />SEX: ------------------------------------ Female <br />ETHNIC BACKGROUND: --------- Caucasian <br />DATE OF BIRTH: -------------------- 11/2/55 <br />LIST, IN PREFERENCE, THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WILLING <br />TO SERVE: 1: ---------------------- Adult Care Home Advisory Board <br />2. ---------------------- 3. ---------------------- <br />Please list work, volunteer and educational experience. <br />WORK EXPERIENCE: 10 years - UNC faculty in Physical Therapy/ Aging <br />VOLUNTEER EXPERIENCE: 7 years Adult Care Home Advisory Board; 2 years Planning <br />Board <br />EDUCATIONAL EXPERIENCE: Wake Forest BA 1973; Univ of ALA Birmingham MS <br />1979; Duke MS PT 1986; Currently Phd Student at UNC in Public Health. <br />OTHER COMMENTS: <br />How did you become aware of Orange County volunteer opportunities? List all that apply: Other <br />If other, how? <br />By submitting electronic application, applicant agrees to Ethics Guidelines and agrees to attend <br />three-hour orientation.This form was submitted online, on Mon Apr 29 11:14:36 2002 <br />