Orange County NC Website
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. 1~ Y <br />FOR OFFICE USE ONLY <br />P l o1'r ~ G'ar~, a N1. ~ul i un <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: I--a <br />Orange County Board of Commissioners' Office <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />Phone (919) 24x2125; 245-2129; 245.2130; 732-8181 <br />Fax: (919) 644.0246 • Email: ncglover~co.orange.n <br />NAME: ~.1~ r I a ~ ~ ~ - <br />WOME ADDRESS:-, <br />clnr: _~~ <br />PHONE: (Day) 9~ <br />EMAIL: C..c~,r ~~ <br />D C~C~~~.~~~ <br />f~ <br />II~R~~.S~~.., ;: <br />~_ _ J <br />;; <br />_..~__ .. <br />~~ Zip Code: ~ <br />_ ~ - ~ -- . . <br />-.~ /9a,2,(~vening/late) .~ ~m (°~ (Fax) °l1 <br /><<.I~~ can •' <br />PLACE OF EMPLOYMENT: LLQ~ C- "C~ N' JOB TITLE: l(~ a Tom. ~~~' <br />IN ORDER.TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />C Bingham C Cheeks j~Hilisborough C Eno C Chapel Hill C Little River C Cedar Grove <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />C Joint PlanninaArea. C Extraterritorial.Area C Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: C Male Female <br />ETHNIC BACKGROUND: C African American~Caucasian C Hispanic C Native American <br />C Other DATE OF BIRTH: <br />PLEASE LIST pN ORDER~OF PREFERENCE) THE.BOARDSICOMMISSIONS ON WHICH YOU <br />WOU BE WILLING TO S gVE. <br />~. -+ Ca;r~ ~~to m~ <br />1. ~ , X11 ~rn-n'i~ e. _ 3. <br />WORK EXPERIENCE: <br />see ~..-~--~~~ h ~. s e s c~m.~ T <br />VOLUNTEER EXPERIENCE: - ~ ~'_~. C~~GI.,Gf' 1 ~t~ ,~~°3~(~CY(~ <br />