Orange County NC Website
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. !~ <br />FOR OFFICE USE ONLY <br />P' ~ o~ ~ L'ar~a- Nl ~u~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; 22 ~n 2 <br />~~LS~ V'15 <br />Orange County Board of Commissioners' Office ~ ~~ <br />P.O. Box 8181 !: <br />Hillsborough, NC 27278 ~ ~.5 ~~ _ <br />Phone (919) 245.2125; 245.2129; 245-2130; 732-8181 ~' <br />Fax: (91/9~)/644-0246 Email: ncglover~co.orange.nc.u -..__...,._ .. <br />NAME: ~Q~ ~' a 1 ' ( ~~ ~ i GL(1 . ,. ~ - ..._ __.._ _~---~.~ <br />WOME ADDRESS: ~~ ~~~~~ ~ ~ ~/~ ~/~, <br />CITY• '~- 5 ~ n ~' O (1 ~ N C - - zip Code: 7 7 . <br />PHONE: (Day) 9~y ~ ~~ /9~,(,Evening/late) _~ ~-t1Y1~__ (F~) ~CC,~r1 °V _ <br />EMAIL: ~r ~a~ ~ I C.~(1 e (~~ . ('(1 ~ ~~ m <br />PLACE OF EMPLOYMENT: LLQ~. ~~ I--~ _ JOB TITLE: _9 (~ f;,~Q Tt`, ~~' <br />IN ORDER.TO ASSURE COUNTYWIDE REPRESENTATION PLEASE LNDlCATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />C Bingham C Cheeks }~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 PlanningAnea. 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 (IN ORDER.OF PREFERENCE) THE.BOARDS/COMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO S RVE. <br />WORK DCPERIENCE: __ <br />S~ se S(.cn'1~ <br />T <br />VOLUNTEER EXPERIENCE: _ ~ P t~_ ~~~GL;GI` 1 ~~~~~~u~'f P <br />