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8 <br />VOLUNTEER A.PPL Z CAT I ON <br />~~ . <br />r~..~.NOE COUNTY BOARDS AND COMMY S S IONS <br />you are an~Orange County resident, at least 18 years old, and willing to <br />.unteer your ,time and expertise to pour community, please complete and <br />:urn to : . " <br />SSE <br />KE ADDRESS: <br />LEPHONE: <br />County Commissioners' Office <br />P. 0. Box 8181 <br />Hillsborough, NC 27278 <br />i~ d u <br />~' • Zip Code Z 7 ~ <br />. f <br />.ACE OF EMPLOYMENT: <br />iB TITLE <br /> <br />~~tEVERSE SIDE LIST J'OB, VOL ~EER, AN~DUCATIONAL EXPERIENCE AND/OR SKILLS <br />• • ~'."ULD LxKE FOR US TO CONSIDER . • <br />~•~~:~' <br />?:»:~ <br />10RDER TO ASSURE COUNTYWIDEREPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF <br />~SIDENCE: <br />Ingham Cheeks _.r._~ <br />illsborough Eno __.._~ <br />hapel Hill ~ Little River <br />edar Grove ~ ~ _ <br />E ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />Y ANSWERING T~iE OLLOWING QUESTIONS: <br />:ale •ETHNIC BACKGROUND: ~ . <br />'emale _,~,~ African American Hispanic <br />Caucasia.n• ~ Other ....~_ <br />' Native A•mexican <br />)ATE OF BIRTH: <br />Z ~- - <br />?LEASE. LxST (IN ORDER OF PREFERENCE) THE BOARDS%COKMISSIONS ON WHICH. YOU <br />COULD BE WI~-LING TO SE~vF• ~ • <br />3 . '~ <br />;. <br />