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Page 1 of 1 Catherine A. Gutmann <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 <br />time and expertise to your community, please complete and submit this form. <br />Name: <br />Name Called: <br />Home Address: <br />Phone: (Day) <br />Phone: (Evening) <br />Fax: <br />Email: <br />Place of Employment: <br />Job Title: <br />Township of Residence: <br />Zone of Residence: <br />DR. CATHERINE A GUTMANN <br />117 WEATHERHILL POINTE <br />CARRBORO, NC 27510 <br />919 286 0411 <br />919 967 2990 <br />cggnp@yahoo.com <br />DURHAM VA MEDICAL CENTER <br />NURSE PRACTITIONER <br />Chapel Hill <br />Sex: Female <br />Ethnic Background: Caucasian <br />Date of Birth: 08/10/1940 <br />Please list (in order of preference) the Boards/Commissions on which you would be <br />willing to serve. 1. Board of Health 2. _______~_~_____ 3• <br />WORK EXPERIENCE: MANY YRS TAUGHT COMMUNITY/PUBLIC HEALTH NURING <br />AT THE COLLEGE LEVEL CURRENTLY A GERIATRIC NURSE PRACTITIONER AT <br />THE DURHAM VA FOR THE PAST EIGHT YRS. <br />VOLUNTEER EXPERIENCE: COMPEER PROGRAM-ORANGE COUNTY MENTAL <br />HEALTH ASSOCIATION AIDS CAREGIVING TEAM CHAPEL HILL CARRBORO <br />SCHOOLS MENTORING PROGRAM HABITAT FOR HUMANITY. <br />EDUCATIONAL EXPERIENCE: BSN, MSN, MPH-MEDICAL CARE ORGANIZATION, <br />DRPH-HEALTH POLICY AND ADMINISTRATION. <br />OTHER COMMENTS: None listed. <br />How did you become aware of Orange County volunteer opportunities? <br />Other. If Other, how? BOARD MEMBER. <br />By submitting electronic application, applicant agrees to Ethics Guidelines and agrees <br />to attend three-hour orientation. This form was submitted online, on 6/27/03 12:38:35 <br />p.m. <br />