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!5 <br />Paae 1 of 1 Kim Walsh <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 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. Kim Walsh <br />3522 Bluestone Court <br />Chapel Hill, NC 27514 <br />(919) 732-460 <br />(919) 732-460 <br />kwalsh6@earthlink.net <br />Blue Cross and Blue Shield of North Carolina <br />Assistant State Health Plan Medical Director <br />Eno <br />Sex: Female <br />Ethnic Background: Caucasian <br />Date of Birth: 04/16/1960 <br />Please list (in order of preference) the Boards/Commissions on which you would be willing to serve. 1. Board of Health. <br />2 ........................... 3..................................... <br />WORK EXPERIENCE: 05/27/03-08/31/03 Independent Contractor, writing local public health bioterrorism response <br />plan Alamance County Health Department Burlington, NC. 9/2002-Present Assistant State Health Plan Medical Director <br />Blue Cross and Blue Shield of North Carolina Durham, NC. 8/2002-Present Faculty Member/Small Group Leader,The <br />Practice Course Duke University Medical Center Durham, NC. 3/2001-12/2001 Medical Director Durham County Health <br />Department Durham, NC. 6/1992-2/2001 Medical Director Alamance County Health Department Burlington, NC 6/91- <br />6/92 Public Health Physician Wake County Department of Health Raleigh, NC. 6/91-9/91 Contract Physician Alamance <br />County Health Department Burlington, NC. 6/91-8/91 Per Diem Physician Kaiser Pennanente Durham, NC. <br />VOLUNTEER EXPERIENCE: Participated in following groups as representative of .Alamance County Health <br />Department: Member, Executive Cancer Committee 5/94-2/01; Alamance Regional Medical Center Member, Advisory <br />Board 5/96-1998; Alamance Minority Cancer Awareness Program Member, Health Advisory Council 1/97-2/01; <br />Alamance-Burlington School System Co-chair, Alamance Child Asthma Coalition 4/99-2/01. <br />EDUCATION: 1988-1991 Family Medicine Residency Training Duke-Watts Family Medicine Program Durham, NC. <br />1983-1987 Doctor of Medicine (MD 12/87) Duke University School of Medicine Durham, NC. 1985-1986 Masters of <br />Public Health (MPH 09/86) University of North Carolina School of Public Health Department of Maternal and Child <br />Health Chapel Hill, NC. 1978-1982 Bachelor of Arts, English Literature (AB 06/82) Dartmouth College Hanover, NH. <br />OTHER COMMENTS: Full, unrestricted North Carolina Medical license. Diplomate of American Board of Family <br />Practice. Participant at Cunty Board of Health meetings as Health Department representative: Alamance County 1992- <br />2001 and Durham County 2001. <br />How did you become aware of Orange County volunteer opportunities? Current Orange County Volunteer <br />If Other, how? By submitting electronic application, applicant agrees to Ethics Guidelines and agrees to attend three- <br />hour orientation. This form was submitted online, on 6/11/03 9:45:31 PM <br />