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/6 <br />FOR OFFICE USE ONLY <br />P <br />~~~~ <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY BOARDS AND COMMISSIONS <br /> <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 this application and return to: <br />Orange County Commissioners' Office <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />Phone (919) 732-8181; 688-7331; 968-4501; 227-2031 <br />Ext. 2125, 2129 or 2130 • Fax: (919) 644-0246 <br /> <br /> <br />CITY: t? ~~P~J' ~ Zip Code: <br />SuHM~~ <br />TELEPHONE: (H) ~'~qL~~l ~ ~ !6 .3`~7 YS3a (Fax) ~i~M ~~ <br />EMAIL: /~'1 ~FZPt~ ~ f~t0~ • ~ (7l~'1 <br />PLACE OF EMPLOYMENT: .-__- JOB TITLE: ~'-~ <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR <br />TOWNSHIP OF RESIDENCE: Bingham Cheeks <br />Hillsborough Eno <br />Chapel Hill 1/_ Little River <br />Cedar Grove <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />Joint Planning Area ~/ Extraterritorial Area Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER <br />AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: <br />Male ETHNIC BACKGROUND:• <br />Female / African American Hispanic <br />Caucasian / Other <br />Native American <br />DATE OF BIRTH: _ .~ ~S `I <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH <br />YOU WOULD B WILLIN TO SERVE. ~iy~t,2.~ ~.h • (0'1~ nLy <br />1. <br />2. <br />3. <br />