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~~ <br />FOR OFFICE U5E ONLY <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 vo <br />expertise to your community, please complete this application and return to D <br />Orange County Commissioners' Office <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />Phone (919) 245-2125; 245-2129; 245.2130; 732-8181 <br />Fax: (919) 644-0246 Email: npaciga~co.orange.nc. <br />FEB ~ 9 2uaz <br />.' f <br />i ,,! ~)%~~ <br />t// i <br />NAME: ~~t'jt, lam, ~~C~~(•~ <br />HOME ADDRESS: <br />CITY: ~ ~ ~~ ~?iLl~v ~ . [`~ - Zip Code:_ <br />PHONE: (Day) ~9/9, ~1~-9-~9G S' (Evening/late) ~9~9~4a9-ERG ~ (Fax) <br />EMAIL: ~%c~:~.tf' d cc.c..,.l n (~ Gwt~ ma.tk. ,Cam <br />PLACE OF EMPLOYMENT: ~ ~ rn a .,ten h !~. i..,O JOB TITLE: <br />27.x"/ ~ - <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION.PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENGE: - <br />O Bingham .O Cheeks O Hillsborough O Eno Chapel Hill O Lettle River O CedarGrove- <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />O Joint Planning Area O Extraterritorial Area O Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: O Male ~( Female <br />ETHNIC BACKGROUND: O African American ~ Caucasian O Hispanic O Native American <br />O Other DATE OF BIRTH: 11-~-'f6 <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SERVE. /~ <br />1 • d~u.f~trlG {r C~ C. 2. . t~~~ Clc.!'c. GA"('. 3. lX~ )Yl rYU•S<a-~i n~n~~~- <br />WORK EXPERIENCE: , C, t <br /> <br />VOLUNTEER EXPERIENCE: <br />