Orange County NC Website
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FQR dFFICE USE.ONLY <br />to <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 appiicatian and return to: <br />Orange County Commissioners' Office ~ 0~~/YG'~' ~o~/,~r <br />P.O. Box 8181 p`~~~~~ ~~~R~ AD, <br />Hillsborough, NC 27278 /`~ <br />Phone (919) 732-8181; 688-7331; 968-4501; ' ~~~~; ~Dl N <br />Ext. 2125, 2129 or 2130 • Fax: (919) 64402 _ ~ ~ t~l .r,~:,; ,/~/I <br />NAME: <br />~~ <br /> <br />HOME ADDRESS: ~ II 111 I _ ._ _ <br />~. <br />cITY• - L( ~ ~ +~ <br />zip Code: ~r7,~'. <br />TELEPHONE; (H) ~ -o? a ~ (W) ('E' -a'8o0 (Fax) rv SY-- 6 Sl <br />EMAIL: ~ ~ ~ S~ ~Ci ~`~_ ~ ~o~u.l~. eo(:~,~ <br />Q <br />PLACE OF EMPLOYMENT: ~ ~+~, JOB TITLE: f~~ I~ssso/'~ <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR <br />TOWNSHIP OF RESIDENCE: Bingham Cheeks <br />Hillsborough Eno -^` <br />. Chapel Hill ~ Little River ~~ <br />Cedar Grove ~"` <br />IN ADDITION, PLEASE IND~CATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />Joint Planning Area xtraterritorial Area Transition Area <br />. .----~ <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBER HIP BY AGE, GE(~pER <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: ! ~.5'~ 9 <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE' BOARDS/COMMISSIONS ON WHICH <br />Y <br />OU WOULD BE W1L~.ING TO SERVE. <br />2. <br />3. <br />