Agenda - 12-10-2002-9h - Laserfiche WebLink

Browse Search

u3 FOR OFF2CE USE ONILY 2 ^Z 2-~ ~ e /o F 2 ~Cl/~7 G, ~'j`a e ~ _ . ~r, , ,-..~, e r~nect~-«-~~ ~-- wvl . VOLUNTEER APPLICATION ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS ~:' 'YVr:.v if you are an Orange County resident, at least 18 years old, and willing to volunteer your time and expertise to your community, please complete this application and return to:._ __ NAME: . ~ Orange County Commissioners' ~OfBce V P.O. Box 8181 Hillsborough, NC 27278 Phone (919) 245-2125; 245-2129; 245 2130; 732-8181 Fax: (919) 644-0246 ~ ,Email: nmartln~co.orange.nc. ' T N C~~ , .~1~Tn nl ~F HOME ADDRESS: 1 °Z Q FEB 2 2 2C~1 i=~='~~\ ,~ ,~ I~~ ~;~ a) c1TY: I~ l L LS P~ o R 0 U G ~ /~ ~ ~ zip cane: a 7a •7~' . PHONE: (Day) ~ 3 0~ ~ g ~3 (Evening/late) 5'~'~" G~ (F~) EMAIL: PLACE OF EMPLOYMENT: ~ Ci~`I I~-,e ~ JOB TITLE: ~rJC'i'• D ~/277~Y- IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE•YOUR TOWNSHI.Q ~._ .OF RES1DEiJCE: ~ ~ .• ^ Bingham ^ Cheeks ~Hlllsborough ^ Eno ^ Chapel Hill ^ Little River D Ceclar Gro,re IN ADDITION, PLEASE INDICATE IF YOU LNE iN ONE OF THEFOLLOWING AREAS: ' ^ Joint Planning Area ^ Extraterritorial Area ^ Transition Area _ WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: , ^ Male ,Female • ETHNIC BACKGROUND: D African American~Caucasian ^ Hispanic D Native American ^ Other DATE OF BIRTH: 1 - a.~"'~- ~~. PLEASE LIST (1N ORDER OF PREFERENCE) THE BOARDS~COMMISSIONS ON WHICH YOU WOULD BE WIC N~TO SERVE. . ' 2 • 3. woRK EzPERiENCe~'~"j' r~- ~~ r/.s; ,.s yea ~/,'//s6v,-au ! r ~'` VOLUNTEER EXPERIENCE:~:__ -S ~ / I ~"~ -- ~ : ~, • °` ' ~ cab ~ ~ Stu to /~2n. %fGr ~'tsu rct nc-Q. 1 n ~{G~rmtf ~r'c'y1 ~y~ r4rr Sc ~ r_ .