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HomeMy WebLinkAboutAgenda - 09-16-2014-11cORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: September 16, 2014 Action Agenda Item No. 11 -c SUBJECT: Board of Health - Appointments DEPARTMENT: Board of Commissioners PUBLIC HEARING: (Y /N) FNo ATTACHMENT(S): Under Separate Cover Membership Roster Recommendations Applications for Persons Recommended Interest List Applications of Persons on the Interest List INFORMATION CONTACT: Clerk's Office, 245 -2130 1 PURPOSE: To consider making appointments to the Board of Health. BACKGROUND: The following appointments are for Board consideration: • Appointment to a second full term (position #1) At -Large Veterinarian for Dr. Susan Elmore, DVM expiring 06/30/2017. • Appointment to a first full term (position #3) At -Large Citizen /Commissioner Appointment for Ms. Esther Earbin expiring 06/30/17. • Appointment to a second full term (position #4) At -Large Nurse for Ms. Liska Lackey, RN expiring 06/30/2017. POSITION NO. NAME SPECIAL REPRESENTATIVE EXPIRATION DATE 1 Dr. Susan Elmore, DVM At-Large Veterinarian 06/30/2017 3 Ms. Esther Earbin At -Large Citizen /Commissioner Appointment 06/30/2017 4 Ms. Liska Lackey, RN At-Large Nurse 06/30/2017 NOTE - If the individuals listed above are appointed, the following vacancies remain: • No vacancies. FINANCIAL IMPACT: None. RECOMMENDATION(S): The Board will consider making appointments to the Board of Health. 2 Board and Commission Members And Vacant Positions Board of Health Meeting Times: 7:00 p.m. fourth Wednesday of each month Terms: 2 Contact Person: Tersee Flores Meeting Place: Chapel Hill and Hillsborough Alt. HD Positions: 11 Length: 3 years Contact Phone: 919- 245 -2411 Description: The Board of Commissioners appoints representatives of specific health - related professions and the general public to this board. It makes policy and is charged with protecting and promoting the public health in Orange County. To learn more about this Board, go to the following web address: http:// www. co.orange.nc.us /health/index.asp Dr. Susan Elmore Day Phone: 919 - 541 -3474 1 Vice -Chair Evening Phone: 919- 967 -4172 308 Glenwood Drive FAX: Chapel Hill NC 27514 E -mail: elmore @niehs.nih.gov Mr. Matthew Kelm Day Phone: 919 - 668 -5398 2 Evening Phone: 919- 357 -4349 103 Lorilane Dr. FAX: 919 - 681 -8187 Carrboro NC 27510 E -mail: matthew.kelm @duke.edu VACANT Day Phone 3 Evening Phone: FAX: E -mail: Ms Liska Lackey Day Phone: 919 - 968 -1450 4 Evening Phone: 507 Oak Ave FAX: Carrboro NC 27510 E -mail: liska.lackey @gmail.com Dr. Michael Carstens Day Phone: 919 - 968 -4774 5 Evening Phone: 857- 498 -1442 108 Carriage Circle FAX: 919- 942 -5291 Chapel Hill NC 27514 E -mail: carstensmike @hotmail.com Sex: Female First Appointed: 09/21/2010 Race: Caucasian Current Appointment: 06/07/2011 Township: Chapel Hill Expiration: 06/30/2014 Resid/Spec Req: At -Large Number of Terms: 1 Special Repr: Veterinarian Resid/Spec Req: At -Large Sex: Male First Appointed: 06/15/2010 Race: Caucasian Current Appointment: 06/18/2013 Township: Chapel Hill Expiration: 06/30/2016 Resid/Spec Req: At -Large Number of Terms: 2 Special Repr: Pharmacist Resid/Spec Req: At -Large Sex: First Appointed: Race: Current Appointment Township: Expiration: 06/30/2014 Resid/Spec Req: At -Large Number of Terms: Special Repr: Citizen/Commissioner Appointment Sex: Female First Appointed: 06/07/2011 Race: Caucasian Current Appointment: 06/07/2011 Township: Chapel Hill Expiration: 06/30/2014 Resid/Spec Req: At -Large Number of Terms: 1 Special Repr: Nurse Sex: Male Race: Caucasian Township: Chapel Hill Resid/Spec Req: At -Large Special Repr: Optometrist First Appointed: 08/19/2009 Current Appointment 05/15/2012 Expiration: 06/30/2015 Number of Terms: 2 Wednesday, September 03, 2014 Page 1 3 Board and Commission Members And Vacant Positions Board of Health Meeting Times: 7:00 p.m. fourth Wednesday of each month Terms: 2 Contact Person: Tersee Flores Meeting Place: Chapel Hill and Hillsborough Alt. HD Positions: 11 Length: 3 years Contact Phone: 919- 245 -2411 Description: The Board of Commissioners appoints representatives of specific health - related professions and the general public to this board. It makes policy and is charged with protecting and promoting the public health in Orange County. To learn more about this Board, go to the following web address: http:// www. co.orange.nc.us /health/index.asp Mr. Corey Davis Day Phone: 919 - 968 -6308 6 Chair Evening Phone: 102 Barbee Court FAX: Carrboro NC 27510 E -mail: coreyd @gmail.com Mr. Tony Whitaker Day Phone: 919 - 490 -1645 7 Evening Phone: 919- 321 -2922 3725 Quail Meadow Drive FAX: 919- 403 -0336 Hillsborough NC 27278 E -mail: tony.whitaker @civil- consultants.co Nick Galvez Day Phone: 7274189921 8 Evening Phone: 7274189921 403 N Elliott Road FAX: Chapel Hill NC 27514 E -mail: ngalvez1234 @gmail.com Dr. Sam L.asris Day Phone: 919 - 732 -7362 9 Evening Phone: 919- 732 -7362 7020 Caviness Jordan Rd. FAX: Cedar Grove NC 27231 E -mail: samlasris @hotmail.com Dr. Paul Chelminski Day Phone: 919 - 966 -0471 10 Evening Phone: 919- 932 -1755 116 Watters Road FAX: 919- 966 -4507 Carrboro NC 27510 E -mail: chelminp @med.unc.edu Sex: Male First Appointed: 12/13/2011 Race: Caucasian Current Appointment: 05/15/2012 Township: Chapel Hill Expiration: 06/30/2015 Resid/Spec Req: At -Large Number of Terms: 2 Special Repr: Citizen/commissioner appointment Appointment Sex: Male First Appointed: 08/19/2009 Race: Caucasian Current Appointment: 05/15/2012 Township: Little River Expiration: 06/30/2015 Resid/Spec Req: At -Large Number of Terms: 2 Special Repr: Professional Engineer Special Repr: Dentist Sex: Male First Appointed: 03/18/2014 Race: Other Current Appointment: 03/18/2014 Township: Chapel Hill Expiration: 06/30/2015 Resid/Spec Req: At -Large Number of Terms: Special Repr: Citizen/Commissioner Appointment Sex: Male First Appointed: 03/18/2014 Race: Caucasian Current Appointment: 03/18/2014 Township: Cedar Grove Expiration: 06/30/2016 Resid/Spec Req: At -Large Number of Terms: 1 Special Repr: Dentist Sex: Male Race: other Township: Chapel Hill Resid/Spec Req: At -Large Special Repr: Physician First Appointed: 08/19/2009 Current Appointment: 06/18/2013 Expiration: 06/30/2016 Number of Terms: 2 Wednesday, September 03, 2014 Page 2 0 Board of Health M Board and Commission Members And Vacant Positions Meeting Times: 7:00 p.m. fourth Wednesday of each month Terms: 2 Contact Person: Tersee Flores Meeting Place: Chapel Hill and Hillsborough Alt. HD Positions: 11 Length: 3 years Contact Phone: 919- 245 -2411 Description: The Board of Commissioners appoints representatives of specific health - related professions and the general public to this board. It makes policy and is charged with protecting and promoting the public health in Orange County. To learn more about this Board, go to the following web address: http:// www. co.orange.nc.us /health/index.asp Dr. Bernadette Pelissier 4516 Mystic Lane Hillsborough NC 27278 Day Phone: 919 - 643 -2762 Evening Phone: 919- 643 -2762 FAX: E -mail: bpelissier @orangecountync.gov Sex: Female Race: Caucasian Township: Bingham Resid/Spec Req: At -Large Special Repr: B.O.C.C. First Appointed: 02/05/2013 Current Appointment: 02/05/2013 Expiration: 01/31/2014 Number of Terms: Wednesday, September 03, 2014 Page 3 Thom Freeman From: Colleen Bridger Sent: Thursday, August 28, 2014 10:46 AM To: Thom Freeman Cc: Tersee Flores Subject: Board of Health reappointments Hi Thom- Last night the Board of Health voted to recommend to the BOCC that they reappoint both Susan Elmore and Liska Lackey to a second and final term on the Board of Health. Can you please forward that recommendation to the BOCC? Also- remind me the date that the BOCC will consider the recommendation to appoint Ms. Earbin to the Board of Health? I need to coordinate her orientation. Thanks! Colleen Bridger, MPH, PhD Orange County Health Director Phone: 919.245.2412 / Cell: 919.612.2053 ?Mrproviog hea)(th.. ;n5pf rlp grange. YO ST i Thom Freeman From: [o|leen8hdger Sent: Friday, August 22'2U1412:07PK4 To: Thom Freeman Subject: BOH appointment Attachments: Esther Eurb|n DatabaseApp|ication.pdf H|Thom- TheBuardofHea|thisrecnmmendingMx Esther Earb|nto fill the vacant general public/at large position nn the Board of Health, I've attached her application if you need additional information. Thanks! Colleen Bridger, MPH PhD Orange County Health Director Phone: 919.24S.241Z/Cell: 919.612.2053 ilk IT, 7n-AoT M�� �o» QIQ� 1 7 Page 1 of 2 Esther Earbin Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background: Ms. Esther Earbin 501 Jones Ferry Road, Apt. S6 Carrboro NC 27510 317- 590 -5457 919- 883 -2179 317- 590 -5457 eearbin @gmail.com Orange County Office of the Public Defender Intern 2011 Chapel Hill Female African American Community Activities /Organizational Memberships: Youth Leader, United Church of Chapel Hill; Member, North Carolina Association of Women Attorneys; Member, North Carolina Bar Association, IP Section Past Service on Orange County Advisory Boards: N/A Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: I have 13 years of experience working with the local public health department in Indianapolis, Indiana. During this time, I worked for administration, under the Director of Public Health. My responsibilities included assisting the Director of Operations with management and executing public health initiatives. Reasons for wanting to serve on this board: I would like to use my diverse experience in public health to benefit the residents of Orange County. I am also interested in learning about the various public health issues faced in Orange County. I also enjoy working with public health professionals and finding solutions to the complex problems involved with their daily work. Conflict of Interest: Supplemental Questions: Other Comments: Page 2 of 2 Esther Earbin This application was current on: 1/22/2014 8:10:45 PM Date Printed: 7/2/2014 9 Page 1 of 2 Liska Lackey Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening): Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background: Ms Liska Lackey 507 Oak Ave Carrboro NC 27510 919- 968 -1450 liska.lackey @gmail.com UNC -CH Clinical Assistant Professor 1985 Chapel Hill Female Caucasian Community Activities /Organizational Memberships: Past Service on Orange County Advisory Boards: Boards /Commissions applied for: Supplemental Questions: Work Experience: A graduate of the UNC -CH School of Nursing, I have worked in Orange County as a nurse practitioner and most recently as a Professor at the School of Nursing, working with the graduate nurse practitioner students. Volunteer Experience: Currently, I serve as a volunteer nurse practitioner at the Chapel Hill homeless shelter clinics and at Alliance Medical Ministry in Raleigh. I am also a member of the Orange County Public Health Reserve Corp. In addition to my health - related volunteer work, I am the Oak Ave neighbourhood coordinator for PORCH, a Chapel Hill organization sponsoring monthly food drives. I also serve on a monthly kitchen team at the Homeless Shelter Kitchen and have been a volunteer at the Carrboro Farmers Market for the past 10 years. Past volunteer work includes serving on the Carrboro Elementary School Governance committee, including one year as the Chair and serving as a member of the Chapel Hill / Carrboro redistricting committee. Education: BSW, Florida State University BSN, University of Texas at Austin MSN, University of North Carolina - Chapel Hill Other Comments: 10 Page 2 of 2 Liska Lackey As a health care provider and a proud citizen of Orange county, I value the health of our community. The health and welfare of our community is dependent upon service from its citizens. I would be proud to serve on an advisory board concerned with the well -being of the community, including its animals. STAFF COMMENTS: Originally applied for Animal Services Advisory Board 02/14/2011. Updated application to add Board of Health . ADDRESS VERIFICATION: 507 Oak Avenue, Carrboro, is in Carrboro Jurisdiction, Chapel Hill Township. This application was current on: 2/13/2011 1:37:25 PM Date Printed: 12/31/2013 11 Applicant Interest Listing by Board Name and by Applicant Name Female 623 William Hooper Circle Contact Person: Tersee Flores Caucasian Board Of Health Cell Phone: Contact Phone: 919- 245 -2411 Ms. Martha Bell Day Phone: 919- 968 -4674 Sex: Female 100 Macrae Court Evening Phone: as above Race: Caucasian Chapel Hill NC 27516 Cell Phone: N/A Township: Chapel Hill E -mail: mbell968@yahoo.com Date Applied: 01/09/2014 Skills: Also Serves On: Dr. Dawn Brezina Day Phone: 252 -315 -4650 Sex: Female 2601 Red Hill Lane Evening Phone: 919- 732 -9030 Race: Caucasian Hillsborough NC 27278 Cell Phone: Township: Eno E -mail: dawnbrezina@gmail.com Date Applied: 02/13/2012 Skills: Physician Also Serves On: Ms. Jennifer BTObst Day Phone: 919- 923 -6044 Sex: Female 1000 Smith Level Rd., Apt. J -7 Evening Phone: 919- 923 -6044 Race: Caucasian Carrboro NC 27510 Cell Phone: 919- 923 -6044 Township: Chapel Hill E -mail: jbrobst@nccu.edu Date Applied: 12/18/2013 Skills: Also Serves On: Ms. Kim Calandra Day Phone: 919- 996 -0718 Sex: Female 102 A Crest Street Evening Phone: Race: Caucasian Carrboro NC 27510 Cell Phone: Township: Chapel Hill E -mail: Date Applied: 01/09/2014 Skills: Acupuncturist Also Serves On: Skills: Avid Environmentalist Also Serves On: Skills: Chinese Medicine Practitioner Also Serves On: Skills: Landscape Artist Also Serves On: Ms. Wendy Calvin Day Phone: 919- 630 -1350 Sex: Female 623 William Hooper Circle Evening Phone: Race: Caucasian Hillsborough NC 27278 Cell Phone: Township: Hillsborough E -mail: Date Applied: 03/18/2013 Skills: Also Serves On: Thursday, September 04, 2014 Page 1 of 5 Applicant Interest Listing Board of Health Ms. Barbara Chavious 401 N Nash St Hillsborough NC 27278 Skills: Public Health Dr. Steven Thomas Daniels 206 Franklin Adams Road Efland NC 27243 Skills: 12 by Board Name and by Applicant Name Contact Person: Tersee Flores Contact Phone: 919- 245 -2411 Day Phone: 919- 732 -3469 Evening Phone: 919- 732 -3469 Cell Phone: E -mail: Barbara Chavious@unc.edu Also Serves On: Day Phone: 919- 732 -8213 Evening Phone: 919 -451 -1874 Cell Phone: 919 -451 -1874 E -mail: stdaniel@gmail.com Also Serves On: Caucasian Sex: Female Race: Caucasian Township: Hillsborough Date Applied: 11/06/2013 Sex: Male Race: Caucasian Township: Cheeks Date Applied: 01/15/2014 Ms Tamara Dempsey- Tanner Day Phone: 919- 560 -5600 Sex: Female 9900 Leslie Dirve Evening Phone: 919 -918 -4086 Race: Caucasian Chapel Hill NC 27516 Cell Phone: 317 -590 -5457 Township: Bingham E -mail: tamaradt@yahoo.com Date Applied: 01/10/2014 Skills: Healthcare Consultant Also Serves On: Board of Social Services Ms. Esther Earbin Day Phone: 317 -590 -5457 Sex: Female 501 Jones Ferry Road, Apt. S6 Evening Phone: 919- 883 -2179 Race: African American Carrboro NC 27510 Cell Phone: 317 -590 -5457 Township: Chapel Hill E -mail: eearbin@gmail.com Date Applied: 01/22/2014 Skills: Also Serves On: Dr. Nurum Erdem Day Phone: 9192591153 Sex: Female 10 Saint James Place Evening Phone: 9199330661 Race: Caucasian Chapel Hill NC 27514 Cell Phone: 9192591153 Township: Chapel Hill E -mail: nurumerdem@gmail.com Date Applied: 01/17/2014 Skills: Also Serves On: Mr. Zachary Giles 8000 Oak Pointe Court Mebane NC 27302 Skills: Day Phone: 9103087228 Evening Phone: 9103087228 Cell Phone: 9103087228 E -mail: zach.s.giles@gmail.com Also Serves On: Sex: Male Race: Caucasian Township: Cedar Grove Date Applied: 02/26/2014 Thursday, September 04, 2014 Page 2 of 5 Applicant Interest Listing Board of Health 13 by Board Name and by Applicant Name Contact Person: Tersee Flores Contact Phone: 919- 245 -2411 Mrs Linda Griffin Day Phone: 919- 630 -9078 321 Mitchell Street Evening Phone: 919- 630 -9078 Hillsborough NC 27278 Cell Phone: 919- 630 -9078 E -mail: E -mail: lgriftin2gnc.rr. com Skills: Also Serves On: Dr Daniel Kemp Day Phone: 3364067871 2007 Starferwood Ln Evening Phone: 3364067871 Hillsborough NC 27278 Cell Phone: 3364067871 E -mail: E -mail: spartanl999ggmail.com Skills: Also Serves On: Mr. Winston Liao 126 Fern Lane Chapel Hill NC 27514 Skills: Public Health Mr. Charles McMullen 108 Jones Avenue Hillsborough NC 27278 Skills: Nursing Profession Mr Ken Morgan 2720 Buckboard Drive Hillsborough NC 27278 Skills: American Heart Association Skills: United Way Board of Directors Miss Danielle Mosley 476 Melanie Court Chapel Hill NC 27514 Skills: Club Nova Sex: Female Race: Caucasian Township: Hillsborough Date Applied: 01/09/2014 Sex: Male Race: Other Township: Bingham Date Applied: 07/02/2014 Day Phone: 919 929 3123 Sex: Male Evening Phone: Race: Asian American Cell Phone: Township: Chapel Hill E -mail: Date Applied: 01/16/2013 Also Serves On: Day Phone: 9197329083 Sex: Male Evening Phone: 919- 260 -3879 Race: Caucasian Cell Phone: Township: Hillsborough E -mail: cmcmullenlgna.rr.com Date Applied: 02/10/2011 Also Serves On: Day Phone: 919 -218 -8596 Sex: Male Evening Phone: 919 -218 -8596 Race: Caucasian Cell Phone: Township: Eno E -mail: morgangk @juno.com Date Applied: 11/06/2013 Also Serves On: Also Serves On: Day Phone: 919- 309 -5685 Evening Phone: Cell Phone: E -mail: Dlynnm26ggmail.com Also Serves On: Sex: Female Race: Caucasian Township: Chapel Hill Date Applied: 06/26/2012 Thursday, September 04, 2014 Page 3 of 5 Applicant Interest Listing Board of Health Ms. Yvonne overcast 216 cobalt ridge road hillsborough NC 27278 Skills: Ms. Antonia Pedroza 409 Saint Marys Road Hillsborough NC 27278 Skills: Mr. Vince Stevens 101 Camille Ct Chapel Hill NC 27516 Skills: Dr. Edward Stirman 554 E Hatterleigh Ave Hillsborough NC 27278 Skills: Ms. Jaimee Watts 108C West Carr Street Carrboro NC 27510 Skills: Nursing Profession Dr. Delbert Williams 7110 Pine Hill Road Durham NC 27707 Skills: 14 by Board Name and by Applicant Name Contact Person: Tersee Flores Contact Phone: 919 - 245 -2411 Day Phone: 9197329840 Evening Phone: 9197329840 Cell Phone: 9194511901 E -mail: yovercast@gmail.com Also Serves On: Day Phone: 252- 738 -3770 Evening Phone: 919- 760 -0210 Cell Phone: 919- 760 -0210 E -mail: pedrozaantonia@yahoo.com Also Serves On: E -mail: vstevens@nc.rr.com Sex: Female Race: Caucasian Township: Hillsborough Date Applied: 01/08/2014 Sex: Female Race: Hispanic Township: Hillsborough Date Applied: 08/13/2014 Day Phone: 919- 923 -2561 Sex: Male Evening Phone: 919- 933 -3058 Race: Caucasian Cell Phone: Township: Chapel Hill E -mail: vstevens@nc.rr.com Date Applied: 05/01/2012 Also Serves On: monty.stirman@gmail.com Date Applied: Day Phone: 919 -241 -4912 Sex: Male Evening Phone: 919 -241 -4912 Race: Caucasian Cell Phone: 423 - 677 -3295 Township: Eno E -mail: monty.stirman@gmail.com Date Applied: 03/13/2014 Also Serves On: Day Phone: 828 -381 -6246 Sex: Female Evening Phone: Race: Caucasian Cell Phone: Township: Chapel Hill E -mail: jaimee.watts@gmail.com Date Applied: 05/16/2012 Also Serves On: Day Phone: 9194936310 Evening Phone: 9194936310 Cell Phone: 9198013552 E -mail: delwilliams@nc.rr.com Also Serves On: Sex: Male Race: Caucasian Township: Chapel Hill Date Applied: 06/25/2014 Thursday, September 04, 2014 Page 4 of 5 15 Applicant Interest Listing by Board Name and by Applicant Name Contact Person: Tersee Flores Board Of Health Contact Phone: 919- 245 -2411 Dr. Dennis Williams Day Phone: 919- 962 -7122 Sex: Male 209 Lake Manor Road Evening Phone: 919- 933 -5408 Race: Other Chapel Hill NC 27516 Cell Phone: Township: Chapel Hill E -mail: dwilliamsgunc.edu Date Applied: 05/16/2012 Skills: Also Serves On: Mrs. Megan Williams Day Phone: 919- 240 -4455 Sex: Female 205 Westside Drive Evening Phone: Race: Caucasian Chapel Hill NC 27516 Cell Phone: Township: Chapel Hill E -mail: mpwilliamsgunc.edu Date Applied: 05/04/2012 Skills: Nursing Professor Also Serves On: Dr Joanne Wilson Day Phone: 919 -810 -2774 Sex: Female 104 Stoneridge Drive Evening Phone: 919- 932 -5391 Race: African American Chapel Hill NC 27514 Cell Phone: Township: Chapel Hill E -mail: anteelgearthlink.net Date Applied: 07/15/2013 Skills: Medical Doctor Also Serves On: Nursing Home Community Advisory Committee Dr. Tracey Yap Day Phone: 502 - 686 -0016 Sex: Female 834 Providence Glen Drive Evening Phone: 919- 240 -4793 Race: Caucasian Chapel Hill NC 27514 Cell Phone: Township: Chapel Hill E -mail: tracey.yapgduke.edu Date Applied: 12/02/2013 Skills: Director Also Serves On: Nursing Home Community Advisory Committee Skills: Nurse Thursday, September 04, 2014 Page 5 of 5 16 Page 1 of 2 ILYAMM TO,.M -11 Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background: Ms. Martha Bell 100 Macrae Court Chapel Hill NC 27516 919- 968 -4674 as above N/A mbe11968 @yahoo.com Retired Registered Nurse - Director of Nursing 1995 Chapel Hill Female Caucasian Community Activities /Organizational Memberships: Member, Sigma Theta Tau Vice Chair, DVAMC Veterans Mental Health Council Member, The Chapel of the Cross Volunteer, Ambulatory Care, DVAMC Member, Retired Officers Association Member, Army Nurse Corps Association (former Regional Director) Past Service on Orange County Advisory Boards: Nursing Home Community Advisory Committee Board of Health Boards /Commissions applied for: Nursing Home Community Advisory Committee Background, education and experience relevant to this board: After retiring from active duty with the Army Nurse Corps in 1995, accepted position of Director of Nursing, Carol Woods Retirement Community, serving in that capacity for 12 years, and then continued in special projects as identified by the President/CEO, Carol Woods, for another 5 years; also eventually had operational responsibility for assisted living, and infection control for the organization. Coordinated clinical assignments in long term care for nursing and nursing assistant students from DCC and NCCU. Taught fundamentals of elder care to staff and students; served as consultant with CARF and AAHSA reviewing health and service delivery standards. Reasons for wanting to serve on this board: Throughout the years at Carol Woods, I met many members of this Cmmunity Committee, through their advisory capacity; always impressed with their respect for the older adult and circumstances that lead a person(s) to seek long term care, I knew I was unable to serve this 17 Page 2 of 2 Martha Bell committee until I retired from the business of elder services. I ve continued to keep my nursing license current, attending related education offerings in the infection control, gerontology and health care for the years since retirement from full time work. While volunteering in Durham, I really want to serve my local community and continue to put my knowledge of aging services and long term care to good use. Conflict of Interest: Board of Health Background, education and experience relevant to this board: RN, BSN, MSN; attendance at 3.5 day infection control in long term care course offered by SPICE every two years; recent course attendance at offering regading CDiff; served as infection control consultant for Carol Woods Retirement Community 12 years while also serving as its Director of Nursing /Health Services. Reasons for wanting to serve on this board: Throughout the years at Carol Woods, I was often involved with Board of Health issues, including outbreak investigation, tuberculosis control, difficulties encountered in Infection Control for the older adult in a long term care /congregate living environment. I purposely kept my nursing license current despite my retirement from full time nurse because I hoped to eventually serve my community in some capacity related to my professional knowledge. I seek only an activity that will use my knowledge rather than any paid position. Conflict of Interest: Supplemental Questions: Other Comments: This application was current on: 1/9/2014 11:27:53 AM Date Printed: 1/9/2014 W Page 1 of 2 Dawn Brezina Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment Job Title: Year of OC Residence: Dr. Dawn Brezina 2601 Red Hill Lane Hillsborough NC 27278 252 - 315 -4650 919- 732 -9030 dawnbrezina @gmail.com Durham Regional Hospital Hospitalist Township of Residence: Eno Zone of Residence: At -Large Sex: Female Ethnic Background: Caucasian Community Activities /Organizational Memberships: Past Service on Orange County Advisory Boards: Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Supplemental Questions: Work Experience: My employment has been as a physician in Internal Medicine. I have worked at academic /teaching institutions in North Carolina and in private practice. Presently I work as a hospital medicine physician for duke Health system at DRH. Volunteer Experience: I have participated on a variety of hospital committees and medicalmission trips. Over the years I have been president of the age -group swimming association and have sponsored foreigh exchange students. I also write a weekly health - education /advice column for the Wilson Daily Times (past 3 -4 years). Education: Undergraduate, medical school, residency training in internal medicine (ABIM certification) Other Comments: 19 Page 2 of 2 Dawn Brezina My husband and I have lived in NC for 25 years and have been very busy during that time, working and raising four children (3 of the 4 now graduated from UNC- Chapel). I feel that I now have the opportunity (time) to make some contributions to community. STAFF COMMENTS: Reapplied 6/14/2006 for Arts Commission, Commission for Environment, Commission for Women. Originally applied for Orange County Planning Board, Board of Health, and Hillsborough Planning Board. UPDATED APPLICATION 10/28/2010 FOR OC PLANNING BOARD. UPDATED APPLICATION 02/13/2012 FOR PLANNING BOARD.. ADDRESS VERIFICATION: 2601 Red Hil Lane is Orange County Jurisdiction, Eno Township. This application was current on: 2/13/2012 Date Printed: 12/27/2013 20 Page 1 of 2 Jennifer Brobst Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background: Ms. Jennifer Brobst 1000 Smith Level Rd., Apt. J -7 Carrboro NC 27510 919- 923 -6044 919- 923 -6044 919- 923 -6044 jbrobst @nccu.edu NC Central University School of Law Legal Director, Center for Child and Family Health 2000 Chapel Hill C.H. City Limits Female Caucasian Community Activities /Organizational Memberships: American Bar Association North Carolina Coalition Against Sexual Assault Durham Orange Women Attorneys Friend of the Chapel Hill Public Library Past Service on Orange County Advisory Boards: none Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: Currently Legal Director, Center for Child and Family Health (medico -legal focusing on at risk youth), and law professor at NCCU; former prosecutor, child advocacy center attorney, Attorney for NCCU Domestic Violence Legal Clinic; Trainer for NC Coalition Against Sexual Assault, including first trainer of Orange County Sexual Assault Response Team Reasons for wanting to serve on this board: Am in between board positions - ended final term as Rules Chair of the NC Commission for Mental Health, Developmental Disabilities and Substance Abuse last year; interested in serving my own local community; professional interest in health law Conflict of Interest: Supplemental Questions: Other Comments: Page 2 of 2 Jennifer Brobst 21 This application was current on: 12/18/2013 12:48:02 PM Date Printed: 12/19/2013 22 Page 1 of 2 Kim Calandra Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening): Phone (Cell): Email: Place of Employment Job Title: Year of OC Residence: Ms. Kim Calandra 102 A Crest Street Carrboro NC 27510 919- 996 -0718 Self Acupuncturist 2008 Township of Residence: Chapel Hill Zone of Residence: Carrboro City Limits Sex: Female Ethnic Background: Caucasian Community Activities /Organizational Memberships: Currently, I am volunteer for the Town of Carrboro on the Appearance Commission. Also, I am the secretary of the non - profit organization, Weaver Community Housing Association. I operate an affordable acupuncture clinic in Carrboro. Past Service on Orange County Advisory Boards: None Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: I am a Licensed Acupuncturist with 10 years of practicing experience. I obtained a Master of Oriental Medicine, and I currently own and operate an affordable acupuncture clinic in Carrboro Reasons for wanting to serve on this board: I want to represent the interests Orange County in the field of holistic healthcare. I want to raise awareness and accessibility with respect to complimentary medicine. I believe that all areas of medicine need to be publicly represented. Conflict of Interest: Perhaps owning a healthcare clinic in Orange County could create a conflict, but my interest in serving the County and volunteering on the Board is purely genuine and in dedication to the residents of Orange County Supplemental Questions: Work Experience: Acupuncturist, Chinese Medicine Practitioner, Landscape Artist 23 Page 2 of 2 Kim Calandra Volunteer Experience: 2005/2006- Secretary for the Natural Living Association of St. John's County, FL 2007 - President of the Natural Living Association of St. John's County, FL Education: University of Florida -BS Psychology Southwest Acupuncture College- Masters in Oriental Medicine Other Comments: I am an avid environmentalist especially towards Orange County. I spend my free time exploring and hiking the natural areas of the community. After reading the Inventory of Natural Areas and Wildlife Habitats for Orange County, NC, I feel compelled to hopefully have the honor to contribute and volunteer my time as a concerned citizen and ecological steward for the CFE. STAFF COMMENTS: 4/30/2012 applied for Commission for the Environment. ADDRESS VERIFICATION: 716 Churchill Drive is in Chapel Hill township, Chapel Hill Town Limits. Submitted new application 01092014 This application was current on: 1/9/2014 Date Printed: 9/4/2014 24 Page 1 of 2 Wendy Calvin Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening): Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Ms. Wendy Calvin 623 William Hooper Circle Hillsborough NC 27278 919- 630 -1350 Office Assistant II 2011 Township of Residence: Hillsborough Zone of Residence: Hillsborough Town Limits Sex: Female Ethnic Background: Caucasian Community Activities /Organizational Memberships: Past Service on Orange County Advisory Boards: Boards /Commissions applied for: Arts Commission Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Board of Health Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Supplemental Questions: Work Experience: Public Service - library and health department. Private Sector - Bookstores, retail managment. Volunteer Experience: Program Coordinator assistant at Nursing Homes. Enviornmental Awareness club President. Various Visual Arts programs. Education: Associates Degree Bachelors Degree completion in 2012 25 Page 2 of 2 Other Comments: Wendy Calvin STAFF COMMENTS: 09/06 applied for Arts Commission, Animal Services Advisory Board, and Board of Health. ADDRESS VERIFICATION: 623 William Hooper Circle is Hillsborough Township ETJ. This application was current on: 3/18/2013 Date Printed: 12/27/2013 26 Page 1 of 2 Barbara Chavious Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background: Ms. Barbara Chavious 401 N Nash St Hillsborough NC 27278 919- 732 -3469 919- 732 -3469 Barbara_Chavious @unc.edu Retired m Hillsborough Female Caucasian Community Activities /Organizational Memberships: Past Service on Orange County Advisory Boards: Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Supplemental Questions: Work Experience: 34 years in public health in NC; 12 as a regional consultant for the State Health Department, working in 8 local health departments; 22 at The UNC School of Public Health as Associate Director of an off - campus MPH, program in Health Administration as the School's alumni Director; as a continuing education specialst; and with the development of the NC Local Health Department Accreditation Program. Volunteer Experience: Former member -at -large on the Orange County Board of Health (1992- 2000); Orange County Human Relations Commission member; OCIM volunteer; NC Public Health Assoc (member for 30 plus years; various leadership positions; American Public Health Association - member 30 years and representative from NCPHA on APHA's Governing Council for 9 years. Education: 1968 - BA - Psychology, Miami University, Oxford, Ohio; 1985 - MPH - Health Administration - UNC School of Public Health. 27 Page 2 of 2 Other Comments: Barbara Chavious I currently serve as a site visitor, representing Boards of Health for the NC Local Health Department Accreditation Program and during the past six years have served on over 15 site visit teams to other NC county Health Departments. STAFF COMMENTS: Updated application 06/16/2011. Applied for Board of Health. ADDRESS JURISDICTION: 401 Nash Street is HI Township. This application was current on: 11/6/2013 Date Printed: 12/27/2013 W Page 1 of 1 Steven Thomas Daniels Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background Dr. Steven Thomas Daniels 206 Franklin Adams Road Efland NC 27243 919- 732 -8213 919- 451 -1874 919- 451 -1874 stdaniel @gmail.com Self Dentist 2009 Cheeks County Male Caucasian Community Activities /Organizational Memberships: NC MoM NC Dental Society Hillsborough Chamber of Commerce Hillsborough Exchange Club Past Service on Orange County Advisory Boards: None Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: Dentist since 2010. MoM Clinics & experience with the SHAC Clinic @ UNC. Reasons for wanting to serve on this board: Oral health outreach Conflict of Interest: Supplemental Questions: Other Comments: This application was current on: 1/15/2014 1:37:49 PM Date Printed: 7/17/2014 29 Page 1 of 3 Tamara Dempsey- Tanner Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background: Ms Tamara Dempsey- Tanner 9900 Leslie Dirve Chapel Hill NC 27516 919- 560 -5600 919- 918 -4086 tamaradt @yahoo.com Children's Developmental Services Agency Quality Assurance Coordinator 1994 Bingham Does not apply Female Caucasian Community Activities /Organizational Memberships: Orange Co. Partnership for Young Children - NC preK (formerly More at 4)Advisory Committee Orange Co. Partnership for Young Children - Funding Allocation Committee Orange Co Partnership for Young Children - Board of Directors - at will designee Orange County DSS Toy Chest volunteer Orange County Preschool Interagency Council Past Service on Orange County Advisory Boards: n/a Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: undergrad & graduate degrees in Public Health Education; over 20 years combined employment in state /local government, specifically Health & Human Services which includes a local health department; Past 15 years worked with agencies (OCPYC & CDSA)that work collaboratively with the Health Dept. to target Orange County children s needs; experience in federal and state programmatic parameters and funding requirements; experience in program evaluation and data analysis; Data entry expertise /navigation with HIS data platform; Familiarity with NCTracks List of Previous Career Positions: QA/AI Coordinator: Durham Children's Developmental Services Agency, 2006 to present Orange County Parnership for Young Children: 1999 -2004 UNC School of Health Policy & Administration: 2/99 -8/99 NCDHHS /DPH /Injury Prevention Branch: 1997 -1999 UNC Dept. of Community Pediatrics: 1995 -1997 C Page 2 of 3 Tamara Dempsey - Catawba Co. Health Dept: 1986 -1993 Reasons for wanting to serve on this board: The Health and Human Services realm has always been my professional foundation. My tenure in a local health department and attending BOH meetings were enlightening experiences. I want to give back to my community via my professional expertise and personal interests especially as it pertains to health and well -being of Orange County s children and families. Conflict of Interest: Board of Social Services Background, education and experience relevant to this board: undergrad & graduate degrees in Public Health Education; over 20 years combined employment in state /local government, specifically Health & Human Services which includes a local health department; Past 15 years worked with agencies (OCPYC & CDSA)that work collaboratively with the Health Dept. to target Orange County children s needs; experience in federal and state programmatic parameters and funding requirements; experience in program evaluation and data analysis; Data entry expertise /navigation with HIS data platform; Familiarity with NCTracks reimbursement platform Reasons for wanting to serve on this board: The Health and Human Services realm has always been my professional foundation. I want to give back to my community via my professional expertise and personal interests especially as it pertains to health and well -being of Orange County s children and families. Conflict of Interest: Supplemental Questions: Work Experience: Children's Developmental Services Agency 2004 to present Orange Co. Partnership for Young Children, 1999 -2004 Injury Prevention Branch, NCDHHS, 1997 -1999 UNC -Dept of Community Pediatrics, 1995 -1997 Catawba County Health Department, 1986 -1993 additional applicable experiences: Conducted over 200 presentations related to public health, injury prevention, early childhood education, program development/evaluation Adjunct instructor & content specialist with FEMA/National Fire Protection Agency, 1992- 1999 Public Information Officer (on -call) Emergency Management Department, Catawba County, 1988 -1993 provided consultation on numerous early childhood education, injury prevention and public health related research efforts PT instructor UNCG Dept of Health & Human Performance; Catawba Valley Community College (Health & Safety) Volunteer Experience: Orange County Toys for Tots, 2000 - present Orange Co. Partnership for Young Children, Allocations Committee, 2005 to present Orange County Preschool Interagency Committee, 2010 - present NC Continuous Quality Improvement Committee (early intervention) NC Partnership for Children Evaluation Committee 31 Page 3 of 3 Tamara Dempsey- Triangle United Way Orange County (children and youth) Orange County Healthy Carolinians Orange County Safe Communities NFPA 1035 Public Fire Educator Professional Qualifications Committee Board Member: NC Public Health Association 1991 -97 Education: M.Ed.: Public Health Education, UNC -G BS: Public Health Education, James Madison Univ. certification: Infant Toddler Family Specialist Other Comments: The spirit of community service is an imbedded characteristic since I was raised in a home where my father modeled community service for >40 years with the county fire and rescue service. As one who has worked my entire career in health and human services, I am automatically drawn and driven to contribute to these efforts. As an Orange County resident, I am committed to supporting efforts that enhance the effectiveness and efficiency of health and human service resources within our county. I would appreciate and value to serve our community in this capacity. STAFF COMMENTS: Originally applied for Orange County Emergency Services Work Group, Board of Health, Board of Social Services 1/4/2012. ADDRESS VERIFICATION: Leslie Drive is OC Jurisdiction, Orange Grove Fire Tax, Bingham Township. Submitted new application 01102014 Added additional career background positions held 01142014. This application was current on: 1/10/2014 Date Printed: 1/14/2014 32 Page 1 of 2 �n1�i'i wi•'.Ca i Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background: Dr. Nurum Erdem 10 Saint James Place Chapel HIII NC 27514 9192591153 9199330661 9192591153 nurumerdem @gmail.com Volunteer Physician Samaritan Health Center Durh MD 2000 Chapel Hill Chapel Hill Township within C.H. city limits Female Caucasian Community Activities /Organizational Memberships: School Improvement Team Culbreth Middle School School Improvement Team Glenwood Elementary PTA Culbreth Middle School PTA Glenwood Elementary Volunteer Physician Samaritan Health Center Past Service on Orange County Advisory Boards: None Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: I am a board certified physician in internal medicine and geriatric medicine. Currently I am a stay -at -home mom and volunteer regularly at the Samaritan Health Center in Durham. Through my training and the various settings I have practiced medicine within (skilled nursing facility, hospital, private practice, uninsured clinic, rescue mission)I feel like I have a seen the needs of many different populations. I believe these experiences as a physician (and my background with a public health education) will give me a unique perspective of the health needs of Orange county. Reasons for wanting to serve on this board: I would like to serve on this board for several reasons. Firstly, I would like to be involved in improving the health and wellness of the residents in Orange County. As well, I see this as a time of great change in our health care system (in terms of insurance coverage and delivery of care). With change comes great opportunity for improvement. Being on this board will give me the opportunity to develop a more in depth knowlege of the needs of the county and be a part of the team to establish creative solutions to meet these needs. Page 2 of 2 Conflict of Interest: Supplemental Questions: Other Comments: I1vi'ii c Page 1 of 2 Zachary Giles Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background: Mr. Zachary Giles 8000 Oak Pointe Court Mebane NC 27302 9103087228 9103087228 9103087228 zach.s.giles @gmail.com GlaxoSmithKline LC /MS Field Service Engineer 2008 Cedar Grove County Male Caucasian Community Activities /Organizational Memberships: I have ran races (5k, marathon) for the American Cancer Society. Past Service on Orange County Advisory Boards: N/A Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: I have a BS in chemistry and have worked for the pharmaceutical industry for 6+ years. My sister is a pathologist fellow at UNC -CH hospitals, and I come from a family of nurses so I have been exposed to the healthcare industry for a number of years without actually being affiliated to any specific entity. Reasons for wanting to serve on this board: Everyone has experienced changes to their personal healthcare in some way, shape, or form and I want to become more involved in those changes. Conflict of Interest: 35 Page 2 of 2 Zachary Giles Mebane Board of Adjustment Background, education and experience relevant to this board: I reside in the community of Mebane and I foresee changes in the community especially in the Orange County part of the community. I would like to become involved in future zoning regulations that could affect my part of the community. I also have an MBA and my profession is more scientific so I am exploring venues to cultivate my business skill set. Reasons for wanting to serve on this board: See Above. Conflict of Interest: I live in Mebane and could be directly affected by decisions made by this board. Orange Water & Sewer Authority Board of Directors Background, education and experience relevant to this board: My mother was the town clerk for my hometown (Linden NC) and was actively involved in water /sewer planning and bill payment. and as a child I assisted her with office duties. Reasons for wanting to serve on this board: Residents in my part of the county are on well water, and it s full of particulate (red clay). This is a problem everyone in my community faces, and I would like to help bring public water /sewer to my community if possible. Conflict of Interest: I could benefit directly from decisions made by this board. Supplemental Questions: Orange Water & Sewer Authority Board of Directors Please list /explain your experience, either professionally and /or from other boards /commissions that you have in the areas of budget, personnel, and management. I have a MBA from Elon University (graduated May 2013), and my mother has worked for the public works in my hometown (Linden NC). I assisted her with office duties (i.e. billing and meter reading). In addition to the experience listed in the question above, please list the work /volunteer experience /qualifications that would add to your expertise for this board. I currently work with LC /MS analytic equipment that is used in the water testing industry (although I work in pharmaceuticals) What do you see as the responsibilities of this board, and what do you hope to accomplish if appointed? To provide clean water and functional sewer to the residents of Orange County. What is OWASA's role in growth /development issues? To provide and maintain the infrastructure needed (i.e. pipes and meters) in providing water /sewer to Orange County residents, and to ensure quality control testing on water samples. Other Comments: This application was current on: 2/26/2014 1:18:11 PM Date Printed: 2/27/2014 C Page 1 of 1 Linda Griffin Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background Mrs Linda Griffin 321 Mitchell Street Hillsborough NC 27278 919- 630 -9078 919- 630 -9078 919- 630 -9078 Igriffin2 @nc.rr.com Duke Health System Health Center Administrator 1981 Hillsborough Female Caucasian Community Activities /Organizational Memberships: Durham Technical Community College Medical Assisting Advisory Committee. I am a Fellow of the American College of Medical Practice Executives, Member of North Carolina Medical Group Managers, former Member and National Treasurer of Neurosurgical Executives Education and Resource Society. Past Service on Orange County Advisory Boards: none Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: I have been a resident of Orange County for over 30 years. My background in Health Care Administration both in Private Practice and at Duke will be a benefit to the Board Reasons for wanting to serve on this board: I have a great desire to make sure all residents of Orange County have good quality health care and am willing to help make decisions for our citizens with this in mind. Conflict of Interest: Supplemental Questions: Other Comments: This application was current on: 1/9/2014 12:38:35 PM Date Printed: 1/9/2014 37 Page 1 of 2 Daniel Kemp Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background: Dr Daniel Kemp 2007 Starterwood Ln Hillsborough NC 27278 3364067871 3364067871 3364067871 spartanl999@gmail.com GlaxoSmithKline Director Quality and Risk Management 2013 Bingham Male Other Community Activities /Organizational Memberships: As I have recently moved to orange county I do not have any community memberships. However, I am a board certified toxicologist and member of the Society of Toxicologic Pathology, Society of Toxicology (SOT) and the American College of toxicology. As well as vice president of the Drug Discovery Specialty section of SOT. Past Service on Orange County Advisory Boards: none Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: I have a BS in Biochemistry and a PhD in toxicology from the University of North Carolina at Chapel Hill. I am certified by the American Board of Toxicology and a standing member of all toxicology societies (Society of Toxicology, American College of Toxicology and Society of Toxicologic Pathology). I have experience with the use of both small animals and large animals in terms of drug development, and am vice president of the Drug Discovery Specialty Section of SOT. I am also the past president of the Invitro and alternative animal models specialty section. have worked in all phases of drug development from early discovery to clinical trials and I feel this experience makes me well suited for this board. Reasons for wanting to serve on this board: I have dedicated my career to the improvement of human health by believing my role in my industry is here to improve the quality of human life by enabling people to do more, feel better and live longer. This board dove -tails nicely with those beliefs and would allow me to give back to the community that I live in. Conflict of Interest: C Page 2 of 2 Daniel Kemp Animal Services Advisory Board Background, education and experience relevant to this board: I have a BS in Biochemistry and a PhD in toxicology from the University of North Carolina at Chapel Hill. I am certified by the American Board of Toxicology and a standing member of all toxicology societies (Society of Toxicology, American College of Toxicology and Society of Toxicologic Pathology). I have experience with the use of both small animals and large animals in terms of drug development, and am vice president of the Drug Discovery Specialty Section of SOT. I am also the past president of the Invitro and alternative animal models specialty section. have been responsible for the care treatment and well being of animals throughout my career. I feel this experience makes me well suited for this board. Reasons for wanting to serve on this board: I deeply care for animals that we have been given the luxury to care for and I would like to show this support and give back to my community by serving on this board. Conflict of Interest: Supplemental Questions: Other Comments: This application was current on: 7/2/2014 10:34:08 AM Date Printed: 7/3/2014 C Page 1 of 2 Winston Liao Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening): Phone (Cell): Email: Place of Employment Job Title: Year of OC Residence: Mr. Winston Liao 126 Fern Lane Chapel Hill NC 27514 919 929 3123 Retired iiU't�s7 Township of Residence: Chapel Hill Zone of Residence: C.H. City Limits Sex: Male Ethnic Background: Asian American Community Activities /Organizational Memberships: St. Thomas More Caring and Sharing Center; STM School North Carolina COPD Taskforce North Carolina Public Health Association American Public Health Association Orange County Election Official Past Service on Orange County Advisory Boards: Boards /Commissions applied for: Advisory Board on Aging Background, education and experience relevant to this board: Before my retirement on Decmeber 31, 2012, 1 was with the Chronic Disease and Injury Section, NC Division of Public Health. During my five and a half years there, I worked with the cancer, heart disease /stroke, diabetes, physical activity & nutrition, injury & violence prevention, tobacco prevention and control, and asthma branches. My work was to promote education and outreach, and intervention programs (including those for the older population), especially for adults with chronic lower respiratory diseases and their associated conditions (e.g., heart disease, diabetes, arthritis, depression, etc.). Reasons for wanting to serve on this board: Conflict of Interest: MW Page 2 of 2 Winston Liao Board of Health Background, education and experience relevant to this board: Same as above. I have an MPH and completed all course work for a PhD in public health. I have served on various advisory boards, including those for the CDC, Public Health Foundation, American Lung Association, etc. I have taught public health at the University of Mississippi, conducted research in many aspects of public health and aging at RTI International and NC DPH, and practiced public health at NC DPH. I have also been active in using data to support and drive policy at the state and national levels. Reasons for wanting to serve on this board: Conflict of Interest: Supplemental Questions: Other Comments: STAFF COMMENTS: Originally (1/17/2012) applied for Advisory Board on Aging and Board of Health. ADDRESS VERIFICATION: 126 Fern Lane is Chapel Hill Township, Chaprl Hill Jurisdiction, and Chapel Hill Town Limits. This application was current on: 1/16/2013 3:19:46 PM Date Printed: 12/27/2013 41 Page 1 of 1 Charles McMullen Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment Job Title: Mr. Charles McMullen 108 Jones Avenue Hillsborough NC 27278 9197329083 919- 260 -3879 cmcmullen1 @nc.rr.com retired Year of OC Residence: 1993 Township of Residence: Hillsborough Zone of Residence: Does not apply Sex: Male Ethnic Background: Caucasian Community Activities /Organizational Memberships: Past Service on Orange County Advisory Boards: Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Supplemental Questions: Work Experience: Almost 50 yrs in various fields of nsg. Other Comments: STAFF COMMENTS: Originally applied for Nursing Home Community Advisory Committee, Adult Care Home Community Advisory Committee, and Board of Health 02/10/2011. ADDRESS VERIFICATION: 108 Jones Avenue is in Hillsborough Jurisdiction, Hillsborough Township. This application was current on: 2/10/2011 10:59:02 AM Date Printed: 12/27/2013 42 Page 1 of 2 Ken Morgan Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment Job Title: Year of OC Residence: Mr Ken Morgan 2720 Buckboard Drive Hillsborough NC 27278 919- 218 -8596 919- 218 -8596 morgangk @juno.com NAIFA North Carolina Executive Director 1982 Township of Residence: Eno Zone of Residence: - Sex: Male Ethnic Background: Caucasian Community Activities /Organizational Memberships: Past Service on Orange County Advisory Boards: Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Supplemental Questions: Work Experience: NAIFA North Carolina, 1995 - present American Heart Association, NC, 1982 -1993 Volunteer Experience: Past President, Virginia Association of Volunteer Rescue Squads; Member Hall of Fame and Life Member; Chairman, Orange County United Way; Board of Directors, Rotary International; Personnel Advisory Committee, Orange County Education: M.Ed., Virginia Commonwealth University Other Comments: STAFF COMMENTS: Originally applied for Human Services Advisory Commission 7/20/2006. Applied for Board of Health 8/13/08. Updated application for Board of Health 05/05/2011. Applied for Orange County Emergency Services Work Group 01/02/2012. Page 2 of 2 Ken Morgan 43 ADDRESS VERIFICATION: 2720 Buckboard Drive Hillsborough, NC 27278 is Eno Township, OCPL jurisdiction. This application was current on: 11/6/2013 Date Printed: 12/27/2013 .. Page 1 of 2 Danielle Mosley Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening): Phone (Cell): Email: Place of Employment: Job Title: Miss Danielle Mosley 476 Melanie Court Chapel Hill NC 27514 919- 309 -5685 Dlynnm26 @gmail.com Year of OC Residence: 2011 Township of Residence: Chapel Hill Zone of Residence: C.H. City Limits Sex: Female Ethnic Background: Caucasian Community Activities /Organizational Memberships: Past Service on Orange County Advisory Boards: Boards /Commissions applied for: Adult Care Home Community Advisory Committee Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Board of Health Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Agricultural Preservation Board Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Supplemental Questions: Work Experience: Club Nova Volunteer Experience: Club Nova 45 Page 2 of 2 Education: Attending school for ged Other Comments: Danielle Mosley STAFF COMMENTS: Applied for Adult Care Home Community Advisory Committee, Board of Health, and Agricultural preservation Board on 06/26/2012. ADDRESS VERIFICATION: Melanie Court is Chapel Hill Township, Chapel Hill Town Limits. This application was current on: 6/26/2012 11:06:45 AM Date Printed: 12/27/2013 ER Page 1 of 2 Yvonne Overcast Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background: Ms. Yvonne Overcast 216 cobalt ridge road hillsborough NC 27278 9197329840 9197329840 9194511901 yovercast @gmail.com Duke Hospital Certified Registered Nurse Anesthetist 2007 Hillsborough Female Caucasian Community Activities /Organizational Memberships: Parent participant in there Hilltoppers 4 -H group. Active in my church United Church of Chapel Hill s youth group. Assist them in service work in Orange County and other cities. North Carolina Association of Nurse Anesthetist. Several Board positions as Secretary, District Director, Nominating Chair for several years. Have been room parent at my children s school. Secretary of the athletic booster club at oldest daughters school. Co- organizer of residents of Churton Grove to meet with Water commission on water costs of the neighborhood. Past Service on Orange County Advisory Boards: None Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: I am a Nurse Anesthetist and have been for 21 years with 16 years of nursing prior to graduate school. I have worked all over NC and currently at Duke Hospital for the past 12 years. I also do free lance work with a private surgeon in Chapel Hill. I am Masters prepared with continuous participation in educational workshops every year approximately 30 -40 hours per year. I teach a class at the Duke School of Nursing. I function as a Preceptor for Nurses training to become Certified Registered Nurse Anesthetist. In the long session of the GA 2013, 1 lobbied heavily to defeat HB 181. Reasons for wanting to serve on this board: My reason for seeking out the At Large position with the Board of Health, is to provide the Board with my healthcare expertise and be a fair representative of the residents of Orange County. Children and the elderly, are just 2 populations at risk of not receiving adequate basic healthcare and with the changes that have occurred with Medicaid and Medicare it is important 47 Page 2 of 2 Yvonne Overcast that these individuals do not get lost in the system or slip through the cracks. Advocacy is important and with my knowledge and expertise I can offer the Board of Health a fair representation to help meet and maintain the Boards mission of maintaining the health of the residents of Orange County. Conflict of Interest: N/A Supplemental Questions: Other Comments: This application was current on: 1/8/2014 9:01:10 AM Date Printed: 9/4/2014 ME., Page 1 of 2 Antonia Pedroza Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background: Ms. Antonia Pedroza 409 Saint Marys Road Hillsborough NC 27278 252 - 738 -3770 919- 760 -0210 919- 760 -0210 pedrozaantonia @yahoo.com Vance County Government DSS Director 2002 Hillsborough Female Hispanic Community Activities /Organizational Memberships: none in Orange Past Service on Orange County Advisory Boards: N/A Boards /Commissions applied for: Human Relations Commission Background, education and experience relevant to this board: My entire career has been focused on serving people who are living in poverty and /or experiencing poverty due to barriers to employment including disabilities, lack of education and experience. Reasons for wanting to serve on this board: I live in Orange County and want to participate in community in a meaningful way. Conflict of Interest: Board of Health Background, education and experience relevant to this board: I have a Master in Health Administration and a Master in Business Administration. The work I do as a DSS Director is often related to health and well- being. Reasons for wanting to serve on this board: I would like to serve my community. Conflict of Interest: i • Page 2 of 2 OPC Oversight Board FAR •M1111 T- 001 1 Background, education and experience relevant to this board: Prior to working in Social Services, I worked with person with disabilities in Orange County. I have over 25 years of experience working with person with a wide range of disabilities. Reasons for wanting to serve on this board: I have always been an advocate for person with disabilities. Conflict of Interest: Supplemental Questions: Other Comments: This application was current on: 8/13/2014 5:32:48 PM Date Printed: 8/14/2014 50 Page 1 of 2 Vince Stevens Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background: Mr. Vince Stevens 101 Camille Ct Chapel Hill NC 27516 919- 923 -2561 919- 933 -3058 vstevens @nc.rr.com NC Office of Rural Health Business Officer - Retired 1989 Chapel Hill Male Caucasian Community Activities /Organizational Memberships: Past Service on Orange County Advisory Boards: Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Supplemental Questions: Work Experience: Business Officer North Carolina Office of Rural Health and Community Care 2006 - 2010. Responsibilities include development, implementation and assessment of strategies for improving prescription drug access for North Carolina residents. Advisor on all pharmaceutical issues to assure financial and programmatic compliance with programs. Clinical Pharmacist, Team Lead for Point of Sale & Drug Rebate North Carolina Office of Medicaid Management Information Systems 2005 -2006. Responsibilities include Affiliated Computer Services RFP deliverable requirements, Design, Construction, System and Integration Testing, User Acceptance Testing, Readiness Testing, Implementation and Post Implementation. Strategic National Stockpile Coordinator North Carolina Public Health Preparedness and Response 2004 -2005. Statewide responsibility for implementation of the Department of Homeland Security and the Centers for Disease Control and Prevention Strategic National Stockpile Program. Community Consultant NC Office of Rural Health, 2003 -2004. Administrative support for 51 Page 2 of 2 Vince Stevens North Carolina Senior Care Program and Prescription Assistance Programs in partnership with County Health Departments and Senior Centers Clinical Manager Advance PCS, Chapel Hill, NC 1997 -2003. Clinical and administrative support for Pharmacy Benefit Management clients. Successfully expanded sales to existing clients through relationship - building and demonstrating a thorough knowledge of products that gave credibility to product recommendations. Client base consisting of Managed Care, Employer groups, Government including Medicaid, and Blue Cross Blue Shield programs. Pharmacy Account Manager First Health Services Corporation - Chapel Hill, NC 1995 - 1997. Administrative responsibility for North Carolina State Health Plan, North Carolina and Tennessee TennCare Medicaid Programs and Blue Cross of Northeastern Pennsylvania. District Manager - Revco Drug Stores Oklahoma, Michigan, North Carolina 1973 -1994. Responsibility for retail store operations including profit & loss responsibility, training sales staff in merchandising and sales strategies, advertising and inventory control, gross margin management, human resources and personnel issues. Supervised 240 employees and 68 pharmacist Middle Management Experience Pharmacy positions at Wal -Mart, and SuperX Volunteer Experience: Chapel Hill Crime Task Force (several years ago) Education: Bachelor of Science Pharmacy, The Ohio State University Licensed Registered Pharmacist in: OH, NC Other Comments: Orig.app.11 /17/99 for Board of Health, Pharmacist Position STAFF COMMENTS: Applied 5/7/2010 for Advisory Board on Aging, Adult Care Home Community Advisory Committee, Board of Health. ADDRESS VERIFICATION: 101 Camille Ct, Chapel Hill is in Chapel Hill Township, Chapel Hill Town Limits. UPDATED APPLICATION 05/02/2012 FOR BOARD OF HEALTH. This application was current on: 5/1/2012 Date Printed: 12/30/2013 52 Page 1 of 2 Edward Stirman Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background: Dr. Edward Stirman 554 E Hatterleigh Ave Hillsborough NC 27278 919- 241 -4912 919- 241 -4912 423 - 677 -3295 monty.stirman @gmail.com retired retired 2012 Hillsborough Male Caucasian Community Activities /Organizational Memberships: none Past Service on Orange County Advisory Boards: none Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: family practice physician in practice in TN for 34 years Reasons for wanting to serve on this board: would like to volunteer in area more likely to have some expertise Conflict of Interest: Hillsborough Planning Board Background, education and experience relevant to this board: physician from TN- retired Reasons for wanting to serve on this board: interested in helping Hillsborough improve Conflict of Interest: Supplemental Questions: Other Comments: Page 2 of 2 Edward Stirman 53 This application was current on: 3/13/2014 2:40:34 PM Date Printed: 3/14/2014 54 Page 1 of 2 Jaimee Watts Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening): Phone (Cell): Email: Place of Employment Job Title: Year of OC Residence: Ms. Jaimee Watts 108C West Carr Street Carrboro NC 27510 828 - 381 -6246 jaimee.watts @gmail.com UNC Medical Center RN, BSN, ICU Nurse 2009 Township of Residence: Chapel Hill Zone of Residence: Carrboro City Limits Sex: Female Ethnic Background: Caucasian Community Activities /Organizational Memberships: Past Service on Orange County Advisory Boards: Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Chapel Hill Parks and Recreation Commission Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Carrboro Recreation and Parks Commission Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Supplemental Questions: Work Experience: 3 Years as a Nurse at UNC, tow in trauma and one in critical care (SICU) W" Page 2 of 2 Jaimee Watts Volunteer Experience: Orange County Public Health Reserve Corps; CERT (Community Emergency Response Team) training; Carrboro Rec and Parks Committee, Healthy Carolinians Education: BSN in nursing with plans for a Masters in either Public Health Nursing or Nutrition Other Comments: STAFF COMMENTS: Applied 4/29/2010 for Board of Health, Chapel Hill Parks & Recreation Commission and Carrboro Recreation and Parks Commission. ADDRESS VERIFICATION: 108 C W Carr Street is Chapel Hill Township, Carrboro City Limits. UPDATED APPLICATION 04/30/2012 TO INCLUDE THE BOARD OF HEALTH. UPDATED APPLICATION 05/16/2012 TO INCLUDE BOARD OF HEALTH AND CHANGE OF ADDRESS. This application was current on: 5/16/2012 Date Printed: 12/30/2013 56 Page 1 of 2 Delbert Williams Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background: Dr. Delbert Williams 7110 Pine Hill Road Durham NC 27707 9194936310 9194936310 9198013552 delwilliams @nc.rr.com NC DHHS /Division of Public Health (Retired) Head, Communicable Disease Surveillance Unit 1990 Chapel Hill Male Caucasian Community Activities /Organizational Memberships: None Past Service on Orange County Advisory Boards: None Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: I served for over 20 years in the NC Division of Public Health Communicable Disease Branch as the chief of the statewide communicable disease surveillance unit. My academic background is a combination of microbiology, biochemistry and botany with a concentration on organism interactions. My tenure in DPH introduced me to health outcomes and mechanisms to measure those outcomes. My training in the biological sciences as well as the activities related to health policy development has given me a unique view of how policy development and impact must be balanced to improve the public health for residents. Reasons for wanting to serve on this board: While I was employed I realized the impact the local Boards of Health had on how our public health actions could be put into place in NC. I think I have a somewhat unique perspective to bring to the Board to ensure that Orange County continues to be a leader in public health activities that are supported at the local level. I also know the current health director and am fully in support of her leadership and expertise. Conflict of Interest: Supplemental Questions: Page 2 of 2 Other Comments: 1110 I074 iiV IIIIFiiiv 57 This application was current on: 6/25/2014 10:15:57 PM Date Printed: 6/27/2014 Page 1 of 1 Dennis Williams Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment Job Title: Year of OC Residence: Dr. Dennis Williams 209 Lake Manor Road Chapel Hill NC 27516 919- 962 -7122 919- 933 -5408 dwilliams @unc.edu University of North Carolina Associate Township of Residence: Chapel Hill Zone of Residence: Carrboro City Limits Sex: Male Ethnic Background: Other Community Activities /Organizational Memberships: Past Service on Orange County Advisory Boards: Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Supplemental Questions: Other Comments: STAFF COMMENTS: Applied 05/16/2012 for Board of Health. ADDRESS VERIFICATION: 269 Lake Manor Road is Chapel Hill Township, Carrboro City Limits. This application was current on: 5/16/2012 9:33:52 PM Date Printed: 12/30/2013 59 Page 1 of 2 Megan Williams Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening): Phone (Cell): Email: Place of Employment Job Title: Year of OC Residence: Mrs. Megan Williams 205 Westside Drive Chapel Hill NC 27516 919- 240 -4455 mpwilliams @unc.edu unc -ch school of nursing clinical assistant professor 2009 Township of Residence: Chapel Hill Zone of Residence: Does not apply Sex: Female Ethnic Background: Caucasian Community Activities /Organizational Memberships: Past Service on Orange County Advisory Boards: Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Supplemental Questions: Work Experience: Clinical Assistant Professor UNC- Chapel Hill 2003 - current Nurse Practitioner MinuteClinic 2008 - current Nurse Practitioner DUMC 2002 -2006 Volunteer Experience: Association of Nursing Students faculty Advisor North Carolina Nurses Association member 1998 - current North Carolina Nurses Association Triangle Region President Education: AS Peace College Raleigh, NC 1995 BSN UNCW Wilmington, NC 1998 MSN Duke University 2002 Other Comments: .9 Page 2 of 2 Megan Williams STAFF COMMENTS: Originally appled for Board of Health 06/06/2010. ADDRESS VERIFICATION: 205 Westside Drive is in Chapel Hill Township, Chapel Hill Town Limits.. UPDATED APPLICATION 05/04/2012 For Board of Health. This application was current on: 5/4/2012 Date Printed: 12/30/2013 61 Page 1 of 2 Joanne Wilson Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment: Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background: Dr Joanne Wilson 104 Stoneridge Drive Chapel Hill NC 27514 919- 810 -2774 919- 932 -5391 anteel@earthlink.net Duke Physician 1990 Chapel Hill Rural Area Resident Female African American Community Activities /Organizational Memberships: Past Service on Orange County Advisory Boards: None Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Nursing Home Community Advisory Committee Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Supplemental Questions: Other Comments: STAFF COMMENTS: Applied 07/15/2013 for Adult Care Home Community Advisory Committee, Advisory Board on Aging, and Board of Health. ADDRESS VERIFICATION: 104 Stoneridge Drive is Chapel Hill Township, Orange County Jurisdiction, and (RB) Rural Buffer Zoning. Page 2 of 2 Joanne Wilson 62 This application was current on: 7/15/2013 9:53:13 PM Date Printed: 12/30/2013 63 Page 1 of 1 Tracey Yap Volunteer Application Orange County Advisory Boards and Commissions Name: Name Called: Home Address: Phone (Day): Phone (Evening) Phone (Cell): Email: Place of Employment Job Title: Year of OC Residence: Township of Residence: Zone of Residence: Sex: Ethnic Background Dr. Tracey Yap 834 Providence Glen Drive Chapel Hill NC 27514 502 - 686 -0016 919- 240 -4793 tracey.yap @duke.edu Duke University School of Nursing Assistant Professor 2011 Chapel Hill Female Caucasian Community Activities /Organizational Memberships: Past Service on Orange County Advisory Boards: Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: Reasons for wanting to serve on this board: Conflict of Interest: Supplemental Questions: Work Experience: Deputy- Director of Nursing for NIOSH sponsored Education and Research Center, University of Cincinnati Funded research grants related to long -term care Education: RN, PhD Other Comments: STAFF COMMENTS: 09/20/2011 applied for Nursing Home Community Advisory Committee, Advisory Board on Aging, and Board of Health. ADDRESS JURISDICTION: 834 Providence Glen Drive is CH Township. This application was current on: 12/2/2013 3:41:57 PM Date Printed: 12/31/2013