HomeMy WebLinkAboutAgenda - 12-09-2014-11a1
ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: December 9, 2014
Action Agenda
Item No. 11 -a
SUBJECT: Adult Care Home Community Advisory Committee - Appointments
DEPARTMENT: Board of Commissioners PUBLIC HEARING: (Y /N) No
ATTACHMENT(S): Under Separate Cover INFORMATION CONTACT:
Membership Roster Clerk's Office, 245 -2130
Recommendations
Applications for Persons Recommended
Interest List
Applications of Persons on the Interest List
PURPOSE: To consider making appointments to the Adult Care Home Community Advisory
Committee.
BACKGROUND: The following information is for Board consideration:
• Appointment to a one year training term (Position #6) At -Large for Mrs. Suzanne Haff
ending 12/09/2015.
• Appointment to a one year training term (Position #7) At -Large for Ms. Yvonne
Mendenhall ending 12/09/2015.
• Appointment to a one year training term (Position #12) At -Large for Ms. Deborah Stewart
ending 12/09/2015.
NOTE - If the individuals listed above are appointed, the following vacancies remain:
• None.
* All positions require a one year training period from date of appointment.
FINANCIAL IMPACT: None.
RECOMMENDATION(S): The Board will consider making appointments to the Adult Care Home
Community Advisory Committee.
NAME
SPECIAL REPRESENTATIVE
EXPIRATION DATE
POSITION NO.
6
Mrs. Suzanne Haff
One Year Training Term
12/09/2015
At-Large
7
Ms. Yvonne Mendenhall
One Year Training Term
12/09/2015
At -Large
12
Ms. Deborah Stewart
One Year Training Term
12/09/2015
At-Large
NOTE - If the individuals listed above are appointed, the following vacancies remain:
• None.
* All positions require a one year training period from date of appointment.
FINANCIAL IMPACT: None.
RECOMMENDATION(S): The Board will consider making appointments to the Adult Care Home
Community Advisory Committee.
2
Board and Commission Members
And Vacant Positions
Adult Care Home Community Advisory Committee
Meeting Times: 3:30 p.m. - 5:00 p.m. Bi- monthly Terms: 3 Contact Person: Charlotte Terwilliger
Meeting Place: Positions: 12 Length: 2 years Contact Phone: 919- 558 -9401
Description: Members are appointed by the Board of Commissioners to at -large positions. There is an initial one -year training term with subsequent eligibility for three additional two -year
terms. This committee works to maintain the intent of the Adult Care Home Residents' Bill of Rights for those residing in licensed adult care homes. The members of this
committee also promote community involvement and cooperation with these homes to ensure quality care for the elderly and disabled adults.
Dr. Mario Battigelli
Day Phone: 919- 942 -5756
Sex: Male
First Appointed:
04/19/2011
Evening Phone:
Race: Caucasian
Current Appointment:
05/20/2014
1
1307 Wildwood Drive
FAX:
Township: Chapel Hill
Expiration:
03/31/2017
Chapel Hill NC 27514
E -mail: mcbattigelli @gmail.com
Resid/Spec Req: At -Large
Number of Terms:
2
Special Repr:
Mr. Daniel Hatley
Day Phone: 919 -200 -0822
Sex: Male
First Appointed:
08/17/2010
Evening Phone: 309 - 252 -1169
Race: Caucasian
Current Appointment:
11/19/2013
2
317 W. University
FAX: 888- 514 -4878
Township: Chapel Hill
Expiration:
10/31/2015
Chapel Hill NC 27516
E -mail: dan @hatleylawoffice.com
Resid/Spec Req: At -Large
Number of Terms:
2
Special Repr: DD /MR
Ms. Deborah Rider
Day Phone: 919 -818 -6489
Sex: Female
First Appointed:
06/19/2012
Evening Phone: 919- 732 -9476
Race: Caucasian
Current Appointment:
09/17/2013
3
2314 Red Oak CT.
FAX:
Township: Hillsborough
Expiration:
06/30/2016
Hillsborough NC 27278
E -mail: drider1736 @gmail.com
Resid/Spec Req: At -Large
Number of Terms:
1
Special Repr:
Mr. Max Mason
Day Phone: 919- 649 -7937
Sex: Male
First Appointed:
06/07/2011
Chair
Evening Phone:
Race: Caucasian
Current Appointment:
06/19/2012
4
821 Tinkerbell Rd.
FAX:
Township: Chapel Hill
Expiration:
06/30/2015
Chapel Hill NC 27517
E -mail: maxomason @yahoo.com
Resid/Spec Req: At -Large
Number Of Terms:
1
Special Repr:
Dr. Anthony John Vogt
Day Phone: 919- 929 -8646
Sex: Male
First Appointed:
10/16/2012
Evening Phone: 919- 929 -8646
Race: Caucasian
Current Appointment:
11/19/2013
5
713 W. Barbee Chapel Road
FAX: NA
Township: Chapel Hill
Expiration:
10/31/2015
Chapel Hill NC 27517
E -mail: ajvogt @earthlink.net
Resid/Spec Req: At -Large
Number of Terms:
0
Special Repr:
Tuesday, November 11, 2014
Page 1
3
Board and Commission Members
And Vacant Positions
Adult Care Home Community Advisory Committee
Meeting Times: 3:30 p.m. - 5:00 p.m. Bi- monthly Terms: 3 Contact Person: Charlotte Terwilliger
Meeting Place: Positions: 12 Length: 2 years Contact Phone: 919- 558 -9401
Description: Members are appointed by the Board of Commissioners to at -large positions. There is an initial one -year training term with subsequent eligibility for three additional two -year
terms. This committee works to maintain the intent of the Adult Care Home Residents' Bill of Rights for those residing in licensed adult care homes. The members of this
committee also promote community involvement and cooperation with these homes to ensure quality care for the elderly and disabled adults.
VACANT
Day Phone:
Sex:
First Appointed:
Evening Phone:
Race:
Current Appointment
6
FAX:
Township:
Expiration:
10/31/2015
E -mail:
Resid/Spec Req: At -Large
Number of Terms:
Special Repr:
VACANT
Day Phone:
Sex:
First Appointed:
Evening Phone:
Race:
Current Appointment
7
FAX:
Township:
Expiration:
10/30/2014
E -mail:
Resid/Spec Req: At -Large
Number of Terms:
Special Repr:
Ms. Joyce Teston
Day Phone: n/a
Sex: Female
First Appointed:
09/17/2013
Evening Phone: n/a
Race: Caucasian
Current Appointment:
06/17/2014
8
2326 Highway 86 South
FAX:
Township: Hillsborough
Expiration:
06/30/2016
Hillsborough NC 27278
E -mail: joyceteston @gmail.com
Resid/Spec Req: At -Large
Number of Terms:
1
Special Repr:
Ms. T. L. Crews
Day Phone: 919 732 -6974
Sex: Female
First Appointed:
03/22/2012
Evening Phone: 919 732 -6974
Race: African American
Current Appointment:
03/19/2013
9
4921 Guess Rd
FAX:
Township: Little River
Expiration:
03/31/2016
Rougmeont NC 27572
E -mail: crewsez @aol.com
Resid/Spec Req: At -Large
Number of Terms:
1
Special Repr:
Dr. Beverly Foster
Day Phone: 919 966 -4995
Sex: Female
First Appointed:
06/18/2013
Evening Phone: 919 967 -2930
Race: Caucasian
Current Appointment:
06/17/2014
10
2454 Springview Trail
FAX: 919 843 -6212
Township: Chapel Hill
Expiration:
06/30/2016
Chapel Hill NC 27514
E -mail: Bev_Foster @unc.edu
Resid/Spec Req: At -Large
Number of Terms:
1
Special Repr:
Tuesday, November 11, 2014
Page 2
0
Board and Commission Members
And Vacant Positions
Adult Care Home Community Advisory Committee
Meeting Times: 3:30 p.m. - 5:00 p.m. Bi- monthly Terms: 3 Contact Person: Charlotte Terwilliger
Meeting Place: Positions: 12 Length: 2 years Contact Phone: 919- 558 -9401
Description: Members are appointed by the Board of Commissioners to at -large positions. There is an initial one -year training term with subsequent eligibility for three additional two -year
terms. This committee works to maintain the intent of the Adult Care Home Residents' Bill of Rights for those residing in licensed adult care homes. The members of this
committee also promote community involvement and cooperation with these homes to ensure quality care for the elderly and disabled adults.
Mr James Bartow Day Phone: 919 932 -2682 Sex: Male First Appointed: 02/18/2014
11 Evening Phone: 919 932 -2682 Race: Caucasian Current Appointment: 10/21/2014
118 Collums Rd FAX: Township: Chapel Hill Expiration: 10/31/2017
Chapel Hill NC 27514 E -mail: jmsbartow @gmail.com Resid/Spec Req: At -Large Number of Terms: 1
Special Repr:
VACANT Day Phone: Sex: First Appointed:
12 Evening Phone: Race: Current Appointment
FAX: Township: Expiration: 10/30/2017
E -mail: Resid/Spec Req: At -Large Number of Terms:
Special Repr:
Tuesday, November 11, 2014 Page 3
Thom Freeman
From: Charlotte Terwilliger <cterwilliger @tjcog.org>
Sent: Friday, November 07, 2014 10:05 AM
To: Thom Freeman
Subject: Recommendations to ACH CAC
Dear Thom,
The Adult Care Home Community Advisory Committee would like to recommend Mrs. Suzanne Haff for a one year
training term. Mrs. Haff has a Masters in Education and a strong interest in assuring quality of care for those less able
to advocate for themselves. She has had experience supporting high standards in the school system and these advisory
skills will be of benefit to this committee.
The Adult Care Home Community Advisory Committee would also like to recommend Ms. Yvonne Mendenhall for a one
year training term. Ms. Mendenhall is completing her Masters in Gerontology and has a great deal of experience
advocating for seniors. She has served on several groups in Orange County whose focus is on the well being and
successful aging of all elders and she is familiar with many of the concerns that residents have living in long term care
facilities.
Please let me know if you need any additional information to move these recommendations forward.
Best Regards,
Charlotte
Charlotte Terwilliger, MSW
Regional Long Term Care Ombudsman
Area Agency on Aging
Triangle ! Council of Governments
4307 Emperor Blvd., Suite 110, Durham, NC 27703
(o) 919- 558 -9401 / (f) 919 - 999 -5101
cterwilliger @ticog.org / www.t9cog.org
E -Mail correspondence to and from this address is subject to the North Carolina Public Records Act and may
be disclosed to third parties unless made confidential under applicable law.
Thom Freeman
From: Charlotte Terwilliger <cterwilliger @tjcog.org>
Sent: Monday, November 10, 201410:00 AM
To: Thom Freeman
Subject: ACH Recommendation - Deborah Stewart
Dear Thom,
The Adult Care Home Community Advisory Committee would like to recommend Ms. Deborah Stewart for a one year
training term. Ms. Stewart is a social worker at UNC Home Health and has a Masters degree. In this role she serves as
an advocate and educator for patients and their families. Her advocacy skills and interest in helping elders and people
who are disabled makes her an excellent choice for this committee.
Please let me know if you need any additional information to move this recommendation forward.
Best Regards,
Charlotte
Charlotte Terwilliger, MSW
Regional bong Term Care Ombudsman
Area Agency on Aging
Triangle J Council of Governments
4307 Emperor Blvd., Suite 110, Durham, NC 27703
(o) 919- 558 -9401 / (f) 919- 998 -8101
cterwilliger@ticog.org / www.tocog.org
E -Mail correspondence to and from this address is subject to the North Carolina Public Records Act and may
be disclosed to third parties unless made confidential under applicable law.
7
Page 1 of 2
Suzanne Haff
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 Suzanne Haff
107 Hunter Hill Road
Chapel Hill NC 27516
919- 933 -9329
suzhaff @gmail.com
Chicle Language & Culture Institute, Part -Time
English Teacher
1988
Chapel Hill
Joint Planning Area
Female
Caucasian
Community Activities /Organizational Memberships:
Past Service on Orange County Advisory Boards:
Boards /Commissions applied for:
Durham Technical Community College Board of Directors
Background, education and experience relevant to this board:
Reasons for wanting to serve on this board:
Conflict of Interest:
Adult Care Home Community Advisory Committee
Background, education and experience relevant to this board:
Masters in Education Worked 45 years in public schools in several states In Durham Public
Schools I worked as a central office specialist helping middle and high school teachers integrate
literacy skills into their content area classrooms. This experience of going to many schools and
supporting many teachers keep their standards high in an advisory way is relevant to this board.
I want to help the Adult Care Homes treat their clients as I would want to be treated. I have
worked for many years as a curriculum support person in schools and am experienced in the
protocols of such an advisory board.
Reasons for wanting to serve on this board:
I want to be a part of assuring quality for those less able to help advocate for themselves. I want
to serve on this board to help our county do the best they can for our older citizens in Adult Care
Homes.
Conflict of Interest:
None
Supplemental Questions:
Page 2 of 2
Suzanne Haff
Work Experience: 45 years as high school and community college educator and
administrator. Teacher and teacher of teachers in Virginia, Ct., Washingto State,
California and North Carolina.
Volunteer Experience: Chapel Hill Planning Board - Appointed by Orange County
Commissioners 2000 -2005 (JPA Residence Area)
Northern Area Task Force - Appointed by CH Town Council 2009
Northwood Neighborhood Association (Currently Secretary)
Escort - Orange County Conference to End Homelessness. Tutor for Chapel Hill Public
Schools. Many neighborhood civic organizations here and in other states. "Good
Neighbor" Award by mayor in Pasadena, California.
Education: BA 1965 Political Science and Economics: Mary Washiington College of the
Univ. of Va.
M.Ed. 1969 University of Virginia. Various othercourses over the years without completion
of degree.
Other Comments:
I'm interested in taking my turn participating in the process of helping keep our county a
pleasant place for all its residents through thoughtful planning. I would like to serve my
community and I believe I offer a progressive yet balanced approach to decision making.
STAFF COMMENTS: Originally applied 1/15/02 for ABC Board. Reapplied 10/07/2007 for
Chapel Hill Board of Adjustment, Durham Tech. Comm. College Bd of Directors, DTCC
Satellite Campus. Reapplied 6/18/2010 for CH BOA, Advisory Board on Aging and Solid
Waste Advisory Boad. Reapplied 09/16/2011 for CH Planning Board. Her Comments:
The JPA Seat on the Chapel Hill Planning Board is currently vacant. The Town Council of
Chapel Hill is currently working on a Transit Feasibility Study Report for Euganks Road
and has had a Concept Plan presented to them to put a shopping Center on the 49 acres
of undeveloped land between Eubanks and 140. the citizens in this section of the County
needs representation and that is why I am applying at this time. ADDRESS
VERIFICATION: 107 Hunter Place is in Chapel Hill Township and Orange County
Jurisdiction. (JPA)
This application was current on: 9/16/2011 Date Printed: 7/28/2014
9
Page 1 of 2
A Yvonne Mendenhall
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:
A Yvonne Mendenhall
304 W Barbee Chapel Rd
Chapel Hill NC 27517
919- 968 -7874
919- 968 -7874
919- 360 -1756
menholiday @aol.com
Retired
Retired
2002
Chapel Hill
Female
Caucasian
Community Activities /Organizational Memberships:
Orange County Project EngAGE
Meadowmont Seniors in Community Aging in Community group founder
MAPP founder, member
Community Emergency Response Team
Completing on MS in Gerontology
OLLI presenter Aging in Community
Recent Charles House volunteer practicum
Past Service on Orange County Advisory Boards:
Served on the last Master Aging Plan workgroup.
Boards /Commissions applied for:
Adult Care Home Community Advisory Committee
Background, education and experience relevant to this board:
Experience volunteering in Aging in Community
Completing MS in Gerontology
Practicum with The Charles House 2013
Volunteer with GCM, Madelyn Ashley,in Senior Support Group
Reasons for wanting to serve on this board:
I am very interested in the wellbeing and successful aging of all elders. Various coursework dealt
with benefits and concerns with seniors (and their families) living in skilled nursing facilities, adult
care homes, assisted living facilities.
Conflict of Interest:
Supplemental Questions:
10
Page 2 of 2 A Yvonne Mendenhall
Other Comments:
This application was current on: 8/24/2014 5:49:16 PM Date Printed: 8/25/2014
11
Page 1 of 2
Deborah Stewart
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:
Deborah Stewart
1405 Buckhorn Rd.
Mebane NC 27302
919- 210 -4857
919- 210 -4857
919- 210 -4857
deb.k.stewart @gmail.com
UNC Healthcare - UNC Home Health
Social Worker
1997
Cheeks
Female
Caucasian
Community Activities /Organizational Memberships:
Member of National Association of Social Workers - NC Chapter; NC Society for Clincal
Social Work (was Treasurer /Board Member 2006 - 2007); 1 work regularly with Orange
County citizens by visiting them in their homes when they are sick or homebound.
Past Service on Orange County Advisory Boards:
N/a
Boards /Commissions applied for:
Adult Care Home Community Advisory Committee
Background, education and experience relevant to this board:
In my current position as Home Health Social Worker, I help assess the need for assistance or
supervision for our patients and I provide education regarding the various long -term care
options, including Adult Care Homes. My primary role is as advocate for our patients and their
families and educator regarding community resources.
Reasons for wanting to serve on this board:
To increase my community involvement and gain a fuller understanding of the inner workings of
Adult Care supports in our area.
Conflict of Interest:
Since I provide information to individuals and their families regarding long -term care options,
some could believe that I make specific referrals to some facilities. However, as a state
employee I am strictly prohibited from doing so. My role is to provide neutral information so
individuals can find the right fit for them.
12
Page 2 of 2
Advisory Board on Aging
Deborah Stewart
Background, education and experience relevant to this board:
The majority of clients that we serve are Medicare recipients and citizens 60 years old and older.
Reasons for wanting to serve on this board:
To increase my community involvement, especially with organizations that provide helpful and
supportive services to people I serve in my work daily.
Conflict of Interest:
Board of Social Services
Background, education and experience relevant to this board:
I earned a Masters in Social Work and hold a NC Clinical Social Work License. In my position as
Home Health Social Worker, I identify the needs of our clients and regularly screen individuals
for potential eligibility for social service supports.
Reasons for wanting to serve on this board:
To increase my community involvement and increase my connection to and understanding of
the various social service programs that serve Orange County citizens.
Conflict of Interest:
Supplemental Questions:
Other Comments:
This application was current on: 7/21/2014 1:43:36 PM Date Printed: 7/22/2014
13
Applicant Interest
Listing
by Board Name and by Applicant Name
Contact Person:
Charlotte Terwilliger
Adult Cate Home Community
Advisory Committee
Contact Phone:
919 - 558 -9401
Mr Stephen Bank
Day Phone:
9199296369
Sex:
Male
7404 Dodsons Xrd
Evening Phone:
9199296369
Race:
Caucasian
Hillsborough NC 27278
Cell Phone:
not used
Township:
Bingham
E -mail:
stevebank@gmail.com
Date Applied:
07/28/2014
Skills:
Also Serves On:
Dr. William Crittenden
Day Phone:
9196362016
Sex:
Male
4206 BRADFORD RIDGE RD
Evening Phone:
9196362016
Race:
Caucasian
EFLAND NC 272439474
Cell Phone:
9196362016
Township:
Bingham
E -mail:
bill.seniorcare@gmail.com
Date Applied:
07/28/2014
Skills:
Also Serves On:
Mrs Suzanne Haff
Day Phone:
919- 933 -9329
Sex:
Female
107 Hunter Hill Road
Evening Phone:
919- 933 -9329
Race:
Caucasian
Chapel Hill NC 27516
Cell Phone:
919- 260 -9277
Township:
Chapel Hill
E -mail:
suzhaff@gmail.com
Date Applied:
07/28/2014
Skills: Neighborhood Assocation Member
Also Serves On:
Skills: Teacher
Also Serves On:
A Yvonne Mendenhall
Day Phone:
919 -968 -7874
Sex:
Female
304 W Barbee Chapel Rd
Evening Phone:
919- 968 -7874
Race:
Caucasian
Chapel Hill NC 27517
Cell Phone:
919- 360 -1756
Township:
Chapel Hill
E -mail:
menholiday@aol.com
Date Applied:
08/24/2014
Skills:
Also Serves On:
Miss Danielle Mosley
Day Phone:
919- 309 -5685
Sex:
Female
476 Melanie Court
Evening Phone:
Race:
Caucasian
Chapel Hill NC 27514
Cell Phone:
Township:
Chapel Hill
E -mail:
Dlynnm26@gmail.com
Date Applied:
10/01/2014
Skills: Club Nova
Also Serves On:
Deborah Stewart
Day Phone:
919 -210 -4857
Sex:
Female
1405 Buckhorn Rd.
Evening Phone:
919 -210 -4857
Race:
Caucasian
Mebane NC 27302
Cell Phone:
919 -210 -4857
Township:
Cheeks
E -mail:
deb.k.stewart@gmail.com
Date Applied:
07/21/2014
Skills:
Also Serves On:
Tuesday, November 11, 2014 Page 1 of 1
14
Page 1 of 1
Stephen Bank
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 Stephen Bank
7404 Dodsons Xrd
Hillsborough NC 27278
9199296369
9199296369
not used
stevebank @gmail.com
retired
na
2004
Bingham
Male
Caucasian
Community Activities /Organizational Memberships:
None. Graduated in 1966 with MA in psychology and completed all classes for PhD in
psychology (did not complete dissertation). Have worked in mental health capacities from
1966 until retirement from Lutheran Family Services ACT Team in 2010.
Past Service on Orange County Advisory Boards:
none
Boards /Commissions applied for:
Adult Care Home Community Advisory Committee
Background, education and experience relevant to this board:
As previously stated - Psychology graduate degree and work experience in field since 1966.
Reasons for wanting to serve on this board:
I know a little something about the field and might have significant insight.
Conflict of Interest:
Supplemental Questions:
Other Comments:
This application was current on: 7/28/2014 3:39:35 PM Date Printed: 7/29/2014
15
Page 1 of 2
William Crittenden
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. William Crittenden
4206 BRADFORD RIDGE RD
EFLAND NC 272439474
9196362016
9196362016
9196362016
bill.seniorcare @gmail.com
Senior Care Management Associates
Geriatric Care Manager
2005
Bingham
Male
Caucasian
Community Activities /Organizational Memberships:
Member - United Church of Chapel Hill\
Member - Hillsborough- Orange County Chamber of Commerce
Member - Hillsborough Leads Group
Member - Chapel Hill Leads Group
Past Service on Orange County Advisory Boards:
Orange County Dept. of Aging Planning Committee
Boards /Commissions applied for:
Adult Care Home Community Advisory Committee
Background, education and experience relevant to this board:
I have over 20 years of experience in assisting seniors to maintain their independence, dignity,
and self- respect by providing appropriate health care and housing services, emotional support
and psychological support and intervention as well as consultation regarding available
community resources. I have an earned doctoral degree in marriage and family counseling and
have provided chaplaincy services in psychiatric and general hospitals, developed and firected a
marriage and family counseling service based in a hospital setting and served as the Executive
Director of continuing care retirement communities including assisted living and skilled nursing
facilities.
Reasons for wanting to serve on this board:
I have been involved in a wide variety of senior care services throughout my career and would
look forward to bringing my background and experience to the Adult Care Home Community
Advisory Committee.
Conflict of Interest:
Supplemental Questions:
Page 2 of 2
Other Comments:
William Crittenden
16
This application was current on: 7/28/2014 10:29:42 AM Date Printed: 7/29/2014
17
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
W
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