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Home My WebLink AboutAgenda - 03-03-2015-11bi ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: March 3, 2015 SUBJECT: Board of Health -Appointment DEPARTMENT: Board of Commissioners ATTACHMENT(S): Under Separate Cover Membership Roster Recommendation Application for Person Recommended Interest List Applications of Persons on the Interest List Action Agenda Item No. 11 -b PUBLIC HEARING: (Y /N) No INFORMATION CONTACT: Clerk's Office, 245 -2130 PURPOSE: To consider making an appointment to the Board of Health. BACKGROUND: The following appointment is for Board consideration: • Appointment to a partial term (position #2) At -Large Pharmacist for Mr. Dan Dewitya expiring 06/30/2016. POSITION NO. NAME SPECIAL REPRESENTATIVE EXPIRATION DATE 2 Mr. Dan Dewit a At-Large Pharmacist 06/30/2016 NOTE - If the individuals listed above are appointed, the following vacancies remain: • Position #3 - -- "At -Large Citizen /Commissioner Appointed" position - - - -- expiring 06/30/2017 FINANCIAL IMPACT: None. RECOMMENDATION(S): The Board will consider making an appointment 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 VACANT Day Phone 2 Evening Phone: FAX: E -mail: 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: 09/16/2014 Township: Chapel Hill Expiration: 06/30/2017 Resid/Spec Req: Number of Terms: 2 Special Repr: Veterinarian Sex: First Appointed: Race: Current Appointment Township: Expiration: 06/30/2016 Resid/Spec Req: At -Large Number of Terms: Special Repr: Pharmacist 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: 09/16/2014 Township: Chapel Hill Expiration: 06/30/2017 Resid/Spec Req: At -Large Number of Terms: 2 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 Friday, February 06, 2015 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 Friday, February 06, 2015 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 Ms. Mia Burroughs 110 Cedar Hills Drive Chapel Hill NC 27514 Day Phone: 919- 932 -6282 Evening Phone: 919- 932 -6282 FAX: E -mail: mburroughs @orangecountync.gov Sex: Female Race: Caucasian Township: Chapel Hill Resid/Spec Req: At -Large Special Repr: B.O.C.C. First Appointed: 01/27/2015 Current Appointment: 01/27/2015 Expiration: 02/29/2016 Number of Terms: Friday, February 06, 2015 Page 3 Thorn Freeman From: Tersee Flores Sent: Thursday, January 22, 2015 10:55 AM To: Thom Freeman Cc: Colleen Bridger Subject: Board of Health recommendations Attachments: Dan Dewitya Database Application.pdf Hi Thom, The Board of Health members reviewed applications for the Pharmacy vacancy on the hoard. The BOH is recommending that the Board of County Commissioners appoint Dan Dewitya for the pharmacist position. Attached is Dan Dewitya volunteer application. Please let me know if you need additional information. Thank you, Tersee Efores Administrative Assistant II to Dr. Colleen Bridger MPH, PHD Orange County Health Department 300 West Tryon Street, Hillsborough, NC 2 72 78 Office: 919- 245 - 2411 Fax: 919- 245 -0896 iflores a,or- aragecouiityrac.gov htQa://tt,+s,�k,.oi^ ecountyne.goi, s �yd F ; � 1 Page 1 of 2 Dan Dewitya 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: Dan Dewitya 112 Bolinwood Dr Chapel Hill NC 27514 -2643 919- 906 -6762 919- 906 -6762 919- 906 -6762 dan.dewitya @gmail.com Lincoln Community Health Center Pharmacist 1985 Chapel Hill Male Asian American Community Activities /Organizational Memberships: NC State Medical Assistance Team (SMAT)Duke Regional Advisory Committee (DRAC); Ajunct Assistant Professor UNC Eshelman School of Pharmacy; University of Florida College of Pharmacy preceptor; NC Seniors Health Insurance Information Program (SHIIP) counselor; Senior PharmAssist Formulary Committee; NCCU School of Nursing guest lecturer; North Carolina Association of Pharmacists Past Service on Orange County Advisory Boards: I have never served on any Orange County Advisory Boards. Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: I have been a pharmacist for more than 15 years at Lincoln Community Health Center, whose goal is ensuring equal and fair access to high - quality health care. I am the formulary manager at the clinic, help ensure the pharmacyaETMs Medicaid compliance and serve on the Environment of Care Committee. http: / /www.lincolnchc.org/ During that time I have also served as an adjunct assistant professor with UNCa €TMs Eshelman School of Pharmacy and a preceptor with the University of Florida College of Pharmacy where I had the opportunity to train future pharmacists. I have been a member of the North Carolina State Medical Assistance Team (NC SMAT) Duke Regional Advisory Committee (DRAC NC -400) since 2011 and will begin serving as an advisor to the SMAT steering committee. http: / /trauma.duhs.duke.edu /disaster - response /nc400 -smat Last year, I completed training with the NC Department of Insurance SeniorsaETM Health Insurance Information Program (SHIIP) and became a SHIIP counselor to help seniors navigate Medicare. I am also a member of Senior PharmAssistaETMs formulary committee. http: / /www.ncdoi.com /shiip/ http: / /seniorpharmassist.org/ Reasons for wanting to serve on this board: 7 Page 2 of 2 Dan Dewitya My volunteer activities have centered on organizations where I can apply my training in promoting public health. I feel very fortunate with the opportunities I have received and see this as a chance to be able to contribute to my community. Conflict of Interest: Supplemental Questions: Other Comments: This application was current on: 11/14/2014 3:46:07 PM Date Printed: 11/17/2014 Applicant Interest Listing by Board Name and by Applicant Name Contact Person: Tersee Flores Board Of Health Contact Phone: 919- 245 -2411 Debra Aycock Day Phone: 919 - 817 -6037 Sex: Female 301 Tramore Drive Evening Phone: 919 -817 -6037 Race: Caucasian Chapel Hill NC 27516 Cell Phone: 919 -817 -6037 Township: Chapel Hill E -mail: debaycock22@gmail.com Date Applied: 02/10/2015 Skills: Also Serves On: 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: Ms. Jennifer Brobst 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. Barbara ChavioAS Day Phone: 919- 732 -3469 Sex: Female 401 N Nash St Evening Phone: 919- 732 -3469 Race: Caucasian Hillsborough NC 27278 Cell Phone: 919- 943 -5319 Township: Hillsborough E -mail: Barbara Chavious@unc.edu Date Applied: 02/06/2015 Skills: Public Health Also Serves On: Dr. Steven Thomas Daniels Day Phone: 919- 732 -8213 Sex: Male 206 Franklin Adams Road Evening Phone: 919 -451 -1874 Race: Caucasian EYland NC 27243 Cell Phone: 919 -451 -1874 Township: Cheeks E -mail: stdaniel@gmail.com Date Applied: 01/15/2014 Skills: Also Serves On: Wednesday, February 11, 2015 Page 1 of 5 Applicant Interest Listing by Board Name and by Applicant Name 9 Wednesday, February 11, 2015 Page 2 of 5 Contact Person: Tersee Flores Board Of Health Contact Phone: 919- 245 -2411 Dr Brian Decker Day Phone: 919.360.6529 Sex: Male 109 Dublin Road Evening Phone: 919.360.6529 Race: Caucasian Chapel Hill NC 27516 Cell Phone: 919.360.6529 Township: Chapel Hill E -mail: bdeckeruncggmail.com Date Applied: 11/03/2014 Skills: Also Serves On: Skills: Environmental Scientist Also Serves On: Skills: Pharmacist Also Serves On: Skills: Real Estate Broker Also Serves On: 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: Township: Bingham E -mail: tamaradtgyahoo.com Date Applied: 01/10/2014 Skills: Healthcare Consultant Also Serves On: Board of Social Services Dan DeWitya Day Phone: 919- 906 -6762 Sex: Male 112 Bolinwood Dr Evening Phone: 919- 906 -6762 Race: Asian American Chapel Hill NC 27514-2643 Cell Phone: 919- 906 -6762 Township: Chapel Hill E -mail: dan.dewityaggmail.com Date Applied: 11/14/2014 Skills: Also Serves On: Dr. NArum 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: nurumerdemggmail.com Date Applied: 01/17/2014 Skills: Also Serves On: Mrs. Jessica Frega Day Phone: 919 426 9465 Sex: Female 1511 Park Lane Evening Phone: 919 426 9465 Race: Caucasian Hillsborough NC 27278 Cell Phone: 919 426 9465 Township: Hillsborough E -mail: jessicaloisggmail.com Date Applied: 10/30/2014 Skills: Also Serves On: Wednesday, February 11, 2015 Page 2 of 5 10 Applicant Interest Listing by Board Name and by Applicant Name Caucasian Township: Contact Person: Tersee Flores 02/05/2015 Board Of Health Contact Phone: 919- 245 -2411 Mr. Zachary Giles Day Phone: 9103087228 Sex: Male 8000 Oak Pointe Court Evening Phone: 9103087228 Race: Caucasian Mebane NC 27302 Cell Phone: 9103087228 Township: Cedar Grove E -mail: zach.s.gilesggmail.com Date Applied: 02/26/2014 Skills: Also Serves On: Mrs Linda Griffin Day Phone: 919- 630 -9078 Sex: Female 321 Mitchell Street Evening Phone: 919- 630 -9078 Race: Caucasian Hillsborough NC 27278 Cell Phone: 919- 630 -9078 Township: Hillsborough E -mail: lgriffin2gne.rr.com Date Applied: 01/09/2014 Skills: Also Serves On: Dr Daniel Kemp Day Phone: 3364067871 Sex: Male 2007 Starterwood Ln Evening Phone: 3364067871 Race: Other Hillsborough NC 27278 Cell Phone: 3364067871 Township: Bingham E -mail: spartanl999ggmail.com Date Applied: 07/02/2014 Skills: Also Serves On: Dr. Michelle McKee Day Phone: 828- 230 -9624 Sex: Female 2108 Country Air Lane Evening Phone: 919- 644 -7849 Race: Caucasian Hillsborough NC 27278 Cell Phone: 828 -230 -9624 Township: Hillsborough E -mail: mckeetarheelgyahoo.com Date Applied: 11/20/2014 Skills: Also Serves On: Mr. Steven Moore Day Phone: 9199298995 Sex: Male 913 Roosevelt Dr Evening Phone: 9199298995 Race: Caucasian Chapel Hill NC 27514 Cell Phone: 9199298995 Township: Chapel Hill E -mail: mooresgcampb ell. edu Date Applied: 11/16/2014 Skills: Also Serves On: Mr Ken Morgan 2720 Buckboard Drive Hillsborough NC 27278 Skills: American Heart Association Skills: United Way Board of Directors Day Phone: 919- 218 -8596 Evening Phone: 919 -218 -8596 Cell Phone: E -mail: morgangk @juno.com Also Serves On: Also Serves On: Sex: Male Race: Caucasian Township: Eno Date Applied: 02/05/2015 Wednesday, February 11, 2015 Page 3 of 5 Applicant Interest Listing Board of Health Miss Danielle Mosley 476 Melanie Court Chapel Hill NC 27514 Skills: Club Nova Ms. Yvonne Overcast 216 cobalt ridge road hillsborough NC 27278 Skills: 11 by Board Name and by Applicant Name Contact Person: Tersee Flores Contact Phone: 919- 245 -2411 Day Phone: 919- 309 -5685 Evening Phone: Cell Phone: E -mail: Dlynnm26@gmail.com Also Serves On: Day Phone: 9197329840 Evening Phone: 9197329840 Cell Phone: 9194511901 E -mail: yovercastggmail.com Also Serves On: Sex: Female Race: Caucasian Township: Chapel Hill Date Applied: 10/01/2014 Sex: Female Race: Caucasian Township: Hillsborough Date Applied: 01/08/2014 Ms. Antonia Pedroza Day Phone: 252- 738 -3770 Sex: Female 409 Saint Marys Road Evening Phone: 919- 760 -0210 Race: Hispanic Hillsborough NC 27278 Cell Phone: 919- 760 -0210 Township: Hillsborough E -mail: pedrozaantoniagyahoo.com Date Applied: 08/13/2014 Skills: Also Serves On: Human Relations Commission Dr. Todd Sega Day Phone: 8144905120 Sex: Male 1113 Arborgate Cir Evening Phone: 8144905120 Race: Caucasian Chapel Hill NC 27514 Cell Phone: 8144905120 Township: Chapel Hill E -mail: toddsegaggmail.com Date Applied: 11/20/2014 Skills: Also Serves On: Dr. Edward Stirman Day Phone: 919 -241 -4912 Sex: Male 554 E Hatterleigh Ave Evening Phone: 919 -241 -4912 Race: Caucasian Hillsborough NC 27278 Cell Phone: 423 - 677 -3295 Township: Eno E -mail: monty.stirmanggmail.com Date Applied: 03/13/2014 Skills: Also Serves On: Ms. Diane Uzarski 3017 Pleasant Green Rd Durham NC 27705 Skills: Day Phone: 9196688595 Evening Phone: 9193097974 Cell Phone: 9193097974 E -mail: diane.uzarskigdm. duke. edu Also Serves On: Sex: Female Race: Caucasian Township: Eno Date Applied: 09/29/2014 Wednesday, February 11, 2015 Page 4 of 5 12 Applicant Interest Listing by Board Name and by Applicant Name Sex: Male Contact Person: Tersee Flores Board Of Health 9194936310 Contact Phone: 919- 245 -2411 Mr. Leroy Werley Day Phone: 919- 933 -3099 Sex: Male 6916 Turkey Farm Rd. Evening Phone: 919- 933 -3099 Race: Caucasian Chapel Hill NC 27514 Cell Phone: 919 -210 -6604 Township: Chapel Hill Date Applied: E -mail: Lwerley3@gmail.com Date Applied: 10/31/2014 Skills: Pharmacist Also Serves On: Female Dr. Delbert Williams Day Phone: 9194936310 Sex: Male 7110 Pine Hill Road Evening Phone: 9194936310 Race: Caucasian Durham NC 27707 Cell Phone: 9198013552 Township: Chapel Hill 07/15/2013 E -mail: delwilliams@nc.rr.com Date Applied: 06/25/2014 Skills: Also Serves On: Sex: Female Evening Phone: Dr. Dennis Williams 209 Lake Manor Road Chapel Hill NC 27516 Skills: Dr Joanne Wilson 104 Stoneridge Drive Chapel Hill NC 27514 Skills: Medical Doctor Dr. Tracey Yap 834 Providence Glen Drive Chapel Hill NC 27514 Skills: Director Skills: Nurse Day Phone: 919- 962 -7122 Evening Phone: 919- 933 -5408 Cell Phone: 919- 602 -2440 E -mail: dwilliams@unc.edu Also Serves On: Sex: Male Race: Other Township: Chapel Hill Date Applied: 11/15/2014 Day Phone: 919 -810 -2774 Sex: Female Evening Phone: 919- 932 -5391 Race: African American Cell Phone: Township: Chapel Hill E -mail: anteel@earthlink.net Date Applied: 07/15/2013 Also Serves On: Day Phone: 502 - 686 -0016 Sex: Female Evening Phone: 919- 240 -4793 Race: Caucasian Cell Phone: Township: Chapel Hill E -mail: tracey.yap@duke.edu Date Applied: 02/05/2015 Also Serves On: Nursing Home Community Advisory Committee Wednesday, February 11, 2015 Page 5 of 5 13 Page 1 of 2 Debra Aycock 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: Debra Aycock 301 Tramore Drive Chapel Hill NC 27516 919- 817 -6037 919- 817 -6037 919- 817 -6037 debaycock22 @gmail.com Retired after 11 years at BCBSNC Clinical Pharmacist 1984 Bingham Female Caucasian Community Activities /Organizational Memberships: Durham - Orange Pharmacists Association American Society of Health- System Pharmacists Regular blood donation at Red Cross Donate and have volunteered at TABLE, Inc. 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 graduated from UNC -CH with a BS Pharmacy degree, and from Virginia Commonwealth University with a Doctor of Pharmacy degree. I have been a registered pharmacist for 35 years and have worked in a variety of settings, most recently at Blue Cross & Blue Shield of NC. I have also worked at Kaiser Permanente (clinical pharmacy coordinator), John Umstead Hospital (now Central Hospital), AccessCare, and Piedmont Health Services (formerly Orange- Chatham Health Services, a local network of community health centers. I understand general clinical pharmaceutical care including mental health, Medicare Part D, community health center care, and insurance coverage. Reasons for wanting to serve on this board: I believe I can be of assistance to the Board of Health with my varied background in pharmacy care. Now that I am retired, I have time to devote to it and would enjoy the opportunity. Conflict of Interest: Supplemental Questions: 14 Page 2 of 2 Debra Aycock Other Comments: This application was current on: 2/10/2015 4:11:43 PM Date Printed: 2/11/2015 15 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 16 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 17 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 This application was current on: 12/18/2013 12:48:02 PM Date Printed: 12/19/2013 19 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 P 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 21 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. 22 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 23 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 /.' Page 1 of 2 Brian Decker 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. Brian Decker 109 Dublin Road Chapel Hill NC 27516 919- 360 -6529 919- 360 -6529 bdeckerunc @gmail.com CVS Health Staff Pharmacist 2000 Chapel Hill Carrboro Transition Area Male Caucasian Community Activities /Organizational Memberships: UNC Eshelman School of Pharmacy Preceptor. Member North Carolina Association of Pharmacists. Past Service on Orange County Advisory Boards: Carrboro Northern Transition Area Advisory Board. Chapel Hill Bicycle & Pedestrian Advisory Board. Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: I am a practicing pharmacist and preceptor to student pharmacists. I will bring my knowledge of current community pharmacy practice, my relationship with the academy and the energy of students to the board. Reasons for wanting to serve on this board: Many of the health issues my patients face are rooted in, what I view as, public health problems: access and health literacy. Conflict of Interest: I am employed as a pharmacist with CVS Health. Any programs or partnerships with community pharmacies that involved pecuniary gain could be construed as conflicting. I would seek to recuse myself from any votes or actions related to this. Supplemental Questions: Work Experience: Real Estate Broker - Brian Decker Properties with Fonville Morisey in Chapel Hill; Manager - Franklin Street Cycles in Chapel Hill 25 Page 2 of 2 Brian Decker Environmental Scientist - Retec in Chapel Hill; CVS Pharmacy: Technician & Intern Volunteer Experience: Current Vice - Chair, former Chair, of the Chapel Hill Bicycle and Pedestrian Advisory Board; Member of the Chapel Hill Streetscape Review Committee; Past Member of the Chapel Hill Northern Area Task Force; Founding Member of the Triangle Off Road Cyclists; I am a former member of NTAAC. I am Chair of the Student Political Action Network. Education: BA Environmental Science - University of Arizona.; UNC PharmD - to be completed 2014. Other Comments: Currently sit on the NTAAC as a Carrboro seat.STAFF COMMENTS: Originally applied for Carrboro Northern Transition Area Advisory Committee 2/2/2008. STAFF COMMENTS: 09/21/2011 1 want to continue to help Carrboro and Orane County be a great place to live and work while adamting to the future /applied for Carrboro Northern Transition Area Adisory Committee. ADDRESS VERIFICATION: 109 Dublin Road, Chapel Hill is Chapel Hill Township, CAPL jurisdiction. Updated application 11/03/2014. This application was current on: 11/3/2014 Date Printed: 11/4/2014 R 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 27 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 R 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 e 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 31 Page 1 of 2 Jessica Frega 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. Jessica Frega 1511 Park Lane Hillsborough NC 27278 919 426 9465 919 426 9465 919 426 9465 jessicalois @gmail.com Community Care of North Carolina Program Analyst 2009 Hillsborough County Female Caucasian Community Activities /Organizational Memberships: American Public Health Association UNC -CH Gillings School of Public Health Alumnus 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 am a Masters of Public Health graduate from the Maternal and Child Health department at UNC -CH Gillings School of Public Health. By training, I am an adept data analyst specializing in health informatics and am proficient in analytics using SAS and even Excel. I have volunteered in the past at the Dare County Department of Public Health, assisting with their Community Health Assessment. Reasons for wanting to serve on this board: I am interested in the health of our community in Orange County and I am interested in giving back to my community via some kind of civil service. The Board of Health feels like an appropriate fit. Conflict of Interest: I work for an organization that is contracted by NC Medicaid to manage various aspects of the Medicaid population in the state. I am not sure if this would cause a problem for the Board, but it would not cause a problem for my employer. Supplemental Questions: Page 2 of 2 Other Comments: Jessica Frega 32 This application was current on: 10/30/2014 12:53:04 PM Date Printed: 10/31/2014 33 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: 34 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 35 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 36 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: 37 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 W Page 1 of 2 Michelle McKee 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. Michelle McKee 2108 Country Air Lane Hillsborough NC 27278 828 - 230 -9624 919- 644 -7849 828 - 230 -9624 mckeetarheel @yahoo.com Formerly AstraZeneca Senior Regional Scientific Manager /Director of Med 2003 Hillsborough Female Caucasian Community Activities /Organizational Memberships: Co- Creator of Tar Heel Tots (Community Fist -Time Moms Group) Member or Little Sprouts (Community First -Time Moms Group) Member of Fox Hill Farms Book Club I am interested in becoming more formally involved in the local community Past Service on Orange County Advisory Boards: I have not currently or in the past served on any Orange County Advisory Boards. Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: I have been a licensed pharmacist in North Carolina for over 16 years. I graduated from the University of North Carolina at Chapel Hill, where I received my Doctor of Pharmacy degree. I further specialized by completing a drug information residency at Campbell University School of Pharmacy. My breadth of experiences in the retail, hospital, industry, and academia sectors allows me to understand the needs and challenges of patients within the community. Reasons for wanting to serve on this board: As the mother of a small child and the daughter of an aging, sick parent, I have been searching for an opportunity to use my pharmacy talents without the constraints of traditional pharmacy employment. In addition, I strongly value community service and wish to further integrate myself within Orange County. Conflict of Interest: Supplemental Questions: Page 2 of 2 Other Comments: I►VAIRi - 1raLVAM M- 39 This application was current on: 11/20/2014 9:37:02 PM Date Printed: 12/5/2014 W Page 1 of 1 Steven Moore 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 Steven Moore 913 Roosevelt Dr Chapel Hill NC 27514 9199298995 9199298995 9199298995 moores @campbell.edu Campbell Univ College of Pharmacy Adjunct Asst Professor 1998 Chapel Hill Male Caucasian Community Activities /Organizational Memberships: Chair, Chapel Hill Cemeteries Advisory Board Fellow, American Society of Health System Pharmacists Fellow, Royal Society for Public Health Past Service on Orange County Advisory Boards: N/A Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: Career with US Public Health Service (activity in health education, emergency preparedness and response, aging, disease prevention and health promotion, personal staff for 4 Surgeons General) Board Certified in Public Health Pharmacy (RSPH) Curriculum coursework (Campbell)lntroduction to Public Health Reasons for wanting to serve on this board: Knowledge and experience in public health pharmacy Conflict of Interest: Supplemental Questions: Other Comments: This application was current on: 11/16/2014 2:17:47 PM Date Printed: 11/17/2014 41 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 42 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 43 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 .. 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 45 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 ER 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 47 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: MN 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 i • Page 1 of 3 Todd Sega 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. Todd Sega 1113 Arborgate Cir Chapel Hill NC 27514 8144905120 8144905120 8144905120 toddsega @gmail.com Pharmacy Quality Solutions Manager of Payer Relations 2014 Township of Residence: Chapel Hill Zone of Residence: Chapel Hill Township within C.H. city limits Sex: Male Ethnic Background: Caucasian Community Activities /Organizational Memberships: Due to establishing residence less than four weeks ago, past community activities are listed: *Volunteer Pharmacist - The Care Clinic, Fayetteville, NC. Helped staff the pharmacy along with physicians and dentists for underserved, working individuals in cumberland county. *Medication Review Sessions - Edinboro United Methodist Church, Edinboro, PA. Conducted medication reviews and education sessions for the congregation at a hometown church. *Prescription Drug Abuse Educator - Developed a prescription drug abuse presentation targeted to 5th grade students in local schools around Northwest Ohio. The session included slides, a pledge, and wristband after completing the pledge which resulted in some students identifying abuse even at 11 -12 years of age. Organizational Memberships: *Academy of Managed Care Pharmacy *National Community Pharmacists Association *Ohio Pharmacists Association *North Carolina Association of Pharmacists Past Service on Orange County Advisory Boards: None 50 Page 2 of 3 Todd Sega Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: As medical professionals, we strive to improve the health related quality of life of those that we serve. From a broader perspective, all of those on the care team contribute in unique ways hoping that individual care results in improved health for the population and the community in which we live. To be sure, this belief has been held in earnest throughout my training and carried through as a licensed pharmacist. I have served in several capacities where I have educated individuals on the key role pharmacists can have on improving outcomes. In addition, I have advocated for expanded roles for pharmacists knowing the impact that can be achieved through increased involvement on care teams. I have practiced in a community setting which allows me to understand the unique challenges front -line community pharmacists face on a daily basis. At the same time, this experience allows me to recognize the often uncapitalized opportunities pharmacists and pharmacies can have on improving overall population health. I have also served as a staff pharmacist at the Academy of Managed Care Pharmacy (AMCP), which allowed me to develop a stronger understanding of how clinical decisions and programs can affect a large population. Furthermore, serving in a membership society provided valuable experience to represent the needs, ideas, and goals of passionate members practicing in a particular area of the profession. I believe that this experience would correlate well to the Board of Health as those selected to serve in this capacity need to constantly represent and be cognizant to the needs of the community. In addition, due to my unique volunteer experience and work with prescription drug abuse awareness programs, I believe that I could successfully leverage that experience to deploy similar programs throughout the schools in Orange County. Prescription drug abuse is unfortunately becoming the number one cause of accidental death as it is even surpassing vehicle accidents in some states and counties, and would suspect that Orange County hasn t been immune to these statistical trends. Reasons for wanting to serve on this board: As I mentioned, I believe that healthcare professionals have a duty to serve the public and be active in the communities where they reside. Therefore, I enjoy to become actively involved and participate along with others sharing a similar view to work towards improving the individual lives for community betterment. I believe that my unique experiences, when combined with the valuable expertise of others on the board, would help contribute to improving and protecting the health - related quality of life for those residing in Orange County. I would also like to serve in this capacity so I can understand how to better leverage pharmacists and educate the public on how to utilize their pharmacist for improved outcomes and assistance. Ultimately, the opportunity would allow me to exercise my passion for the profession and maximize the impact that pharmacists can have on the health of those that reside in Orange County. Conflict of Interest: Supplemental Questions: Page 3 of 3 Other Comments: Todd Sega 51 This application was current on: 11/20/2014 8:54:49 PM Date Printed: 12/5/2014 52 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 53 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 54 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 55 This application was current on: 3/13/2014 2:40:34 PM Date Printed: 3/14/2014 56 Page 1 of 2 Diane Uzarski 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. Diane Uzarski 3017 Pleasant Green Rd Durham NC 27705 9196688595 9193097974 9193097974 diane.uzarski @dm.duke.edu Duke Translational Research Institute Project Leader, Associate Director of Biobanking 2005 Hillsborough Female Caucasian Community Activities /Organizational Memberships: American Red Cross - Disaster Team volunteer since 2003 Previous Vice Chair of Board - San Francisco YMCA Past Service on Orange County Advisory Boards: I am interested in serving on the Department of Health Advisory Board. I nursing practice candidate at Duke University, and have a background in injury prevention and emergency nursing. Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: am a doctoral of health policy, As an RN with 34 years of experience in intensive care and emergency nursing,l have a broad understanding of our health care system from preventive care to treatment issues. I received a master of public health degree from UC Berkeley, and became active in county wide injury prevention strategies by managing a local coalition. I am currently completing my doctoral in nursing practice at Duke University, and have broadened my understanding of health care access and policy issues on a local, state and federal level. Reasons for wanting to serve on this board: I believe that both my recent academic and 34 years of experience in health care have given me a deep understanding of our current health care challenges including health care access issues, health education,and prevention challenges presenting county government today. I have actively and effectively participated in board work, and am a positive contributor. The ability to carefully weigh and analyze issues is a personal strength that I believe may assist me to be an effective advisor to a Board of Health. I believe in Orange County and its ability to make decisions to improve the health and well being of its residents. Conflict of Interest: Page 2 of 2 Supplemental Questions: Other Comments: Diane Uzarski 57 This application was current on: 9/29/2014 10:49:18 AM Date Printed: 9/30/2014 Page 1 of 2 Leroy Werley 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. Leroy Werley 6916 Turkey Farm Rd. Chapel Hill NC 27514 919- 933 -3099 919- 933 -3099 919- 210 -6604 Lwerley3 @gmail.com Retired Was Director of Pharmacy at Durham County Publi 1990 Chapel Hill County Male Caucasian Community Activities /Organizational Memberships: NC SHIIP counselor Healthy Carolinians of Orange County IFC NC Food Bank Carrboro Arts Center volunteer OLLI classes Chapel Hill Carrboro School volunteer with ESL class Chapel in the Pines Hand Bell choir Medical Reserve Corps volunteer Past Service on Orange County Advisory Boards: Orange County Board of Health 2000 -2004 Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: Graduated from UNC School of Pharmacy 1974, worked in community pharmacy for18 years, was Director of Pharmacy at Durham County Department of Public Health forever 21 years. Having served on the Board of Health ten years ago I understand the role required. Reasons for wanting to serve on this board: I have spent my adult life serving the community. Now that I have retired I want to continue with that goal. Using my pharmaceutical knowledge, my communication skills and my volunteering heart I bring them to the table of the Board. Conflict of Interest: 59 Page 2 of 2 Leroy Werley Supplemental Questions: Other Comments: Orig. app. 11/19/99 for Board of Health, Pharmacist Position. WORK EXP: Director of Pharmacy, Durham County Health Department, 7+ yrs; Was a member of the leadership team, work with community outreach programs, supervisor and team leader, safety officer for the health dept., member of numerous groups and committees, and help coordinate health dept. and jail pharmaceutical services. VOLUNTEER EXP: Taught Sunday School and Vacation Bible School; Helped coach youth soccer and other teams. Volunteered sign language for hearing impaired; Worked with Boy & Girl Scout troops; Taught summer 4 -H classes; Guest speaker in public schools promoting pharmacy; Volunteered hundreds of hours as a clown /magician at nursing homes, day cares hospitals, clinics, neighborhood health fairs, & other health dept. functions; Shelters and thrift shops; Community outreach programs. EDUCATIONAL EXP: My unique talents in blending my varied experiences has helped me to teach youth, work with the elderly, train pharmacists and technicians, and be a prreceptor to several pharmacy students. I continue to educate myself in pharmaceutical areas by attending many more C.E.'s than is required. COMMENTS: I think that I am in the unique position of understanding public health because of my work exp. and my volunteer experience and the fact that we have a vital and functioning pharmacy outreach here at the Durham County Health Dept. Updated Application 10/31/2014. This application was current on: 10/31/2014 Date Printed: 10/31/2014 .1 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 61 This application was current on: 6/25/2014 10:15:57 PM Date Printed: 6/27/2014 62 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 919- 602 -2440 dwilliams @unc.edu University of North Carolina Faculty 1996 Township of Residence: Chapel Hill Zone of Residence: Carrboro City Limits Sex: Male Ethnic Background: Other Community Activities /Organizational Memberships: Active in the University community including volunteer efforts at the IFC homeless shelter clinic, and a volunteer for the Health Dept Emergency Services response. Past Service on Orange County Advisory Boards: Boards /Commissions applied for: Board of Health Background, education and experience relevant to this board: As a pharmacist, I hope to bring knowledge and insights related to pharmacy related services. Reasons for wanting to serve on this board: I am interested in service to my profession and my community. 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. Updated application 11/15/2014. This application was current on: 11/15/2014 Date Printed: 11/17/2014 63 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 M., This application was current on: 7/15/2013 9:53:13 PM Date Printed: 12/30/2013