HomeMy WebLinkAboutAgenda - 03-15-2005-9d8ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: March 15, 2005
Action Agenda
Item No. 9
SUBJECT: Adult Care Home Community Advisory Committee- Two New Appointments
DEPARTMENT: Board of Commissioners
PUBLIC HEARING: (Y/N) No
ATTACHMENT(S): Under Separate Cover
Membership Roster
Interest List
INFORMATION CONTACT:
Clerk's Office, ext. 2130, 2125, 2126, 2129
Application(s)/Resume(s) of Person(s) on the TELEPHONE NUMBERS:
Interest List Hillsborough 245-2130
Chapel Hill 968-4501
Durham 688-7331
Mebane 336-227-2031
PURPOSE: To consider making new appointments to the Adult Care Home Community
Advisory Committee,
BACKGROUND: There are two At-Large vacancies on the Adult Care Home Community
Advisory Committee, Appointees will be serving first full terms, ending June 30, 2008.
Position Number S ecial Re resentation Ex iration Date
5 At-Lar e 6/30/2008
6 At-Lar e 6/30/2008
FINANCIAL IMPACT: None.
RECOMMENDATION(S): Consider making new appointments to the Adult Care Home Community
Advisory Committee, as the Board may desire,
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5
Applicant Interest Listing
by Board Name and by Applicant Name
Contact Person:
Adult CareHouae Conuuuu ityAdviso~y Conanaittee Contact Phone:
MS. Jeanette Clark Day Phone: 919-620-8662
221 Rencher St Apt 3 Evening Phone: 732-7856
Hillsborough NC 27278 FAX: 6208662
E-mail:
Skills: Nursing Home Experience Also Serves On:
Ms CapTia Harris
327 Forzest Street
Hitlsbourgh NC 27278
Skills: Fast Food Service
Day Phone: 919-732-7483
Evening Phone: 919-923-6318
FAX:
E-mall: RorograndbabyJ 7 n aot com
Also Serves On;
Ms .Tohatma Jensen
2201 Baycourt Trail
Hillsborough NC 27278
Shills: Medical Technologist
Mr. Jonglwon Lee
I I 1 Howell St Apt B
Chapel Hill NC 27514
Skills: Habitat for Idumanity
Day Phone: 225-1925
Evening Phone: 245-1637
FAX:
E-mall: jjenscnj@mindspring com
Also Serves On:
Day Phone: 919-360-1422
Evening Phone:
FAX:
E-mail: j1ee5(rd~email unc edu
Also Serves On:
Katherine Leith
919-968-208?
Sex: Female
Race: African American
Township: Hillsborough
Date Applied: 02/23/2003
Sex: Female
Race: African American
Township: Fillsborough
Date Applied: 09/09/2004
Sex: Female
Race: Caucasian
Township: Hillsborough
Date Applied: 11/09/2003
Sex: Male
Race: Asian American
Township: Chapel Hitt
Date Applied: 12/27/2003
Ms, .Judith Mitchell
3620 Dairyland Road
Hillsborough NC 27278
Skills: Community Service Volunteer
Skills: EMT
Skills: Receptionist
Ms. Rupa Shukla
GOI Jones Ferry R- A-5
Carzboro NC 27510
Skills: Coach
Day Phone: (919)933-8361 Sex: Female
Evening Phone: 919-933-1851 Race: Caucasian
FAX; 919-933-6623 Township: Bingham
E-mail: jmitche1158@earlhlink net Date Applied: 11/15/2003
Also Serves On:
Also Serves On:
Also Serves On:
Day Phone: 962-2143 Sex: Female
Evening Phone: 270- 3707 Race: Asian American
FAX: Township: Chapel Hill
E-mail: shukla@email unc edu Date Applied: 09/28/2004
Also Serves On:
Thursday, March 03, 2005 Page 1 0(2
Applicant Interest Listing
Adaclt Care Honze Conamu~aity Adviso~~~ Committee
by Board Name and by Applicant Name
Contact Person: Rafl~erine Leith
Contact Phone: 919-968-2082
Skills: Sales
Skills: Special Olympics-NC
Atso Serves On:
Also Serves On:
Thursday, March 03, 2005 Page 2 of 2
Page 1 of 1
Jeanette Clark
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
'Township of Residence:
Zone of Residence:
Sex:
Ethnic Background:
Date of Birth:
Ms, Jeanette Clark
221 Rencher St Apt 3
Hillsborough NG 27278
919-620-8662
732-7856
6208662
Central Family Care
Supervisor in Charge
Hillsborough
Hillsborough ETJ
Female
African American
7/8/1955
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Adult Care Nome Community Advisory Committee
Joint Orange Chatham Community Action Agency
Work Experience:
I have been in the medical experience for about 12 yrs, I am a certified nurse assistant,
and a certified medical technician, 1 have nursing home and adult care home
experience, I supervise a group home now for mental residents
Volunteer Experience:
I have no volunteer experience but I have done outreach before and I have a certificate
for a class I took as an outreach worker.
Education:
GED
Other Comments:
STAFF COMMENTS: Originally applied far Nursing Home CAC and Adult Care Home
Community Advisory Committee and JOCCA, ADDRESS VERIFICATION: 211 Rencher
St is in Orange County in Hillsborough Township in Hillsborough ETJ,
This application was current on: 2/23/2005 Date Printed: 3f3/2005
Page 1 of 1
Capria Harris
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Township of Residence
Zone of Residence:
Sex:
Ethnic Background
Date of Birth:
Ms Capria Harris
327 Forrest Street
Hillsbourgh NC 27278
919-732-7483
919-923-6318
Rarograndbabyi 7@aol.com
Hillsborough
Does not apply
Female
African American
8/31/1986
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Hillsborough Planning Board
Board of Social Services
Human Relations Commission
Work Experience:
I have worked at the Holiday Inn, the KFC and Hardees.
Volunteer Experience:
I have volunteerd at the Center for Volunteer Caregiving and at the Sportsplex and Tom
Thumb Daycare Center in Salemburg When I was attending school I also volunteerd at
two Nursing Homes in Salemburg.! also have 150 hours in community service from
school.
Education:
I attended Tarheel Challenge in Salemburg where I received my GED, June,11,2004
Other Comments:
I grew up here then I went to school in Salemburg. I am back home now Icoking for a job
or a place to volunteer. I hope that you will give me a call and let me voltateer for you or
offer me a job thank you. STAFF COMMENTS: Originally applied for Adult Care Hame
Ocmmunity Advisory Committee, Hillsborcugh Planning Board and Board of Social
Services. ADDRESS VERIFICATION: 327 Forrest Street is in Hillsborough City Limits.
This application was current on: 919!2004 3:25:52 PM Date Printed: 3/3!2005
Page 1 of 1
Johanna Jensen ~
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
.lob Title:
Ms Johanna Jensen
2201 Baycourt Trail
Hillsborough NC 27278
225-1925
245-1637
jjensenj@mindspring,com
Medical Technologist
Township of Residence: Hillsborough
Zone of Residence: -
Sex: Female
Ethnic Background: Caucasian
Date of Birth: 9/19/1963
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Work Experience:
Duke University Hospital, Medical Technologist, 5/1990- present
Volunteer Experience:
Education:
BS in Medical Technology, Medical College of Virginia
Other Comments:
STAFF NOTES: 10/03 Original appl. For CFW; ACHCAC. ADDRESS VERIFICATION:
2201 Baycourt Trail, Hillsborough is in Beckett's Ridge 5ubd, in Hillsborough City Limits,
In Hillsborough Township. MOAD/ncg ,
This application was current on: 11/9/2003 Date Printed: 3/3/2005
Page 1 of 1
Jonghoon Lee ~O
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Mr. Jonghoon Lee
11 1 Howell St, Apt B
Chapel Hill NC 27514
919-360-1422
jlee5@email.unc.edu
Place of Employment:
Job Title:
Township of Residence: Chapel Hill
Zone of Residence: Does not apply
Sex: Male
Ethnic Background: Asian American
Date of Birth: 7/28/1977
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Board of Health
Nursing Home Community Advisory Committee
Work Experience:
Hardee's Restaurant
UNC-CH Libraries
Pantry
Dental Research Center
Volunteer Experience:
Dental Research Center
Orange County Habitat for Humanity
Education:
Sanderson High School-Raleigh, NC
UNC-CH; Chemistry Major, Math Minor
Other Comments:
STAFF COMMENTS: Original) applied for Adult Care Home Comm. Adv. Committee;
Board of Health; and Nursing Home Comm. Adv, Committee. ADDRESS
VERIFICATION: 111 Howell St Apt B is in the Chapel Hill township in the Chapel Hill
City Limits.
This application was current on: 12/27/2003 2:27:55 PM Date Printed: 3/3/2005
Page 1 of 1
Judith Mitchell ~~
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Ms, Judith Mitchell
3620 Dairyland RDad
Hillsborough NG 27278
(919)933-8381
919-933-1851
919-933-6623
jmitchell58@earthlink,net
Retired
Township of Residence: Bingham
Zone of Residence:
Sex: Female
Ethnic Background: Caucasian
Date of Birth: 6/20/1940
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Work Experience:
Currently (11/03) I am working for Home Health Solution, Was retired from as
receptionist for Carrboro Peds. And Internal Medicine, Prior to that I worked as tJNC
Student Health as a receptionist in Women's Health.
Volunteer Experience:
Department of Social Service; Orange County Fire Department -EMT -First Responder.
Education:
Nigh School; Few courses at Community College, 18 credit hours; Adult Education
Courses,
Other Comments:
STAFF NOTES: Renewed app. 11115/03 for A,C.H.CAC, Applied 1/16/2001 for Adult
Gare Home Community Advisory Committee. OTHER COMMENTS: Very interested
in helping the adult mentally alert but physcially challenged live on their own. There is
nothing for them in this county. I also beleive that Senior Citizens should have better care
both physically and mentally. There are a lot of lonely seniors in just this county alone.
You may check with Chris Nutter or Heather Barrow for references. Or with any of the
Doctors at Carrboro Peds, And Internal Medicine..
This application was current on: 11/15/2003 Date Printed: 3/3/2005
Page 1 of 2
Rupa Shukla PZ
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background:
Date of Birth:
Ms. Rupa Shukla
601 .Jones Ferry RD A-5
Carrboro NC 27510
962-2143
270- 3707
shukla@email.unc.edu
UNC- CH Lineberger Comprehensive Cancer Cent
Research Technician/ Lab Manager
Chapel Hill
Carrboro City Limits
Female
Asian American
4/11/1981
Boards/Commissions applied for:
Adult Care Home Community Advisory Committee
Carrboro Planning Board
Southern Orange Senior Center (New) -Design Co
Work Experience:
University of North Carolina at Chapel Hill-- Lineberger Cancer Center
Ann Taylor Loft, Sales Associate
Volunteer Experience:
Orange County Special Olympics-- Swim Coach
Trinity Adult Day Care Center (Tullahoma, TN)
Relay- for- Life
Education:
BA History and BA Chemistry from UNC- Chapel Hill
Other Comments:
I have helped out in my mother's adult day care center for the past 10 years. The center
specialized in Alzheimer's care, but also allows patrons with other physical ailments to
participate. The Trinity Adult Care Center is a great place for caregivers to comfortably
leave their loved ones while they are at work. The center provides meals, physical
exercises, as well as games that strengthen the participants' minds-- working on their
recall skills and helping to sharpen their minds. The knowledge I have gained through
this experience would definitely help me to serve on either the Adult Care Home
Community Adivsory Committeee or the Southern Orange Senior Center Design
Page 2 of 2
Rupa Shukla
/j
Committee! Thanks! STAFF COMMENTS: Originally applied for Adult Care Home
Community Advisory Committee, Carrboro Planning Board and Southern Orange Senior
Center Desaign Committee. ADDRESS VERIFICATION: 601 Jones Ferry Rd is in
Chapel Hill Township, in the Carrboro City Limits.
This application was current on: 9/28/2004 10:11:58 AM Date Printed: 3/3/2005