HomeMy WebLinkAboutAgenda - 12-06-2004-9d6ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: December 6, 2004
Action Agenda
Item No. 9- ~ -Cj
SUBJECT: Nursing Home Community Advisory Committee
DEPARTMENT: Board of Commissioners PUBLIC HEARING: (Y/N) No
ATTACHMENT(S): Under Separate Cover
Membership Roster INFORMATION C ONTACT:
Copy of letter written to Nursing Home Clerk's Office, ext. 2130, 2125, 2126, 2129
Administration
Letter of Recommendation TELEPHONE NUMBERS:
Application(s)/Resume(s) of Person(s) Being Hillsborough 245-2130
Recommended Chapel Hill 968-4501
Interest List Durham 688-7331
Application(s)/Resume(s) of Person(s) on the Mebane 336.227-2031
Interest List
PURPOSE: To consider making new appointments to the Nursing Home Community Advisory
Committee.
BACKGROUND: There are two vacancies on the Nursing Home Community Advisory Committee,
There is one At-Large vacancy and one Nursing Home Administration vacancy. The Clerk's Office has
received a recommendation from the NHCAC for Arthur St. John, If appointed, Mr. St, John will be
serving an initial one-year training term.
All Orange County Nursing Homes were sent a letter on August 5, 2004 giving them 45
days to nominate a volunteer to represent them on the NHCAC, the Clerk's Office has not received a
response. The 45 days waiting period ended on September 20, 2004, therefore allowing the BOCC to
make appointments without their nomination,
Nursing Home Community Advisory Committee
Pos. No. S ecial Re Term Exp. Date
1 At-Lar e Initial One YearTrainin Term 1/31/2006
6 Nursin Home Administration Initial One YearTrainin Term 1/31/2006
The N,C, G,S, 131d,31 (b) (4) states:
"Of the members, a minority (not less than one-third, but as close to one-third as possible)
shall be chosen from among persons nominated by a majority of the chief administrators of
adult care homes in the county. If the adult care home administrators fail to make a
nomination within 45 days after written notification has been sent to them requesting a
nomination, these appointments may be made without nominations,"
FINANCIAL IMPACT: None.
RECOMMENDATION(S): Consider making one new appointment to the as the Board may desire.
~n
o o
o v
0 r
0
~ v v
o 0 v,
0 o v
0 0 r
0
~ - N
o 0 v~
0
'
' o o
N 0 0
N -
' 0 0
~~ 0
~ 0 0
C 0
'~'
' 0 0
C C 0 ~
m
'..
tFJ
~''.. N
~
~ rv
N N
~ ~.
N N O
~ ii r t0
N
\ O N
Ht
~ '~
I M r
O N O '~
Nf
T
~^
O F
m O
O
~ ?
O V
O V
O '
I O~ O\
O O Q~
O V
V'
0 0 b
0 !
1 V b
0 0 V
0
I Z E I i I
~ o ~ v ~ p p ~ a ~~ I 9 u ~ P ~
u y
~ y ~ ai ~
E o
E
C
k Fi
N ii
C G
'
S NC (
~'
C~
~ O
~
C~ C
F O
d ~ tF„ O C ~ ~
i w °
~ W a
E w
~.' 6 4 G 6 W a C d w d'
C R '
° 6 p
, 6.
'. v 'c '
~ ,
d o. ~ j ° ~'' 6 n. 4 j o i ¢ $ ~ o ,~ . d
a t j ° ~I d a W ~
o ~ ~ ..
~~ U ~ 'c v z ~ ~ z - ~ Z , ~ z ~ C z o
. `i ~" ° d
_. ~ _ ' U U U ~ U
'', N ON O 'O "I F_
'. ~ a~ ~
~
rn
I n
i~-i ~ a
P
~ v ~ ~ ~ E
v
~ E = i
=
~ °
'" m
m
=' _
J.
w °
eo
S
$ o co m o c x ao a
q y = ~ m m
u _
d Ca a
O r`~ roq
C q
J
m ~
qq
J
E ~
a ~ `~ g
g
~
~ q
n tii
.!
~ 7
~ ? N
G
, .J J
~ E . ~.
°
C b
= U
U 6
G
~ 0
0 ~
Z
u c Q 6 ti 6 0 4 6 u
. U I G d ~ 0
^ll
~G! n n ~ u
c c ~ E
v
v
a'
v ..
a
a
v
°~ c°i ..
a i
w ~ ..
a ~' p, !
_. v v
R P .. ~
o,
v v
a a ..
s
u ~ V N F ~ i
C i
~ C N a ~ ~ F ~ ~ N ~ ~ ~ y ~ ~
\
' o>
U U P: G
N u m
I P: ~ o ~
I a ^ U
N
~ i
~ ^ V ~
~~ ~ F U
/ ~
~'-1 ° F
° o
H
~
a ,, ti
h ;n
na ~
F v a
~
a I
~
N
u y ~
O ~ ~ ~ ~ ~i "i ~i ~ ~+ l
i
I ~ W N M C v
v I ', I 'I ~'..
~
•'..~ 0.1 ~ nq 5
O ', ~, '.
= a .
E
o = a ~
m, I
U
N v `F' ~
O
~
i E
C = I,
N
M I
N
~
~ ~
h O
~°^ E E I o ~ ~ °q ~ ~ ~
j
~ ^ vri G
~ ' y O O
° O n i~ O N
b N P
P ~ N
T
P W i N
~( y~ y
n+ ~ C
' V O
i I
~
O +
.
P O O~
P P
P U
G
V O
lu
•y ., O~ p~ ~ ~
P
~ ~
+
' ~ N y~j C P U P P P r_
.. P
.. P G
..
w~
~V A ti
V
~ F y
C U
C y~
'] ..
~~ N
C N
C ..
~ ~ni N C~
C C y
'] ~'tJ N °
C G y
'] ~ 1 O
G C
°
~ E
p € o o 'G E o o E °
r G
E L ° 4w ~ $
c
'~ w
O ti ~ s
~ a s
a w
W s
a s
s w
W .
c
a y Li.
u5 a a va .
. .
a a. u
V= E~ _. T ' ~ N C ~ C
r E y
O h
Q C c
J
(] C
C . G
Q C Q G
i Q C
c U m ai u ! v .',..
°' >
•N ti G
~i o
~ '' I
_
o ~
~ o
° ',, 'i I
~
~ e`i p o o 'I '..
w o y u u '.,
~
> .Ti G V V .ter V rO
~ O V ~
~ Vy.
O E G. ~ O ~ r ~ FO r O ~ N ~ N
r
V .~ F 6 N N 0.i' N .
O ~L' ryfd~ 7
0 ~ O ~ ~
Z w Z O
y
0, t R~
~w vi v> ~ N ~+
_
E N Z.
o .
v ._ U y ' m
O y N¢ R ti C .
~ Ci U x U
~ t! O a
r N
""T"Y~ ~_ C ~ T
m R
N
V 6 . ~
M V
3 G
G "
r R .-
E
F, o
W
' I O
v rn s
~ O c~
U i,
~ o .-
~ U m
~~
~ o s
~ U o
p,
~+ W ~, I
i U W r ', z
E ~
~ V J U !/]
. ^' m v '~ F
j~~~1
?~
,~
Q C
• ~ O
• ~ Qi
U
O
''~
~,M,
~f
O
H C
U V
~ O
y G ~
0
{^.~ q
~ E a
3 om
N V E
U v ~
'~ h o
N O q
q m R
R] ~J." o
d ~v
a
vCi C o ~
- '>
t1. 0. m P.
~ n ~ E
U U a E
O
L
O p
~_ c
~ V y
~ i
fV ~+1 E y
~ q q
[= a gF
6 i
N tq ~
N
E E
^y ~ 0 0
W ~ w t_J
.y ~ O
ti vl v
,,, G FFu
1 ^ y F
V .s ~ v
y
~'~'_ U "
O
~ u
.ti ~
"~ ° W ::
c u m
?? o ~ t a
.N ~ U ~ o
~ `u ~ v o
~ ~ c
O (% d U
q '=O
V
W ~ C.V
E o E
6 ~ C ~
o v ~;,
ono v g~
h 'r q 7
d a a
E c
~F a g
n F C R
N
•» ~ ~ ~
O
O
O
O FF
c
a
i
E G
F
o
¢ a W
~
W 4 u
D
c
~
z
~ c
o
U ~
E
0
E
0
W F
'',,. 4 Z
~ ~
`~ s ~ a
`~
o
F ~
a
~
U
i ~
~ d
~
CJ N
c c ~ 'm
0 o E
a w w w
~ m
Q E
c'u
v v ~n
'.,.. N N N
O
ry N O
O O O
~ v Y
C ~
2 a x o
i n W ~
E
u" c o
e z
U
m
~ V N
n q
w m
~ ~
~ U 6 Q
a o,
~ a ~ ~ a
G U
i u ~
O ~ U
F ~ o.
N ~
~i
v
I G
I
O O i
v v ~
N ~
V q
a Q. C
i ~ P ~
a ~ u.
w
M
Q E
w'
N
U
.". ~ z
Y % t
u' o
a _°
y
~ ~ x
h
W N VI
U O O
O~ O O
N h O N
N N ~
O O O
ti ~ O ..
c ~ ~ F
a E
a x' o
4 w
w ~ ~
g z
U
n S w w
~ ~
~ U U 4 C
a o,
`tea Ha a
C U
i a~ ~y
0 ~ U
N
F ~ a
y ~
~i
E
Vy
C
°w e o ~
~°°`yF
rn rn a O
O~ O~ U
P 0` P
v ii
C C '] .~
0 o R E
wa"
w
Q C
u
W
> r
Q N
~ ~ z
O ° o
y x
/ o
.k ~' n
U N
~~1 ° U
r~
00
M v h
O O O
~ N N
O rv ~ v
b b ~V^
O O O FF
v C O C
C F
o G_ "" h
0.
D. ~ O
aw
d ~
u-' c ^
~ z
U
m
F ~
q O q~ W
u ~ 'y ~
~ U + 6 Q
n
~ ~ ~ o
a ~ ~ ~
~ ~
O ~ J
F ~ ~
Y
C
V
n rn
0 0 '~
~? `o c
N N C
1+1 rl q
i~ h
a P
a. rn E
d
C C '] .~
w w ~ E
w
m a
L] `c
w'
W
t4 N
~ ~. h
~ F N
Q' N z
O
F~ o
~' '~ 3
U A
x
P
rn m ~
O~ O O
O~ O O
\ N
O~ b O N
O i
1 h ~
O O O
Q ~ G
O
o E .", F
R C
~ ~ O
w v
~_ _ ~
w c
e z
U
q tq-0 tvq
U
w U U ¢ G
~ a t ~ d
U
~ ~
O d U
y
~ ~ d
N ~
~i
c
O
rn rn
rn a
~ ~? c
vQi
b b O
O~ O~ ~
01 G L
O~ P C
u ti
C C '] ~J
w o. w E
w
~ a
Q ^
w'
I
UJ
ryM~
I W
4.
',~
O
b
9 r
a' N
~z
ex
~ u
6
~, s
o U
tv0
0
N
w
D
V
z
F
~..{{
?"1
• ~/~ .O
V! N
• ~ QCCI
J
O
1~~'''~
V
CC3
O
n
O C
y V
4
~ O
N > »%
E o
u
~ E F
w ~,
3 o m
y V C
U y G
'~ h o JL'
V N ~ V
q ~ p N
~ S ~
^ ~ a
~a
c ei o ~
N ~ >
v t ~ E
d 6, SJr 6
c ~
~ ~ 9 V
c c"' E
U U G E
~ >
o
o ~
0
°".
V
L G
v u U
T
N rn E y
~? u C F
YG 0- p h
c E c
F°.' J o F-
n3
N t n
Y E
O
o E E
V O
O
O
4
~V m
1 ~ FV
~ V p~
N C
ti yF
V ~ E
s
L ~ U
c
0 " o 0
y ~ ~ u
'v ~ ~. G
r'i T vC
j
C V ~
° «~". ~ o
.~~ U ~ o
~ ~ `o ~ o
+".~ ° E o
o y u u
~ Z' c ~`+~
~ ~ ~ u
UE ag;
a ,~ ° a
~ o U a v
o _ 4 a
~ ~ n o
m v 4 a
~ C
~F• a E
c c a
.~ ~ u ~
v u u
y ~ ~ Q
^
O N
O h
O
O
` O
N O
N
O N ~ J
I b
O b
O V
O
~
O
^ GG
O
c
~
4
•
m C
~
',
E
°
}.
a H
o
~,. 6 o. W
a
¢ v
o
~' ~ 7
', r z °
U ~
I G
u ¢
~ E
E
¢ =
5 x
V
~
C
U
4 m
~ m
~
E .y ~ .
w ¢ U 6 Z
U d
y ~
~ m C4 u
> u ~
H N m
v 4
U
b < W V
N W N
P r N
N1 Vl r '
P Obi a p
P 0` P ~"
U
c a ~ 'E
~ ~ w
w
~ c
o
i
W
~ u e
~ C
W Q N
c
Q ~ Z
S ^
~_
C S
o
p Z a
~' ° U
I O
N N
O
N ~,
O
N
vi
I O
\ ~
N o
~
V"
O ~D
O b
O
~
k ~ u
I o ~ ~
K.
h
V
wo
W "
w 4 E
i c
c ^
z ~
a
~
U h
E
E
4
n
S u
o
5
v
E
w
v ~
3 rn
E
~
ti =
U n
U ¢ z
(j d
m
~ p,
c P
~ 2
v
a
~
0
H a
~ U
a
~ .
a
0
V
W M vii
M n
C d
a 0` V
U Orn
D` D` a
V V
G C
a a W
w
Q c
W
.C
I w
~'
N
FQ
/y
N
J
„ z
u
c ~_
^. _
rv U
n
0.
0
VJ
n
E
r
z
a
C
BARRY JACOBS. CNAIR GRANGE COUNTY BOARD OF COMMISSIONERS
.STEPHENH HALKIOTIS. VlCECHAIR POST OFFICE Box 8'~ 81
MARGARET W. BROWN
MOSES CAREY. JR 200 SOUTH CAMERON STREET
A/JOEM CORDON
HILLSBOROUGH, NORTH CAROLINA 27278
August 5, 2004
//Title» //FirstName» «LastName»
//JobTitle»
«Company»
//Address 1»
//City», //State» «PostalCode»
* * * This letter was sent to all Orange County Nursing Homes,
Dear /~JobTitle»:
Qta~a` ~a4nP
17 ~ry-52
a
`_r ~.
4
~~~7h ~aco~~o
The Nursing Home Community Advisory Committee members are
volunteers appointed by the Orange County Board of Commissioners to serve
the residents of long-term care facilities within the County, The County is
responsible for maintaining the intent of the residents' Bill of Rights,
promoting community involvement in the homes and providing public
education on long-term care issues. The members visit each county nursing
home quarterly and file a report on that visit with the Regional Ombudsman
for the Triangle J Area Agency on Aging. You have met some or all of the
members during these visits.
The Committee currently has 12 seats with 4 of them representing the
Administration of the Nursing Homes, One of these four seats is vacant, and
the other three are filled, with the members serving their first full terms, with
all terms expiring on 6/30/2005. The three members all would like to
continue on the Committee,
Here is a list of the members who represent the Administration of the Nursing
Homes.
Orange County, N.C, Nursing Home Community Advisory Committee
TRe.~..'ho~. ~. Anr.rooaritir,n N„rcina unmP AflminiC}'1'A tiC)7"7
Seat No. Member Name V Term Ex iration Date Term
5 Mario C. Batti elli 6 30 2005 First Full Term
11 Yvonne D. Eaves 6 30 2005 First Full Term
12 Bettie L. Flash 6 30 2005 First Full Term
This letter is beingwritten to you to request that you choose a person to
fill the vacant seat. Statutory requirements (N.C. G.S. 131e-128) state
that "Each committee member shall serve an initial term of one year, Any
Page 2 of 2
«Title» cF'irstName» <d,astName»
«Company»
August 5, ?004
person reappointed to a second or subsequent term in the same county
shall serve athree-year term. Persons who were originally nominees of
Nursing Home Chief Administrators..., or who were appointed by the
Board of County Commissioners when the nursing home
administrators...failed to make nominations, may not be
reappointed without the consent of a majority of the nursing home
chief administrators.... If the nursing home chief administrators
...fail to approve or reject the reappointment within 45 days of being
requested by the board of county commissioners, the commissioners
may reappoint the member if they so choose."
If you need any further information, please do not hesitate to call.
Sincerely,
Monica Evans
Assistant to the Clerk
Orange County Boazd of Commissioners
cc. Kate Barrett, Eldercaze Specialist
Jill Al-hafez-Passmore, Ombudsman, Triangle J Area Agency on
Aging
www.co.oranae.nc.us
Protecting and preserving -People, Resources, Quality of Life
Orange County, North Carolina -You Count!
(9i9) 245-2130 • FAX (919) 644-0246
Mary Ann Peter
118 W. Tryon Street
Hillsborough, NC 27278
September 27, 2004
The Honorable Barry, Jacobs, Chair
Orange County Board of County Commissioners
P,O, Box 8181
Hillsborough, NC 27278
Deaz Chair Jacobs,
Subject: Committee Appointment
The Orange County Nursing Home Community Advisory Committee reviewed all
applicants for the Committee and recommends Mr, Arthur St. John for membership. Mr.
St, John is a "tax-paying citizen" and a resident of 101 Hayworth, Chapel Hill, NC,
27514,
He is a retired real estate appraiser, a member of East Chapel Hill Rotary Club, a board
member of the Preservation Society of Chapel Hill and a volunteer in a number of
community organizations, He is vitally interested in the welfaze of older Orange County
residents, particularly those who reside in nursing homes. He has excellent
communication skills, is an intelligent and perceptive person and diligent in carrying out
responsibilities, He has demonstrated his interest through attending a Nursing Home
Community Advisory Committee meeting and asking questions to fully understand the
responsibilities of membership.
He submitted his application last week, but I haven't seen it yet on the website. It would
be helpful if Monica Evans will please attach a copy to this letter of recommendation.
Sincerely, ~~
~~-e-~-~, ,~,
Mazy Ann Peter, }tN, PhD
Chair
Orange County Nursing Home Community Advisory Committee
Page 1 of 1
Arthur St..John `l
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Mr. Arthur St,John
101 Hayworth Drive
Chapel Hill NC 27517
919-968-3003
919-968-3003
st1299@bellsouth.net
Retired
Township of Residence: Chapel Hill
Zone of Residence: C.H, Gity Limits
Sex: Male
Ethnic Background: Caucasian
Date of Birth: 1/17/1932
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Work Experience:
Real esatate appraiser
Volunteer Experience:
Education:
BS Marine Engineering, US Coast Guard Academy
MBA Wharton School, U of PA
Other Comments:
STAFF COMMENTS: Originally applied for Nursing Home CAC 9/24/2004, ADDRESS
VERIFICATION: 101 Hayworth Drive Chapel Hill, NC 27517 is in the Chapel Hill
Township in the Chapel Hill City Limits,
This application was current on: 9/22/2004 4:41:30 PM Date Printed: 11!22/2004
Applicant Interest Listing
by Board Name and by Applicant Name
Contact Person: Kate Barrett, LCSW/Eldercaze
Nlll"sir:gHonieCoi<1:rnunityAdvisoryCommittee Contact Phone: 919-968-2085
Ms. Pamela Pierce Durham
3807 NC 54 W
Chapel }till NC 27516
Skills: Customer Service
Skills: Data Analysis
Stalls: Developed and presented grief worksho
Skills: Industrial Engineer
Skills: totem Hospital Chaplain
Skills: Patient Couselor in Hospital Setting
Mr..longhoon Lee
7 t I Nowell St Apt B
Chapel Hill NC 27514
Skills: Habitat for }lumanity
Ms. Dawn C. Pickett
107 Joncs Street
Chapel HillNC 27514
Skills: Advisory Board Experience
Day Phone: 919-967-4559 Sex: Female
Evening Phone: same Race: Caucasian
FAX: Township: Bingham
E-mail: ppdurham@yahoo com Date Applied: 05/26/2004
Also Serves On:
Also Serves On:
Also Serves On:
Also Serves On:
Also Serves On:
Also Serves On:
Day Phone: 979-360-1422 Sex: Mate
Evening Phone: Race: Asian American
FAX: Township: Chapel Idill
E-mail: j1ee5@email unc edo Date Applied: 12/27/2003
Also Serves On:
Day Phone: 919-929.8965 Sex: Female
Evening Phone: 9t9-929-8965 Race: Caucasian
FAX: Township: Chapel Hitt
E-mail: pickettdawn@hotmail com Date Applied: 10/23/2003
Also Serves On:
Ms. Tan'e Powell
656 Cmige Donn
ZINC Chapel Hitt
Chapel Hill NC 27514
Skills: Cashier
Skills: Community Service Volunteer
Skills: Customer Service
Day Phone: 9701+74-9083
Evening Phone: 919-914-0924
FAX:
E-mail: japo@email unc edu
Also Serves On:
Also Serves On:
Also Serves On:
Sex: Female
Race: African American
Township: Chapel Hill
Date Applied: 09/30/2004
Mr, Arthur St.,lOhn Day Phone: 919-968-3003 Sex: Male
101 Hayworth Drive Evening Phone: 919-968-3003 Race: Caucasian
Chapel Hill NC 27517 FAX: Township: Chapel Hill
E-mail: st1299@bellsooth net Date Applied: 09!22/2004
Skills: Real Estate Appraiser Also Serves On:
Monday, November 22, 2004 Page I of t
Page 1 of 1
Pamela Pierce Durham ~ V
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, Pamela Pierce Durham
3807 NC 54 W
Chapel Hill NC 27516
919-967-4559
same
ppdurham@yahoo.com
UNC-CH
Intern Patient Counselor
Bingham
Bingham Twnsp
Female
Caucasian
1 /21 /1956
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Work Experience:
UNC - CH Intern Patient Counselor, 1/2004 - 5/2004; Intern Oncology Ghaplanin,
8/2003 - 12/2003; Intern Chaplain, 8/2001 - 12/2001; Burlington House of Fabrics Group,
Burlington Industries, Inc„ Burlington, NC: Sr. Quality Services Manager, 9/99 - 10/2001;
Buyer, 6/1997 - 9/1999; Quality Services Mgr., 8!1986-6/1997; Manufacturing Manager,
9, 1985-8/1986; Industrial Engineer, 8/1978-9/1985. Professional Affiliations; American
Counseling Association; American Rehabilitation Counseling Assoc.
Volunteer Experience:
Conrucopia House Cancer Support Center, Chapel Hill.
Education:
Master of Science, Rehabilitation Psychology and Counselling, 5/2004/ UNC - GH; BA
Science in Business Admin., UNC-G, 8/1978,
Other Comments:
STAFF NOTES: Originally applied for Nursing Home Community Advisory Committee,
5/26/2004, ADDRESS VERIFICATION: 3807 Highway 54 West, Chapel Hill, NC 27516
((current 5/26/04), is located in Bingham Township, not in any city limits or ETJ. O/G
Land Records, M, Burton. ncg,
This application was current on: 5/26/2004 Date Printed: 11/22/2004
Page 1 of 1
Jonghoon Lee ~~
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Mr. Jonghoon Lee
111 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: 1 t/22/20D4
Page 1 of 1
Dawn C, Pickett tOs
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, Dawn C. Pickett
107 Jones Street
Chapel Hill NC 27514
919-929-8965
919-929-8965
pickettdawn@hotmail.com
Chapel Hill
At-Large or C,H. city limits
Female
Caucasian
11 /2/1945
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Work Experience:
Volunteer Experience:
Education:
Other Comments:
On 10/23/03, she updated her application with staff at CFE; she is still interested in CFE
but primarily in NHCAC. 11/25/02 renewed her app, for Nursing Home Community Adv.
Committee, 1st choice; CFE, 2nd choice. Applied 2/19/02 for Nursing Home Community
Advisory Committee; Adult Care Home Community Advisory Committee; Commission for
the Environment, WORK EXPERIENCE: Medical Review of N.C,, Senior Assoc; OVP
Projects. VOLUNTEER EXPERIENCE: Wake County Nursing Home Advisory
Committee; N,C, Health Access Coalition (see attached letter). EDUCATIONAL
EXPERIENCE: B.A, Industrial Relations, UNC-Chapel Hilh addrs.ver.mpqust.ncp, 107
Jones Street is in C.H. city limits,
This application was current on: 10/23/2003 Date Printed: 11/22/2004
Page 1 of 1
Jane Powell ~ ~
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. Jane Powell
656 Craige Dorm
UNC Chapel Hill
Chapel Hill NC 27514
910-474-9083
919-914-4924
japo@email.unc.edu
Wynnsong 15 Theatre
Cashier
Chapel Hill
Chapel Hill Township within C.H. city limits
Female
African American
10/18/1983
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
Affordable Housing Advisory Board
Animal Shelter Operations Task Force
Work Experience:
Ocean Beach Club: waitress and secretary, Dairy Queen: cashier, Wynnsong 15: cashier
Volunteer Experience:
Volunteer with Public Service Scholars, Volunteer at Dobbins Hill apartments on
Mondays, Volunteer at UNC Hospital on Mondys, DO other volunteering when needed,
Education:
High School-Lumberton Senior High School, attending UNG Chapel, BS Nursing
Other Comments:
STAFF COMMENTS: Originally applied for Nursing Home Community Advisory
Committee, Affordable Housing Advisory Board, and Animal Shelter Operations Task
Force. ADDRESS VERIFICATION: 656 Craige Dorm is on the campus of UNC-Chapel
Hill and is located of of Manning Drive in Orange County, in the Chapel Hill Township in
the City Limits
This application was current on: 9!30/2004 Date Printed: 11/22/2004