HomeMy WebLinkAboutAgenda - 09-09-2008- 1fORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: September 9, 2008
Action Agenda c
Item No. ~_
SUBJECT: Nursin Home Community Advisory Committee-New Appointment
DEPARTMENT: Board of Commissioners
PUBLIC HEARING: (Y/N) No
ATTACHMENT(S): Under Separate Cover
Membership Roster
Letter of Recommendation
Application(s)/Resume(s) of Person(s)
Recommended
Interest List
Application(s)/Resume(s) of Person(s) on the
Interest List
INFORMATION CONTACT:
Clerk's Office, 245-2130
PURPOSE: To consider making one new appointment to the Nursing Home Community
Advisory Committee.
BACKGROUND: The Clerk's office has received a recommendation from the Nursing Home
Community Advisory Committee for Tiffany Washington. If appointed she will be serving aone-
yeartraining term, which will end on 6/24/2009.
FINANCIAL IMPACT: None.
RECOMMENDATION(S): Consider making one new appointment to the Nursing Home Community
Advisory Committee.
Board and Commission Members
And Vacant Positions
Nursing Home Community Advisory Committee
Mfg Titnq: 3:30 p.m. Beery other to Monday stardng with Jan. Terms: 2 Contact Person: Vibelar 'hllery~ OTR2
Meeting Place: Seymour Cemter Positions: 12 Length: 3 years Contact Phone: 919.968-2087
Description: Ap appointments are made by the Boeud of Commissionms. Thb committee helps to mainWn the intent of the Reuiderrb' Bill of Right. promotes community involvement cued
provides public education on bas-term sae iauera. Tin regional ombudsmen with 1Hemgle J Council of t3ovemmenb provides spacialiaed training and support.
Mr. Arthur St. JOhn
l
lot Hayworth Drive
Chapel Hill NC 275 t 7 Day Phone: 919-968-3003
Bvettiog Phone: 919-968-3003
FAX:
B-mail: st1299®beUwutlr.rrot Sex: Male
Race: Gucuian
Township: Chapel Hiq
, Resid/Spec Req: A~ Lt+~
3pecul Repr: At-Large First Appointed:
Current Appointmatt:
Bxpiradat:
Number of Tetnn: 0184/7005
06/138006
01/308009
1
~, ~ ~i OW~g Day Phones 919.403.1965 Sea: Male First Appointed: 031068008
Bvetting Phone: 919-967-3693 Race: Cwtwian Current Appointment: 03l'068008
2
10t Parluide Circb 'FAX: 91903-8965 Townslip: Chapel Hill Bxplration; 03/318009
Chapel Hill NC 27516 B-mail: ~ndsP~ne~ Resid/Spce Req: At-Large Number of Tuns:
Special Repr. At-i•rae
Mrs. Patricia Revels Day Phone: (919) ut-ao7 Ste; Female First Appointed: o3row7oo8
Bvenittg Phone: Same Race: Gucasian Carnal Appointment: 03/068008
3
329 West IUng Street FAX: NiM Township: HiWborough Bxpitatioa: 03/318009
Hillsborough NC 27278 B-mail: 18nc.rr.com . Resid/Spec Rieq: At-Large Number of Tetnu:
Special Repr: At Large
Ms. Shawn Karnash Day Phone: 919.479661 sea: Ferrwle First Appointed: 06/178007
4 Bvearing Phone: same Race: Cwcasian Carnal Appointment: 06/178007
3313 Qwil Hollow Drive FAX: Township: LiWe Rives Expiation: 06/308008
Hillsborough NC 27778 B-mail: du~roaluunuh®duke.edu R~jd/Sp~)~q: At Lsr~e Number of Terms: 0
. .Special Rapt: At-Eves
Mr. Mario C. Battigelli Day Phones. 919-942-3756 Sex: Male First Appointed: 041038001
5 Evening Phone: Rata: Gucasian Ctttr~t Appointtttatt: o6ro7noos
1307 WiWwood Drive FAX: Township: Chapel Hill Bxpiration: 06/308008
Chapel Hill NC 27314 B-mail: MAO®ATQAOL.COM Raid/Spec Req: At-Lags Number of Ttunu: 7
Speedal Repr. Nutring Home AdmWstratlon
Monday Jana 09, 2008 Page 1
Board and Commission Members
And Vacant Position3 ,
Nursing Home Community Advisory Comrnutee
Meeting Tittles: 5:30 pm. Svay other l at Monday atardog with 7aa. Tattrs: 2 Contact Perron: Vibdre Tilley, O'TR/L
Meeting Place: ~~ ~~ Poattona: 12 Length: 3 years Contact Phone: 919.968.2087
Desc$ption: All ^ppoinanena aro made by the Hoard of tbaaniaionas. Thb coernrdetea halpa to erwhrtain the inapt of the Raidena' Hiit of Righa, Promotes community involverrtatt and
provides public education on long-perm sate ieaua. The tegionai oatbudarraet with'Il'iangle J Council of (tovarnmena provides epeeialized ttsinhtg and auppott.
MS. Susan TaylOt Day Phone: 919-256-1048 Sac: Fronde First Appointed: OsnlROO7
Eveatittg Phone: 919-337.6639 Race: Cwcaaian Current Appointraent: 06818007
6
' FAX: Township: HiWborough Bxpintion: 09/308008
ltail
2103 Baycourt
Hillsborough NC 27278
B-mail: aayla20f~ocarcom
Resid/Spec Real: At-Cage
Number of Tema:
Spexial Rape Nursing home Admhtistradon
Sue W$ttrrs
Ms Day Phone: 919-643-2040 Sac: Fmra-te First Appointed: 09818004
. Bveroing Phone: 919-643-2040 Race: Caucasian Current Appointraatt; 11/158003
7
608 Red Fox 1tai1 FAX: ~ Tovvttahip: HiWborough BxpiraHon: 09/308008
Hillsborough NC 27278 B•mail: ronwatas8aetttlh~lc.net ReaidlSpec Real: At-Crags Number of Temtf: 1
Spexial Repr: At-T~
------_
VACANT Day Phone: Sex: First Appointed:
8 Bvesaiag Phone: Race:: Currant Appo ~ ~ 06/308009
FAX: Township: ~P
~~; Resid/Spex Real: At Large Number of Tesrins:
Special Re:pr: A~l~
MS. Mary Anil Peter Day Phone: 919-732-6073 Sox: Femalo First Appointed: OW03R003
Ct1al1' Bveahtg Phone: 919-732-6073 Race: Cweasian Cumnt Appointment: 06/128007
9
118 W. Trpan Street FAX: Tov~ttdtip: HiWbwough Expiration: 06/308009
Hillsborough NC 27278 H-mail: marY.nape~ta'(~arthUnk•net Resid/Spec Req: At-La~ga Ntunba of Tenru: 2
Special Repr: At-ice
Mg. Patricia Koch Day Phone: 942-6637 sex: Femde Fitst Appointed: 06/t98006
t0 Evening Phone: same Race: Crocasian Currant Appointmatt: 06/128007
tS40 Farrell Rd FAX: Township: Chapel Bill Bxpitatiem: 06/308009
Chapel Hi11 NC 27517 B-mail: Pn~B.com Resid/Spec Rcq: At-Large Ntrmber of Tantfs: 1
Special R.elm At-lam
W
Monday, June 09, 2008 ~ 2
Board and Commission Members
And vac8nt PusidOns
Nursing Home Community Advisory Committee
Mewing Times: 3:30 p.m. Bvay other in Monday sorting with Jan. Terms: 2 Contact Perron: Vibeke Talley, OTR/L
Meeting Place: Seynawr Center Poeldons: 12 I.ettgth: 3 years Contact Phony 919.968.2087
Description; All appoi~b aro made by the Board of Commiwionas. Thin committee helps to maintain the intent of tha RaideaM Bili of Rights, promotes comnxmity involvartsint and
provides public educadon ~ long-tam cam iaua. The ngioml ombudarstn with 1Nangla J Council of Oovanmenb provides specialized training and support.
Mg. Anne Winfield Day Phone: 91919-9139 Sec: F~ First Appointed: 1a17R006
11 Bvening Phone:. Race: Caucasian Current Appobattttmtt; 12I03R007
6712 Pwlhie lhive FAX: Township: Chapel Hill Bxph~ation: 12/318010
Chapel Hill NC 27514 B-mail: abwinHeld(g~ninda~ing.com )i~d/Sp~ I~q; At-Large Ntunber of Tint: 1
• Special Rapt: Nursing Home Adndnistradon
MIg. 08101 Hierman
12
1028 Lakeview Dr.
Cedar t3rove NC 27231
Day Phone: 919/644/8414 Sex: Females First Appointed: 1x178006
Bvening Phone: yams Race: Caucasian Currant Appointment: 12ro38oo7
FAX: same Township: Cedar Orove Bxpindon: 12/318010
B-mail: donhieman@aol.wm Resid/Spec Req: At-I.ar~ga Number of Terms: 1
Special Repr. Nursing Home Administradon
Monday. Junes 09, 2008 Page 3
-Origfaal Message-----
From: Mary Ana Peter [mailto:maryannpeteroearthliak.netl
Seat: Momday, June 09, 2008 8:52 AM
To: Donna Baker
Cc: Jill Passmore
Subject: Tiffany Washington nomination for nursing home committee
To: Orange County Board of County Commissioners
Barry Jacobs, Chairman
From: Mary Ana Peter -
Chair, Orange County Nursing Home ~'nmtm**+ity Advisory Committee
Re: Noniinatioa for OCWHCAC
June 9, 2008
we are pleased to recommend Tiffany Washington for membership on the committee. Ms
Washington is a PhD st•~t in the UNC-Chapel Hill School of social work and is a resident
of Orange County. She has attended a committee meeting and has submitted her application
stating her interest. we would be very fortunate to have someone with her qualifications
and interest in long term care as a member of this committee. we hope that you will
appoint her at the next opportunity.
Thank you most sincerely for your support of this committee.
i
•-'!
.;
• X-
G
Page 1 of 2
Tiffany Washington
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Titre:
Township of Residence:
Zone of Residence:
Sex:
Ethnic Background:
Date of Birth:
Ms. Tiffany Washington
515 Hinton James Drive #138 (mail: PO Box 746)
Chapel Hill NC 27514
(33639-8144
twashing(d~email.unc.edu
UNC Chapel Hill - DHRE
Community Manager
Chapel Hill
Does not apply
Female.
African American
5/29/1978
Boards/Commissions applied for:
Nursing Home Community Advisory Committee
AduR Care Home Community Advisory committee
Advisory Board on Aging
Work Experience:
02-05 Medical Social Worker Northside Dialysis Center Winton Salem
03-05 Medical Soaal WorkerAmedisys Home Health Winston Salem
05-07 Patient Services Coordinator, Southeastern IGdney Council Raleigh
05-07 Medical Social Worker, Gentiva Home Health, Raleigh, NC
Voluntiesr Experience:
NationallGdney Foundation
UNC IGdney Center
March of Dimes
Budde up America
American Red Cross
Education:
1996-2000 UNC Chapel Hill - BA
2000-2002 UNC Greensbon~JNCA&TSU - Master of Soaal Work
2007-present UNC Chapel Hill -PhD in Social _~INork
Other Comments:
I have 2 years experience investigating complaints and grievances of dialysis and
transplant patients in North Carolina, South Carolina, and Georgia. My research an3a is
n
Page 2 of 2 Tiffany Washington
health and aging. I enjoy volunteer vNOrk and community service. STAFF COMMENTS:
Originally applied for Nursing Home Community Advisory Committee. Adult Care Home
Community Advisory Committee and Advisory Board on Aging on 5J5/2008. ADDRESS
VERIFICATION: 515 Hinton James Drive #138 is in Chapel Hill township UNC~
jurisdiction.
This applicaRion was wnsnt on: SF.~/200811:12:32 PM Dabs Prfnbsd: 6/9,/ZOOi;
Applicant Interest Listing. ~ byBosrdNatneandbyA}~plic~tName
C,oalact Petaa~ VSheloe Talley, OTR/L
Nursing Some Community Advisory Committee c 919-9~s-~og~
Mt BCC $la~C]lII
117 Grad St
Chspd lid I1C 27516
Slo71r~ Flabitat for Bmrtmriry
Slrs'llr~ Sociobgy Major
Iky plwne: 91912-4394
Evening pho~ 919-812-4394
FAX:
E~1 ~~
Abo Sava Oa:
Also Savor On:
sarc - Mork
Race:
Ta~rnahip: Ctrapd ilID
Date Applied: 021038008
Ms. Jeanette Clark
ZZl Rasher St Apt 3
Hil~boroegh A1C 27278
Ms.~ Peggy Cblln
l013ays~rraw Place
Chapd All lilC 27517
Sklls: Geriatric Cne
pay Phase: 919620-8662
Bveaiag Phoa~ 732-7856
FAX: 62662
E-matl
Also Sava Oe:
Se:: Farnk
Rarer African Aa~aiam
Township: I3~74boeou8h
Date Applied: 0283/2005
]My Phat~ 919.489-6624 Srx Fanak
Bveaing Phone: saa>+ Rscc es
FAX: Township: Chapd 13l!
$-met1: peggycohnl~olcnet Date Applied: 10/108005
Ahio Saves On: Adult Care Aoa~e Coaraamity Advisa~y Coaanittee
Also Sava On: Advisory Bond on Aging
~$. ET T7ARE~j ~~N~ pay pho~ 919.933.862 $p~; Fam1e
..1605 N. GR~OROUGH ROAD Evening Phone: Race: African Amaiaur
CARRBORO NC 27510 FAX: Township: ~ ~
&mail: Date Applied: 1 tros8oo5
slolk: Ra6red Ahio savor On:
MT Ed FloweiS pay Phone: 919-357-9256 ~; Mork
2813 i3ecloetCs Ridge Drive Evening Photari 919-357-9256 Race:
l~aboroogh WC 27278 FAX: Township:
E~r7: F~ FLOw>rxsgYAAOO.oow pate Applied: 1 in arzoo7
Slams: t:hr7~r,~ is:~s Ahio saves Oa:
StiAc: NrrcleQ PhysiasK Also Sava On:
Monday, IurAe 09.2006' Page 1 of 2
9
Applicant Interest Listing byBoatdNamea~byApphcantName
C.a~sct Person:
Nursing home Community Advisory Committee cones Pho~: Vibelae Talky, OTR/L
9i9-~s-zos~
Ms. Jane Powell DayPhooC 9to~74~J083 Sac >~le
656 CaiBe Dam Evening Phane: 919~9U-4924 Racy
iINC ChaQd ® FAX: Tovvosbia ~ lID
~ l~n NC ns14 B-mm7: i^p~~ Dabe Applied: o9~3u2oo4
sty C.asloa Also Saves oa:
Sla'»s: Community Service VoLmbea Also saves oa:
Stalls: c~tamer Service ALo Savec On:
Ms. T8n'Imy Thacker Day Phones 63s-4387 ~; Fanak
517 N. I~L71 Strat Evening Phony Ram ~1qO Amrncm
Ii7lsbarouglt NC 27278 FAX: T
F~7: gr8lpsy~yahoo.com Date Applied: 02/14/2006
Stalls: CeroSed Noses Aide Also Saves On:
Ms. Tiffiny WashingtoII D~- Phones C~~39-8144
51511mtoa James lkive f138 (ma7: l'O Baac 746) Evening Phony
C6apd 1171 NC 27514 FAX:
B-me~7: taras~n~s7-aic.edu
Sla'lls: social warlmr Also saver on:
~; Femsk
j~a African Amaicm
Townes ~ lid
Dale Applied: 05105/1008
Maday. hme 09.2008 t'age 2 of 2
fd
Page 1 of 1
Blake Burldin
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Addn3ss:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Mr. Blake Burklin
117 Creel St
Chapel HMI NC 27516
919-812394
919-812-4394
burklinQemail.unc.edu
Johnny T Shirt
Township of Residence: Chapel Hill
Zone of Residence: Chapel Hill Twnsp
Sex:
Male
Ethnic Background: Caucasian
Date of Birth: 11/15/1983
Boards/Commissions applied for:
Orange County Planning Board
Nun~ing Herne Community Advisory Committee
Work Experience•
Harris Teeter
Triangle Sportsplex
Johnny T Shirt
Volunteer Experience:
UNC Hospital
Habitat for Humanity
Education:
B.A. in Sociology from the University of North Carolina at Chapel Hill
Other Comments:
As an undergraduate sociology major I was able to design and implement IRB approved
soaal research on stigmatized populations confidentially. I believe as a I'rfe long resident
of the Chapel HiIV New Hope area, that I will have some insight the ,Board might find
valuable. STAFF COMMENTS: Originally applied for Orange County Planning Board ~
Nursing Home Commun'rly Advisory Committee on 2/3/2008. ADDRESS
VERIFICATION: 117 Creel St, Chapel Hill, is Chapel Hill township in CHPL jurisdiction.
Tnr:.ppaanor~ was curr~t on: 2r3r2oo6 X0:53:29 PM Dab Print.a: srsrzooa
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:
Ms. Jeanette Clark
221 Reacher St Apt 3
Hillsborough NC 27278
919-620-8662
732-7856
6208662
Central Family Care
Supervisor in Charge
Hillsborrnigh
Hillsborough ETJ
Female
Ethnic Background: African American
Date of Birth: 7/8/1955
Boards/Commissions applied for:
Nursing Home 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 technidan. I 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 dass I fiook as an outreach worker.
Educatlon:
GED
Other Comments:
STAFF COMMENTS: Originally applied for Nursing Home CAC and Adult Care Home
Community Advisory Committee and JOCCA. ADDRESS VERIFICATION: 211 Reacher
St is in Orange County in Hillsborough Township in Hillsborough ETJ.
This application was wma~t on: 2/23/2005 Dab Printed: 6J9/L006
i~
Page 1 of 1 Peggy Cohn
- 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:
Ms. Peggy Cohn
Peggy
10 Bayswater Place
Chapel Hip NC 27517
919-489-6624
same
peggyoohn1 ~earthlink.net
retired
Geriatric Can: Manager
Chapel Hill
C.H. City Limits
Sex: Female -
Ethnic Background: Caucasian
Date of Birth: 8/28/1938
BoardslCommissions applied for:
Nursing Home Community Advisory Committee
Work Experience:
Community Health Nursing educ~ifior UNC and Penn State University
Director of Family Ties, Geriatric Care Management, State College PA
Volunteer Experience:
Nursing Home visitation
Non profit Boards in PA
Education:
BA, vmllesley
BSN, Columbia Un'nrersity
MPH, UNC
PhD, Penn State University College of Health and Human Developmenet
Other Comments:
STAFF COMMENTS: Originally applied for Adult Care Home Commun'dY Advisory
Comm'~ttee and NHCAC and Adv. Board on Aging 10/10/2005. ADDRESS
VERIFICATION: Mailing address. listed above. Residence is 233 McCauley Street in
Chapel Hill city limits.
Tnt: sppUeatlon was cumsnt on: ~a~t ~ ~:3a~~ AM Dsa Prtrrtad: srsr2oos
(3
Page 1 of 1
ELIZABETH CRONER
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Addn3ss:
Phone: (Day)
Phone: (Evening)
Fax:
Email:
Plsce of Employment:
Job Title:
MS. ELIZABETH CRONER
1605 N. GREENBOROUGH ROAD
CARRBORO NC 27510
919.933.862
RETIRED
Township of Residence: Chapel Hill
Zone of Residence: Carrboro City Limits
Sex:
Ethnic Background:
Date of Birth:
Female
Afican American
5/14/1934
Bosrds/Commissions applied for.
Advisory Board on Aging
Nursing Home Community Advisory Committee
Work Experience:
RETIRED FROM STATE OF OHIO, CLEVELAND DEVELOPMENTAL CENTER; STAFF
SUPV. '
Volunteer Experience:
CURRENTLY ASSISTING ABUNDANT LIFE CHURCH PANTRY
Education:
HIGH SCHOOL; CONTINUED EDUCATION;
Other Comments:
STAFF COMMENTS: Originally applied for Adv. Board on Aging, Nursing Home CAC,
and Board of Social Services 11/8/2005. ADDRESS VERIFICATIOfti: 1605 N.
Greensboro St is in Carrboro Cily Limits in Orange County in ftte Chapel Hill Township.
This app~atlor~ was wrront on: 11/5/2005 ~ ~ ~s:47 AM oat. P~aaa: sl92oot3
i~
Page 1 of 2
Ed Flotivers
Volunteer Application
_ _ Orange County Advisory Boards and Commissions
Name:
Name Called:
Horns Address:
Phone: (may)
Phone: (E~ning)
Fax:
Email:
Place of Employment:
Job Title:
Township of Residence:
Zons of Residence:
Sex:
Ethnic Background:
Date of Birth:
Mr Ed Flowers
2813 BedcefYs Ridge Drive
Hillsborough NC 27278
919-357-9256
919-357-9256
ED FLOWERS~YAHOO.COM
Duke University Hospital
Senior Nuclear Medidne Technologist
Hillsborough
Male
Caucasian
2/10/1944
Boards/Commissions applied for:
Nursfig Home Community advisory Committee
Work Experience:
1965 -1970 Nuclear Medidne Technologist NC Baptist Hospital
1970 -1976 Chief Nuclear Medidne Technologist Duke Medical Center
1976 -1991 Technical Administrator -Nuclear Medicine -Duke Medical Center
1991 - prestnt Senior Nuclear Medidne Technologist
Volunteer Experience:
Dufiam Congregations in Action
Yokefellows -Durham County - Alamance/Orange Counties
Dufiam Nursery Sd~ool Advisary Committee
Blowing Rode Conference Center Board of Directors -Treasurer
Education:
High School -Southwest Forsyth.
College -Mars Hill
Radiologic Technology -North Carolina Baptist Hospital
Nuclear Medidne Technology -North Carolina Baptist Hospital
Other Comments:
Extens'nre experience with n:gulatory agencies (e.g., JCAHO, N.C.Radiation Safety,
OSHA. Nudear_ Regulatory Commission) STAFF COMMENTS: Originally applied for
Nursing Home Community Advisory Community Advisory Committee on 11/18/2007.
ADDRESS VERIFICATION: 2813 Bedcett's Ridge Drive, is Hillsborough Township.
15
Page 1 of 1
Jane Paweil
Volunteer Application
Orange County Advisory Boards and Commissions
Name:
Name Called:
Home Address:
Phone: (Days
Phone: (Evening)
Fax:
Email:
Place of Employment:
Job Title:
Township of Residence:
Ms. Jane Paweli
656 Craige Dorm
UNC Chapel Hill
Chapel HHI NC 27514
910-4749083
919-914-4924
japo~email.unc.edu
Wynnsong 15 Theatre
Cashier
Chapel Hill
Zone of Residence: Chapel Hill Township within C.H. city limits
Sex:
Ethnic Background:
Date of Birth:
Female
African American
10/18/1983
Boards/Commissions applied for:
Musing Home Community Advisory Committee
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.
Educatlon:
High School-Lumberton Senior High School, attending UNC Chapel. BS Nursing
Other Comments:
STAFF COMMENTS: Originally applied for Nursing Home Community Advisory
Committee, Affordable Housing Advisory Board, and Animal Shelter Operations Task
Fong. ADDRESS VERIFICATION: 656 Craige Dorm is on the campus of UNC-Chapel
Hill and is located off of Manning Drive in Orange County, in the Chapel Hill Township in
the City Limits.
This application was cunwrt on: 9/3QIZ004 Dab Prinbd: ~/9V2008
~~
Page 1 of 1
Tammy Thacker
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. Tammy Thacker
517 N. Hill Street
Hillsborough NC 27278
638387
gr8tpa~yahoo.com
Aryzen Health and Wellness
President and CAN II
Township of Residence: Hillsborough
Zone of Residence: Hillsborough Town Limits
Sex: Female
Ethnic Background: African American
Date of Birth: 5/31/1968
Boards/Commissions~applied for:
Nursing Home Community Advisory Committee
Work Experience:
I have been in Health Care for over 15 years and I have a good knowledge base about
the elderly. I understand people need and what it takes to live in a safe environment
Volunteer Experience:
I have volunteered in the classrooms of my children.
Education:
Cergfied CNA I and II. Certfied EKG technican and Certfied Medication Technican.
Other Comments:
STAFF COMMENTS: Originally applied for Adult Care Home and Nursing Home Care
Advisory Boards and Advisory Board on Aging 2/14/2006. ADDRESS VERIFICATION:
517 Hill Street is in the Town of Hillsborough in Orange County.
This application was currant on: 2H4!Z006 Dab PrintOd: B/9/L008