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016 <br />In the space below, describe the nominee's participation in groups or organizations for <br />• older adults and on councils or committees that advise or oversee programs that have an <br />impact on older persons: I currently serve as a board member on the Lee County Senior <br />Services Advisory Board and the Cumberland County Coordinating Council on Older Adults. I <br />am also serving on the Forget Me Not Project Committee. I was pleased to be apart of our LIFE <br />St. Joseph of the Pines team who participated in the Cumberland County Alzheimer's Walk and I <br />assisted with the Cumberland County Senior Beauty Pageant in 2010. I plan to be even more <br />involved this year. <br />In the space below, describe any special skills or attributes of nominee, which would enhance <br />his/her effectiveness as a member of the Triangle J Area Agency on Agni's Advisory Council on <br />Aging: <br />• If not a self - nomination, please indicatb the name, address an d phone number of person or group <br />making nomination: <br />IfFTiiL� <br />Ers F, 1" <br />Phone Number (including area code) <br />SIGNATURE OF NOMINEE >/l 1 I/YI Date: <br />(Note: The signature is required for self - nominations as well as for nominations made by other individuals or <br />groups. This signature of the nominee serves as verification that the person being nominated consents to his/her <br />name being placed in nomination and indicates a commitment on the part of the nominee to participate fully in the <br />orientation, training and work of the Advisory Council on Aging.) <br />SIGNATURE AND TITLE OF COUNTY REPRESENTATIVE INDICATING COUNTY <br />ENDORSEMENT OF NOMINEE <br />• Date: <br />