HomeMy WebLinkAbout2019-05-21 AppointmentItem Number: 16.a.
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CITY OF IOWA CITY
www.icgov.org
May 21, 2019
Airport Commission - One vacancy to fill a four-year term, July 1, 2019 - June 30, 2023. (Term expires for
Minnetta Gardinier)
ATTACHMENTS:
Description
Vacancy Notice/Coversheet
Board Demographics/Attendance
Clair, Scott -Application
Gardinier, Minnetta -Application
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
AIRPORT COMMISSION
One Vacancy — Four Year Term
July 1, 2019 — June 30, 2023
• Duties: To exercise all the powers granted to cities and towns under Chapter 330 of the
Code of Iowa, except the power to sell said airport.
• To annually certify the amount of taxes within the limitations of the Statutes of the State of
Iowa to be levied for Airport purposes. All funds derived from taxation or otherwise for
airport purposes shall be under the full and absolute control of the Airport Commission,
deposited with the City Treasurer, and disbursed only on the written warrants or order of
the Airport Commission.
• The Airport Commission meets the third Thursday of each month at 6:00 p.m.
Iowa City appointed members of the boards and commissions must be 18 years of age and live in
Iowa City. The City of Iowa City encourages diversity in the appointment to boards and commissions.
Applications must be received by 5:00 p.m., Tuesday, May 14, 2019. An application can be
completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the
Clerk's office.
Questions about the Iowa City Airport Commission should be directed to Michael Tharp, Airport
Operations Specialist at 356-5045.
12V" lip-of--
Board/Commission Application Cover
Late Handouts Distributed
Board/Commission: Airport Commission
5.— ZD — /9
One Vacancy to fill a four- year term (Date)
7/1/2019 - 6/30/2023
It is hereby established, as a formal policy of the City Council of Iowa City, that each application for reappointment to
a City Board or Commission will be considered without regard to incumbency. If reappointed,an individual would be
limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve.
Council Announcement Date: 4/2/2019
Application Deadline: 5/14/2019
Council Appointment Date: 5/21/2019
Date of Non-Gender Appointment: 7/2/2019
After date above Council may appoint without regard to gender
Gender Balance Requirement: 1- Female
Current Gender Balance: Female: 0 Male: 4
Gender Name and Address
Male Clair, Scott
7 Glendale Terrace
Female Gardinier, Minnetta 2' Term ending 6/30/19
1527 Muscatine Ave
Board/Commission Application Cover
Board/Commission: Airport Commission
One Vacancy to fill a four-year term
7/1/2019- 6/30/2023
It is hereby established,as a formal policy of the City Council of Iowa City,that each application for reappointment to
a City Board or Commission will be considered without regard to incumbency. tJeappointed,an individual would be
limited to one reappointment to a full toin order to increase the opportunities for new applicants to serve.
Council Announcement Date: 4/2/2019 /
Application Deadline: 5/14/2019
Council Appointment Date: 5/21/2019
Date of Non-Gender Appointment: 7/2/2019
After date above .uncil may appoint without regard to gender
Gender Balance Requirement: 1- Female
Current Gender Balance: Female: 1 Male 3
Gender Name and Address
Male Clair, Scott //i
7 GlendaleJCerrace
Female GardinierwMinnetta erm ending 6/30/19
1527 Muscatine Ave
Airport Commission
Name Term ending
# years as
resident of IC Occupation
Gender
Age*
Country of
Origin*
Sexual Gender
Orientation* Religion* Disability* Ethnicity* Identity* Race* Unique Identifiers*
Robert Libby 6/30/2020 -1st Term
1 month
M
Christopher Lawrence 6/30/2021- 1st Term
10 Systems Admin
M
29
Derek LaBrie 6/30/2022 - 1st Term
2 Flight Inst
M
22
US
Heterosexual Caucasian
Warren Bishop 6/30/2022 - 1st Term
29 Physician, Professi
M
65
USA
Heterosexual None USA Male Caucasian
VACANT 6/30/2023
Please note: The information provided is the information provided on the application at the time of submission.
* Information is voluntary
April 18, 2019
Page 5
Airport Commission
ATTENDANCE RECORD
2018-2019
Key:
X = Present
X/E = Present for Part of Meeting
O = Absent
O/E = Absent/Excused
NM = Not a Member at this time
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Warren Bishop
06/30/22
O/
NM
NM
NM
E
X
X
X
X
X
X
Minnetta
07/01/19
O/
O/
Gardinier
X
X
X
X
X
E
X
X
E
X
Robert Libby
07/01/20
O/
O/
X/
X
X
O/E
E
X
X
X
X
E
E
Christopher
07/01/21
Lawrence
X
X
X
X
X
X
X
X
X
X
Derek LaBrie
07/01/22
O/
X
X
X
X
X
E
X
X
X
X
Key:
X = Present
X/E = Present for Part of Meeting
O = Absent
O/E = Absent/Excused
NM = Not a Member at this time
I
` - 1
Advisory Board/Commission Application Form
rY
I
This application is a public document and as such can be reproduced and distributed for
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY
considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
10/6/2018
First Name
Scott
Last Name
Clair
Home Address*
7 Glendale Terrace
City
IOWA CITY
State
IA
Zip Code
52/45
1. Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
319-400-8830
Email Address*
clairscottd@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Airport Commission
2. How long have you been a resident of Iowa City?*
2003-2005, 2007 to present
(13 yr total)
3. Occupation: *
Business Development Mgr.
4. Gender*
*This question is rrandatory in order for the City to comply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Derrographics sectionof the application below.
V Male
F Female
5. Experience and/or activities which you feel qualify you for this position:*
Private pilot and aircraft owner with aircraft at Iowa City airport (N65988). AOPA and EAA member. B.S.
Mechanical Engineering (Illinois, 1991), and J.D. Law (Iowa, 2004). 20 years experience in new product and
business development at John Deere.
6. What is your present knowledge of each advisory board you are interested in?*
Limited, but willing and able to learn and contribute.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will
be asked to resign from one if appointed to another.
7. Do you currently have a conflict of Interest?*
No
8. Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
9. Age
49
10. Country of Origin
USA
11. Sexual Orientation
Heterosexual
12. Religion
None
13. Do you have a disability?
No
14. Ethnicity
European
15. Race
European
16. Gender identity
Male
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Z�A'_
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
Drop-down
I Advisory Board/Commission Application Form
' - rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
5/6/2019
First Name
Minnetta
Last Name
Gardinier
Home Address*
1527 MUSCATINE AVE
City
IOWA CITY
State
IA
Zip Code
52240-6232
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
319-331-6235
Email Address*
m.gardinier@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Airport Commission
Preference on first choice
If Tultiple boards are being applied for.
How long have you been a resident of Iowa City?*
21 years
Occupation:*
Associate Professor, Univ Iowa
Gender*
*This question is rrandatory in order for the City to corrply with the state's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Derrographics sectionof the application below.
r Male
rJ Female
Experience and/or activities which you feel qualify you for this position:*
I am completing my 2nd term on the Iowa City Airport Commission (10 years). So I have a tremendous amount
of working knowledge about the airport and its relationships with the Iowa City community. I am an active
recreational pilot (since 2003) with a plane hangared at IOW (since 2005), so I have a good understanding of
the aviation industry too. As a homeowner on the flight path for landing at IOW, I also have an appreciation for
ensuring that IOW maintains good relationships with its neighbors.
I am very active in two aviation organizations that promote women in aviation, which is woefully
underrepresented in this industry - only 6% of pilots are women. In this regard, I serve on the Board of
Directors for the Air Race Classic. Iowa City has hosted this race twice in the past 10 years. I also play a
leadership role in The Ninety -Nines, International Organization of Women Pilots and anticipate joining their
International Board of Directors later this summer.
If selected to continue on the Airport Commission, I look forward to our new initiatives to promote the public
side of the airport as we open our new public viewing/picnic area and look towards greater engagement with
the Iowa City community. I am retiring from the University on July 1, which will afford me more time to pursue my
aviation -related activities and passion. I hope to volunteer more time at the airport to network informally with
both adults and children who come out to visit the airport, especially women and young girls - to introduce
them to a field that they might otherwise not hear much about.
What is your present knowledge of each advisory board you are interested in?*
I understand that the Airport Commission has two openings at the present time: 1) my expiring term; and 2) an
uncompleted term for a Commission member who is leaving the area. As noted above, I am very well
acquainted with the IC Airport Commission and its operation. So needless to say, I will "hit the ground running"
if reappointed. That said, I also recognize that the City of Iowa City has a stated goal to appoint NEW members
when possible to ensure that fresh perspectives and new ideas are brought into the mix. I understand this
policy and support it also. I look forward to an opportunity to continue my participation, but certainly
understand if another qualified candidate is selected.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
65
Country of Origin
United States
Sexual Orientation
Female
Religion
Roman Catholic
Do you have a disability?
No
Ethnicity
Non -Hispanic
Race
Caucasian
Gender identity
Female
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
Item Number: 16.b.
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CITY OF IOWA CITY
www.icgov.org
May 21, 2019
Community Police Review Board - One vacancy to fill a four-year term, July 1, 2019 - June 30, 2023. (Term
expires for Don King)
ATTACHMENTS:
Description
Vacancy Notice/Coversheet
Board Demographics/Attendance
Canady, Laurie -Application
Conaway, Samuel -Application
King, Donald -Application
MacConnell, Jerri -Application
Olmstead, Harry -Application
Orozco, Hellectra -Application
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD:
COMMUNITY POLICE REVIEW BOARD
One Vacancy — Four -Year Term
July 1, 2019 — June 30, 2023
Duties of the Community Police Review Board include:
• Reviewing Police Department investigations into allegations of misconduct lodged against police
officers; conducting further investigation of the complaint when the Board deems it necessary,
and issuing a public report which explains why and the extent to which the complaint is sustained
or not sustained;
• Maintaining a central registry of complaints against sworn police officers and issuing annual
reports regarding the disposition of the complaints to the City Council;
• Reviewing police policies and practices from time -to -time and recommending changes to the City
Council when the Board deems it appropriate.
• The Community Police Review Board meets the second Tuesday of each month at 5:30 p.m.
Iowa City -appointed members of boards and commissions must be at least 18 years of age and live in
Iowa City. The City Iowa City encourages diversity in the appointment of citizens to boards and
commissions.
Applications must be received by 5:00 p.m., Tuesday, May 14, 2019. An application can be
completed and submitted on the City of Iowa City website at www.icgov.org or by contacting the City
Clerk's office.
Questions about the Iowa City Community Review Board should be directed to Chris Olney City Clerk's
Office at 356-5043.
Board/Commission Application Cover
Board/Commission: Community Police Review Board (CPRB)
One Vacancy to fill a four-year term
7/1/2019 - 6/30/2023
It is hereby established, as a formal policy of the City Council of Iowa City, that each application for reappointment to
a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be
limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve.
Council Announcement Date: 4/2/2019
Application Deadline: 5/14/2019
Council Appointment Date: 5/21/2019
Date of Non -Gender Appointment: 7/2/2019
After date above Council may appoint without regard to gender
Gender Balance Requirement: 1 -None
Current Gender Balance: Female: 2
Gender
Name and Address
Female
Canady, Laurie
64 Arbury Drive
Male
Conaway, Samuel
2643 Westwinds Dr Apt #4
Male
King, Donald
542 Foster Rd
Female
MacConnell, Jerri
320 E. Washington St
Male
Olmstead, Harry
1259 Shannon Dr. Apt #102
Female
Orozco, Hellecktra
2627 Rushmore Dr
Male: 2
1St Term ending 6/30/19
Community Police Review Board - Current members
# years as
Name Term ending resident of IC Occupation Gender
Age*
Country of Sexual
Origin* Orientation*
Religion*
Disability*
Ethnicity*
Gender
Identity* Race* Unique Identifiers*
Monique Galpin (Vice -
Chair) 6/30/2020 - 1st term 10 F
Orville Townsend 6/30/2020 -1st term 53 M
David Semler 6/30/2021 -1st term 4 Lawyer M
38
USA Male
Unitarian
Caucasian
Latisha McDaniel 6/30/2021 -Unexpired 6 Research Assoc F
40
USA Bisexual
Agnostic
No
cisgender Black
VACANT 6/30/2023
Please note: The information provided is the information provided on the application at the time of submission.
Information is voluntary
COMMUNITY POLICE REVIEW BOARD
ATTENDANCE RECORD
YEAR 2018-2019
KEY: X
ineeting pate
O
= Absent
TERM
5/8/18
6/12/18
7/23/18
8/21/18
9/11/18
10/9/18
11/13/18
12/11/18
1/8/19
2/20/19
3/12/19
4/9/19
4/29/19
NAME
EXP.
Donald
7/1/19
X
X
X
X
X
O
X
X
X
X
X
X
X
King
Monique
7/1/20
X
X
X
X
X
X
X
X
X
X
X
X
X
Galpin
Orville
7/1/20
X
X
X
X
X
X
X
X
X
X
X
X
X
Townsend
Latisha
7/1/21
_____
__—_
______
______
X
O
X
X
O
X
X
X
McDaniel
Royceann
7/1/21
X
O/E
-----
-----
____
_____
------------
Porter
-------
-------
-------
--------
""----
David
7/1/21
X
X
X
O
X
O
X
O
X
O
X
X
X
Selmer
KEY: X
= Present
O
= Absent
O/E
= Absent/Excused
NM
= No meeting
---
= Not a Member
I
` - 1
Advisory Board/Commission Application Form
rY
I
This application is a public document and as such can be reproduced and distributed for
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY
considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
8/25/2018
First Name
Laurie
Last Name
Canady
Home Address*
64 Arbury Drive, Iowa (IA)
City
IOWA CITY
State
IA
Zip Code
52246
1. Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
3193304587
Email Address*
lauriecanady@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Community Police Review Board (CPRB)
2. How long have you been a resident of Iowa City?*
30 years not including
undergrad
3. Occupation:
Homemaker
4. Gender*
*This question is rrandatory in order for the City to comply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Derrographics sectionof the application below.
F Male
V Female
5. Experience and/or activities which you feel qualify you for this position:*
ICCSD volunteer 1996-2017
Iowa City Road Races board member 2000-2012, Race Director
Citizen for many years as well as parent in the community.
HAM Radio Operator KCOWLO
Various other boards
6. What is your present knowledge of each advisory board you are interested in?*
In talking with others and reading about this Board, I feel I would be a good fit in terms of what is happening on
the streets of Iowa City. I am eager to learn more about this board and serve-- other than what I have read
online.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will
be asked to resign from one if appointed to another.
7. Do you currently have a conflict of Interest?*
No
8. Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
9. Age
60
10. Country of Origin
United States of America
11. Sexual Orientation
Straight
12. Religion
Protestant
13. Do you have a disability?
No
14. Ethnicity
Caucasian
15. Race
White
16. Gender identity
Female
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
Drop-down
I Advisory Board/Commission Application Form
' - rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
5/1/2019
First Name
Samuel
Last Name
Conaway
Home Address*
2643 Westwinds Dr. Apt #4
City
IOWA CITY
State
IA
Zip Code
52246
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
3199300791
Email Address*
saconaway4@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Housing and Community Development
Commission(HCDC)
Select a Board or Commission you are interested in:*
Community Police Review Board (CPRB)
Preference on first choice
If rrultiple boards are being applied for.
Housing and Community Development Commission
How long have you been a resident of Iowa City?*
26 Years
Occupation:*
PATH Provider for Johnson County/BSW Abbe Center
Gender*
*This question is rrandatory in order for the City to comply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Derrographics sectionof the application below.
V Male
F Female
Experience and/or activities which you feel qualifyyou for this position:*
I work with individuals experiencing homelessness and at risk of homelessness that have a serious mental
illness and a serious mental illness and co-occurring substance abuse disorder. I work on assisting my clients
obtaining housing within Johnson County and primarily the Iowa City Metro Area. I have knowledge of the rental
market within Johnson County.
What is your present knowledge of each advisory board you are interested in?*
I am not as familiar with the Housing and Community Development board; however I feel I would be a great
advocate for less served populations. From my brief understanding, it is the role of the board to advocate for
people under served in Iowa City area and develop plans for sustainable housing as well as allocating money
for local social service agencies to improve or procure housing for clients; either living in a shelter or a
habilitation/transitional housing.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
31
Country of Origin
United States
Sexual Orientation
Cisgender
Religion
Non -religious
Do you have a disability?
No
Ethnicity
Hispanic
Race
White
Gender identity
NA
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
I Advisory Board/Commission Application Form
' - 1 rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
5/8/2019
First Name
Donald
Last Name
King
Home Address*
542 Foster Rd
City
IOWA CITY
State
IA
Zip Code*
52245
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
3195947660
Email Address*
gohawkeyes54@yahoo.com
Boards & Commissions
Select a Board or Commission you are interested in:
Community Police Review Board (CPRB)
Preference on first choice
If Tultiple boards are being applied for.
How long have you been a resident of Iowa City?*
18 years
Occupation:
Semi retired
Gender*
*This question is rrandatory in order for the City to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Derrographics sectionof the application below.
V Male
F Female
Experience and/or activities which you feel qualify you for this position:*
Was appointed in Sept 2015 to fill an unexpired term and have served as Chair since Nov 2018. 1 am currently
a board member who has police experience. My appointment would be the final 4 year term under the city
policy that I would be able to fulfill. I am asking for the extension. Thank you.
What is your present knowledge of each advisory board you are interested in?*
Have served on community police review board.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
64
Country of Origin
us
Sexual Orientation
Religion
Do you have a disability?
No
Ethnicity
Race
Gender identity
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
r
=_= Advisory Board/Commission/Committee Applicjc�
np
-��
This application is a public document and as such can be reproduced and dlstri uid for
CITY OF IOWA CITY the public. This application will be considered for twelve months only a6ditpu#,tically
UNESCO CITY OF LITERATURE considered for any vacancy during that time. Iowa city, IOWA
NOTE: Must be 18 years of Age and live within city limits of Iowa City to apply
Date of ApplicationIq Y4 a d t R
Which Board or Commission are you interested in all C��
Applicant Information:
First Name 3 e c -f i C j rXI Last Name oac Co n o e I l
Home Address kfati i r% .3 en
City _�Ic>u-*� Q 641t State pt,J CL— Zip Code 'sLf
Contact phone number3lq Email Address
1. Is your home address (listed above) within the corporate limits of Iowa City? YES 1( NO
2. How long have you been a resident of Iowa City? LT V e-ct
r- It
3. Occupation: % l V'- — ��r` J �G-- 55 J
4. Gender*
*This question is mandatory in order for the City 6 comply with the State's gender balance requirement which
treats gender as binary "Gender Identity" may be provided in the demographics section of the application below.
0 Male
® Female
S Fxneripnr-ae and/nr oni;t,;*;oma ...1,: L r__1 ur _ _ r_ _ -i -
_--_-- J -» -vv- .7- 1W1 11110 FVAl L1Vll.
0 ea f-,, f,,V
frt� c vs C' ric, ci� l c)f l e vl - li`r) M 3J._ d'
"�Or
c f�
� i— 2 a'�` �Z?C ct ✓ � it !%' ` 11 f U � i G . •
6. What is your present knowledge of each advisory board you are interested in?
y
C o �? r it o 1 r -1 y -t`h r� Int as �;r, r`e1_M r
c PV
00 ,;a ci q I C/.�) J e=, zr.11 c �t U' r4
Flor fYi
Please contact the city attorney at 319-356-5030 to discuss questions or concerns regarding -'a p en a
conflict of interest. The following describe some but not all potential conflicts.
Potential Conflict of Interest
MAY 0 8 2019
City Clerk
The Housing and Community Development Commission makes recommendations tolfllVENYrdtfrefl
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise
or have exercised any functions or responsibilities with respect to federally funded activities, or who are in
a position to participate in the decision—making process or gain inside information with regard to such
activities, may obtain a financial interest or benefit from a federally -assisted activity, or have a financial
interest in any contract, subcontract, agreement with respect to the proceeds of the federally—assisted
activity, either for themselves or those with whom they have business or immediate family ties, during their
tenure or for one year thereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a
city Board or Commission from having an interest in a city contract. Section 362.5
City Council Resolution #15-300 established a policy that the following persons shall not be eligible for
appointments to Boards and Commissions.
A council member's spouse, domestic partner or partner in cohabitation, children, step children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-
law, sister-in-law, grandparents, and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent,
poster child, persons who are parents of the same child, and persons whom the employee is in an intimate
relationship.
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one
reappointment to a full term in order to increase the opportunities for new applicants to serve.
................................................................................................................................
7. Do you currently have a conflict of interest? YES NO—t—
Please identify any potential conflicts between membership on the advisory board and your personal
interests, including financial interests and your duties to an employer/ List all businesses in which you or
your spouse/domestic partner, have an ownership interest (for example, sole proprietor, partner, 5% or more
of corporation's stockholdings).
List potential conflicts of interest (See above for information regarding conflict of interest)
Please indicate if there are none.
BUSINESS NAME BUSINESS ADDRESS
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
S. Do you currently serve on another Iowa City board or commission? YES N04
If yes, which one do you prefer?
The City Council values all types of diversity on its boards and commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the board and commission is representative of the community and the groups(s)
which it serves, please provide your information for the following:
Demographic Information:
9. Age 7'3
10. Country of Origin
11. Sexual Orientation reg,(
12. Religion i f D !
13. Do you have a disability? YES NO
14. Ethnicity C45&116c ice%!
15. Race cauc-a5 a a ✓�
16. Gender Identity —PO fy4n C—'—
Note:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social
and economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise finance
and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an appointee. If you
fail to answer all the questions, except demographics, Council will not consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving. Contact information is attached.
MAY 082019
City Clerk
Iowa City, Iowa
'r a
— Advisory Board/Commission Application Form
�W�
R+ .��'�� This application is a public document and as such can be reproduced and distributed for
..�_ l the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
8/14/2018
First Name
Harry
Last Name
Olmstead
Home Address*
1259 Shannon Drive, Apartment 102
City
IOWA CITY
State
IA
Zip Code
52246
1. Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
319-855-2666
Email Address*
Harry03@aol.com
Boards & Commissions
Select a Board or Commission you are interested in:*
Community Police Review Board (CPRB)
Select a Board or Commission you are interested in:*
Library, Board of Trustees
Select a Board or Commission you are interested in:*
Senior Center Commission
2. How long have you been a resident of Iowa City?*
10 years
3. Occupation:
Retired Teacher
4. Gender*
*This qu
estion is mandatory in order for the CRY to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" Trey
provided in the Derrographiccs sectiomof the application beim.
R Male
r Female
5. Experience and/or activities which you feel qualify you for this position:*
I believe knowledge, experience, and experience develop leadership skills. Educationally I went to Layton
School of Art Photograph major 1973 2 year certificate. University of Wisconsin -Milwaukee BS Education and
Recreational Therapy 1975. University of Alabama at Birmingham Rehabilitation Counseling (3 credits shy of
Masters. Teach for America 1991 - 1974 Special Education LD & BD.
I also have served on the Iowa Human Rights Commission 6 years (2 years as chair), Iowa City Housing and
Community Development Commission 3 years (1 year as chair), Johnson County Para -transit Board 5 years (2
years as vice -chair, Johnson County Liviable Community 4 years (3 years as chair of Transportation sun -
committee, University of Center for Human for 6 years to present (4 years as vice -chair), State of Iowa
Olmstead Consumer Task Force 5 years (11 year as vice -chair & 2 years co-chair of Medicaid Privatization sub-
committee.
6. What is your present knowledge of each advisory board you are interested in?*
Having serving on several Iowa City Commissions I have a working knowledge of how boards serve the citizens
and City Council. I have given a presentation to the Iowa City Senior Center Col mission also I've attended 3
years of the annual report and public forum of the Iowa City Police Review Board.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate family ties, during their tenure or for one year thereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will
be asked to resign from one if appointed to another.
7. Do you currently have a conflict of Interest?*
No
8. Do you currently serve on another Iowa City board or commission?
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
9. Age
68
10. Country of Origin
United States of America
11. Sexual Orientation
Straight
12. Religion
Quaker
13. Do you have a disability?
Yes
Please explain:
I'm a person with a right above the knee and and use a power wheelchair for mobility.
14. Ethnicity
United States of America
15. Race
White
16. Gender identity
Male
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant* !
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
Drop-down
I Advisory Board/Commission Application Form
' - 1 rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
3/25/2019
First Name
Hellecktra
Last Name
Orozco
Home Address*
2627 Rushmore Drive
City
IOWA CITY
State
IA
Zip Code
52246
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
2103810525
Email Address*
poneloyagirl@hotmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Community Police Review Board (CPRB)
Select a Board or Commission you are interested in:
Parks and Recreation Commission
Preference on first choice
If Tultiple boards are being applied for.
CPRB
How long have you been a resident of Iowa City?*
3 yrs
Occupation:*
Student
Gender*
'This question is rrandatory in order for the City to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Demographics sectionof the application below.
F Male
V Female
Experience and/or activities which you feel qualifyyou for this position:*
I have worked in Emergency Management and Public Safety and currently working on a degree in Criminal
Justice with a concentration in Homeland Security.
What is your present knowledge of each advisory board you are interested in?*
I have read through meeting minutes of previous meetings.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate family ties, during their tenure or for one year thereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
39
Country of Origin
Nicaragua
Sexual Orientation
Religion
Christian
Do you have a disability?
No
Ethnicity
Latin/Hispanic
Race
White
Gender identity
Female
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
Item Number: 16.c.
+r
P_
W�rm�M
CITY O� IOWA CITY
www.icgov.org
May 21, 2019
Historic Preservation Commission (At -Large) - One vacancy to fill a three-
year term, July 1, 2019 - June 30, 2022. (Term expires for Zach Builita)
ATTACHMENTS:
Description
Vacancy Notice/Coversheet
Board Demographics/Attendance
Builta, Zac -Application
Corcoran, Kate -Application
Hajdu, Michael -Application
Pedelty, H -Application
Sellergren, Jordan -Application
Wagner, Frank -Application
Wu, Austin - Application
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
HISTORIC PRESERVATION COMMISSION
Four Vacancies — Three Year Term
July 1, 2019 — June 30, 2022
(1) At Large Representative
(1) Brown St. Representative
(1) Jefferson St. Representative
(1) Summit St. Representative
• Duties of the Historic Preservation and Land Marks Commission include: conducting studies for
the identification and designation of Historic Districts; reviewing and acting upon all applications
for Certificate of Appropriateness; cooperating with property owners and city agencies regarding
remedy of dangerous conditions.
• Furthering the efforts of historic preservation in the City by making recommendations on
preservation issues, when appropriate, by encouraging the historical, architectural or cultural
value, and by encouraging persons and organizations to become involved in preservation
activities.
• Applicants for district representatives to the Historic Preservation Commission must reside in the
district that is specified.
• This Commission meets the second Thursday of each month at 5:30 p.m.
Iowa City appointed members of the boards and commissions must be 18 years of age and live in
Iowa City. The City of Iowa City encourages diversity in the appointment to boards and commissions.
Applications must be received by 5:00 p.m., Tuesday, May 14, 2019. An application can be
completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the
Clerk's office.
Questions about the Iowa City Historic Preservation Commission should be directed to Jessica
Bristow, Sr Planner at 356-5243. Application forms are available from the Clerk's office upon request or on
the City website at www.icgov.org.
Board/Commission Application Cover
Board/Commission: Historic Preservation Commission - At -Large
One vacancy to fill a three-year term
07/01/2019 - 6/30/2022
It is hereby established, as a formal policy of the City Council of Iowa City, that each application for reappointment to
a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be
limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve.
Council Announcement Date: 4/2/2019
Application Deadline: 5/14/2019
Council Appointment Date: 5/21/2019
Date of Non -Gender Appointment: 7/2/2019
After date above Council may appoint without regard to gender
Gender Balance Requirement: 4 -Female, 1 -Male
Current Gender Balance: Female: 2 Male: 5
Gender
Name and Address
Male
Builta, Zac
920 E Burlington St Apt 1
Female
Corcoran, Kate
20 Arbor Hill Circle #41
Male
Hajdu, Michael
828 Dearborn St.
Male
Female
Male
Male
1St Term ending 6/30/19
Pedelty, H
1111 E Burlington St.
Sellergren, Jordan
1729 N. Dubuque Rd
Wagner, Frank Previously served unexpired plus 3 full terms
519 S. 1st Ave ending 6/30/18
Wu, Austin
422 S Dubuque St. Apt 21
Historic Preservation Commission -
Current members
Name
Term ending
FF years as
resident of
IC
Occupation
Gender
Age*
Country of
Origin*
Sexual
Orientation*
Religion*
Disability* Ethnicity*
Gender
Identity* Race* Unique Identifiers*
Kevin Boyd (At large) -Chair
6/30/2020 -2nd Term
25
Natl Political
Director
M
37
USA
LG BT
Not
practicing
White
Gosia Clore (Longfellow)
6/30/2020 -2nd Term
5
Research
Scientist
F
Thomas Agran (Northside)
6/30/2020 -2nd Term
8
Artist
M
30
USA
Straight
Caucasian
GT Karr (At large)
6/30/2020 -1st Term
38
Business Owner
M
38
USA
Hetrosexual
Christian
Caucasian
Quentin Pitzen (At large)
6/30/2021 -1st Term
44
Contractor
M
66
USA
Hetrosexual
White
Helen Burford (College Green)
6/30/2021 -1st Term
17
Retired
F
69
USA
Jewish
Caucasian
Lee Shope (Woodlawn)
6/30/2021 - 1st Term
59
Retired IT
M
77
USA
Male
Christian
American
Male White
VACANT (East College St.)
6/30/2021
VACANT (At -Large)
6/30/2022
VACANT (Brown St)
6/30/2022
VACANT (Jefferson St)
6/30/2022
VACANT (Summit St)
6/30/2022
Please note: The information provided is the information
provided on the
application at the time of submission.
* Information is voluntary
HISTORIC PRESERVATION COMMISSION
April 11, 2019
Page 9 of 9
HISTORIC PRESERVATION COMMISSION
ATTENDANCE RECORD
2018-2019
TERM
NAME
EXP.
5/10
6/14
7/12
8/9
8/23
9/13
10111
11/08
12/13
1/10
2/14
3/14
4/11
AGRAN,
THOMAS
6/30/20
X
X
O/E
X
X
X
O/E
X
X
O/E
O/E
X
O/E
BAKER,
ESTHER
6/30/18
X
X
--
--
BOYD,
KEVI N
6/30/20
X
X
X
X
X
X
X
X
X
X
X
X
B U I LTA,
ZACH
6/30/19
X
X
X
X
X
X
X
X
X
X
X
X
X
B
HELEN
HELEN
6/30/21
--
-
X
X
O/E
X
O/E
X
X
X
X
O/E
CLORE,
GOSIA
6/30/20
X
X
X
O/E
O/E
X
O/E
X
X
O/E
X
X
X
DEGRAW,
SH
SHAROONN
6/30/19
X
X
X
O/E
X
X
X
X
X
X
O/E
X
X
KARR, G.
T
6/30/20
X
X
O/E
X
X
X
X
X
X
X
X
X
X
KUENZLI,
CECILE
6/30/19
X
X
O/E
X
X
X
X
X
X
O/E
X
X
MICHAUD,
6/30118
X
X
--
--
--
-
--
--
PAM
PITZEN,
QUENTIN
6/30/21
--
X
X
X
X
X
X
X
X
X
X
X
SHOPE,
LEE
6/30/21
--
--
X
X
X
O/E
X
X
O/E
X
X
X
SWAIM,
GINALIE
6/30/18
X
X
--
--
--
--
--
--
--
--
--
--
WAGNER,
6/30/18
X
X
-
FRANK
I Advisory Board/Commission Application Form
' - 1 rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
5/13/2019
First Name
Zac
Last Name
Builta
Home Address*
920 e burlington st apt 1
City
IOWA CITY
State
IA
Zip Code*
52242
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
3194324172
Email Address*
zac-builta@uiowa.edu
Boards & Commissions
Select a Board or Commission you are interested in:
Housing and Community Development
Commission(HCDC)
Select a Board or Commission you are interested in:
Historic Preservation Commission (HPC)
Historic Preservation Commission Category*
At -Large
Preference on first choice
IF rrultiple boards are being applied for.
Housing and Community Development Commission
How long have you been a resident of Iowa City?*
9 years
Occupation:*
research assistant/lab manager
Gender*
*This question is rrandatory in order for the City to comply with the state's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Demographics sectionof the application below.
W Male
F Female
Experience and/or activities which you feel qualifyyou for this position:*
I believe that my time living as a low income/at risk of homelessness resident of Iowa City has given me a
unique perspective. My living situations have fluctuated my entire life but especially the last decade in Iowa City
where my work or school was so varying. I have lived and dealt with multiple rental property businesses and
have dealt with a multitude of the problems that come into living in some of these locations. I was almost
evicted earlier this year after having been laid off from my work. I was able to secure work after using some of
the resources that Iowa City offers such as general assistance and the food bank for food.
While I was handling these obstacles I was also completing my third year as a commissioner on the historic
preservation commission where I served as vice chair for the last half year(I became vice chair before all of the
disaster that was my life really started kicking in and everything fell apart) and continued to be a contributing
member to the commission despite the personal and housing problems that I was facing. I enjoyed serving the
community as a member of this commission and thought it might be interesting to broaden my horizons and try
to serve the city and use my e>periences and perspective to improve conversations on lower income housing,
homelessness, and underemployment on the HCD.
What is your present knowledge of each advisory board you are interested in?*
The Housing and Community Development commission appears to be a commission that represents the
residents of Iowa City in regards to lower income housing and building a community that can help provide jobs
and opportunity to everyone regardless of socioeconomic class. This could be done through outreach,
programs, jobs assistance etc.
The Historic Preservation Commission is a group of representatives that review proposals from city residents
for updating, replacing, or repairing houses that are of historical value to the community. Other tasks this
commission take responsibility for are helping decide on historical preservation districts in the Iowa City area
and designating different houses and buildings as historically important to the character and architecture of
the city. Its because of this commission that the rich character of Iowa City has been preserved for so long
without letting an abundance of modern development and construction take away from that character.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
Yes
Board current serving on*
Historic Preservation Commission (HPC)
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
Country of Origin
Sexual Orientation
Religion
Do you have a disability?
Ethnicity
Race
Gender identity
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
I � t
-.-
""'®'�Advisory Board/Commission/Committee
CITY OF IOWA CITY Application Form
UNESCO CITY OF LITERATURE
This application is a public document and as such can be reproduced and distributed for the
public. This application will be considered for twelve months only and automatically
considered for any vacancy during that time.
Advisory Boar Commission ommitlee Name
Date of Application ,']1 /�
Name
Home Address
Contact phone numbe�f1?�Email Address�LOf'G�
Your home address m t be within the corporate limits of Iowa City? U J
How long have you lived in Iowa City?
Occupation: 4
Gender: Male Female Ll� '
Experiences and/or activities which you feel qualify you for this position:
What is your present knowledge of this advisory board?
CC1WVVt4.6GL1e110 fmy�,,) 2
c9 C
G7D t
.<r
v
What is your present knowledge of this advisory board?
CC1WVVt4.6GL1e110 fmy�,,) 2
Please contact the city attorney at 319-356-5030 to discuss questions or concerns regarding a
potential conflict of interest.
Potential Conflict of Interest
The Housing and Community Development Commission makes recotmnendations to the City
Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no
persons who exercise or have exercised any functions or responsibilities with respect to federally
funded activities, or who are in a position to participate in the decision—making process or gain
inside information with regard to such activities, may obtain a financial interest or benefit from a
federally -assisted activity, or have a financial interest in any contract, subcontract, agreement with
respect to the proceeds of the federally—assisted activity, either for themselves or those with whom
they have business or immediate family ties, during their tenure or for one year thereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions,
member of a city Board or Commission from having an interest in a city contract. Section 362.5
City Council Resolution #15-300 established a policy that the following persons shall not be
eligible for appointments to Boards and Commissions.
A council member's spouse, domestic partner or partner in cohabitation, children, step children,
children for whom the Council Member assumes parental responsibility, mother, father, son-in-law,
daughter-in-law, sister-in-law, grandparents, and grandchildren, aunt, uncle, niece, nephew, first
cousin, foster parent, poster child, persons who are parents of the same child, and persons whom the
employee is in an intimate relationship.
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one
reappointment to a full tern in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at tb4,same
time. You will be asked to resign from one if appointed to another.
L7 ao
Do you currently have a conflict of interest? YES NO J/
List potential conflicts of interest (See last page for information regarding conftictPnteist)
Please indicate if there are none. �a -D
r
Do you currently serve on another Iowa City board or commission? YES NO l'
If so which one do you prefer?
The City Council values all types of diversity on its boards and commissions. Your responses on
this page provide valuable information to the Council in achieving that goal.
In order to ensure that the board and commission is representative of the community and the
groups(s) which it serves; please provide your information for the following:
Age
Country of Origin
Sexual Orientation
Religion __
Do you have a disability? YEs NO
Race, Color or Ethnic Group �I
*Note:
The Human Rights Commission strives to ensure the Commission is representative of the
community. Therefore appointment shall take into consideration persons of various raci
religious, cultural, social and economic groups in the city. (Ordinance) al,
The Housing and Community Development Commission strives to satisfy its purpose and
intent, when possible to have at least one person with expertise in construction, at least one
person with expertise finance and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an appointee.
If you fail to answer all the questions, Council will not consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving. Contact information is attached.
ru
3 G
t
co
r-
-0
M
s
CD
KATE CORCORAN
20 Arbor Hill Circle 941 • Iowa City, IA 52245 • Cell: (206) 941-8733
kalccorcvgmiail_com
May 7, 2018
City Council
City of Iowa City
410 E. Washington St.
Iowa City, IA 52240
Re: Application for appointment as At Large Representative
Iowa City Historic Preservation Conunission
Dear members of the City Council:
As you may recall, I served as an At Large Representative on the City's Historic
Preservation Commission from 2013 to 2016, but was not reappointed when my term ended.
I'm writing today to tender my application for the at -large position that will be vacant July 1.
Here's what I'd bring to the position:
• substantive knowledge of historic preservation, including the related federal laws and
Iowa City ordinances
• understanding of the quasi-judicial process in which Commission members review
and make decisions on Certificate of Appropriateness applications
• a facility for gathering, digesting �tnci analyzing information quickly
• strong communication skills and the ability to resolve issues with courtesy, respect and
compassion
• high attention to detail, devotion to accuracy, and a talent for problem -solving
• a native Iowa Citian s love for her community
You are certain to have many qualified applicants, but I believe that my strong record of
public service, together with my maturity, collaborative nature and good judgment, makes me a
strong candidate for this appointment. Please allow me to bring my energy, high standards and
passion for historic preservation to the Commision.
Thank you for considering my application.
r6a
Sincerely yours, `?�
o
2.
t
Kate Corcoran j5 7
3
rO
rV
Q
KATE CORCORAN
20 Arbor Hill Circle #41 • Iowa City, IA 52245 • Cell: (206) 941-8733
katecorcCegrnail.coni
EXPERIENCE
12/17 -present KELLY SERVICES, INC. IOWA CITY, IOWA
Technical Editor, ACT, Inc.
As temporary employee, edit, rewrite and manage production process for scores of ACT
documents, forms, letters, booklets and test manuals.
8/16-11/16 2016 DEMOCRATIC CONSOLIDATED CAMPAIGN IOWA CITY, IOWA
Political Field Organizer — Rural Johnson County
Identified, recruited, trained and supervised volunteers in towns and rural areas in 13
Johnson County townships to make contact with community members and support the
election of national and state Democratic candidates. Planned, organized and executed
extensive phonebanking and canvassing operations, and made 200 recruitment calls a day.
8/15-4/16 UNIVERSITY OF IOWA PATIENT FINANCIAL SERVICES IOWA CITY, IOWA
Revenue Cycle Representative —Medicare Team
Gained mastery of Epic medical -record and accounts -receivable systems to timely correct
and file Medicare Part A and Part B hospital claims. Researched claims on Medicare online
billing website, identified coding errors/omissions, sent claims to appropriate UIHC
department for recoding and/or documentation of medical necessity, refiled claims, and
submitted appeals. Collaborated with patients, insurance carriers, and federal agencies to
resolve outstanding accounts receivable and credit balances.
10/13-1/2015 GENERAL DYNAMICS INFORMATION TECHNOLOGY CORALVILLE, IOWA
Customer Service Representative — Dual -trained in Medicare and Marketplace/Affordable Care Act
Used telephone, e-mail, Web browsers and multiple technology platforms simultaneously
to provide knowledgeable responses and resolve callers' issues. Explained Marketplace
and Medicare health insurance programs, rules, eligibility, enrollment, costs and coverage.
Provided referrals to federal and state agencies and organizations. As Medicare claims
specialist, traced and explained disposition of claims and appeals and interpreted HCPCS
codes. Completed online applications and enrollment in health insurance ancl&ug plans.
C7 =�
2010-2011 PFAU COCHRAN VERTETIS AMALA SEATttf�WATING'nN
Contract Attorney�
Worked for plaintiffs' firm specializing in representing victims of chit-A-Obd sAual abuse.
Completed special projects that included organizing and reviewinga-1� inTMely0
redacted discovery documents produced in civil cases filed in KingCFiy, ttyy shin.
2004-2010 UNIVERSITY OF WASHINGTON SEATTLE, WA'
Assistant Director for Public Service/Public Interest Programs
School of Law Center for Career Planning and Public Service, July 2007 —April 2010
As career coach, helped law students identify interests, research opportunities, and
prepare essays, resumes, and cover letters for internships, externships, clerkships, and full -
and part-time positions. Directed Olympia Fellows and Pro Bono programs.
Lecturer, School of Law, 2004-2006
Taught beginning and advanced courses in legal research and writing and introductory
lath= course for non -law students. Served on Curriculum and Admissions committees and
was faculty supervisor for 29 law students performing for -credit externships.
1998-2004 UNIVERSITY OF IOWA IOWA CITY, IOWA
Program Assistant, School of Journalism and Mass Communication
Directed school's career services and internship -for -credit programs. Educated and
advised students about careers and coached them as reporters, writers, designers,
photographers, and researchers; solicited employers and organized on -campus interview
programs; publicized internships and jobs; provided programming and opportunities for
students to network with media professionals and alumni; provided written and oral
references; nominated students for scholarships and awards; entered their work in national
contests. Administered internships for credit for about 60 students a year.
Summer'97 THE DAILY IOWAN IOWA CITY, IOWA
Writing Coach
Worked with 50 -member editorial staff of 20,000 -circulation University of Iowa student -
run newspaper. Wrote daily critique of paper, conducted individual coaching sessions
with editors, reporters, and designers, attended weekly editorial meetings, and was
available during daytime and evening hours to answer questions and give advice.
1996-2000 LAW OFFICE OF KATE CORCORAN IOWA CITY, IOWA
Attorney and Mediator
Fngaged in solo civil practice (part-time, 1998-2004) with emphasis on mediation.
Conducted mediations for Iowa Public Employment Relations Board with teachers, school
support personnel, police officers, sheriffs deputies, and county employees. Provided pro
bono mediation of divorce and custody cases in Johnson and Linn County District Court
and age, race, and sex discrimination cases filed with Iowa Civil Rights Commission.
1994-2001 UNIVERSITY OF IOWA IOWA CITY, IOWA
Adjunct Assistant Professor, School of Journalism and Mass Communication
Taught undergraduate and master's program courses in reporting and writing, editing,
legal reporting and persuasive writing. For seven semesters, taught adne
vanced gaziI
production class in which students wrote, shot for, edited and designeccL int�I onlineeditions of the School's biannual alumni magazine. yam. _< '•''
C}
1994-1996 IOWA SUPREME COURT U,
Executive Director, IOffi'a Suyreme Court Commission on Planning for the 2i t 4ntg � �'�i
Directed $250,000 strategic planning project on future of Iowa s judicir}TncOrg. rt d
and staffed two conferences for 72 -member commission, as well as monthly ra�etings held
by steering committee and five 12 -member teams; wrote grant proposals and &Rd fund-
raising; wrote press releases and handled media relations; researched and drafted
questions for public opinion survey; conducted focus groups with 141 court stakeholders;
traveled around Iowa to make presentations to judges, attorneys, court personnel and die
public; organized public hearings throughout the state; and was in charge of compiling,
editing, publicizing and disseminating commissions final report.
2
1992-1994 CHILDERS & FIEGEN, P.C. CEDAR RAPIDS, IOWA
Attorney
1991-1992
Associate in four -attorney firm that specialized in bankruptcy and commercial litigation.
Worked on state and federal court cases and administrative proceedings. Counseled
clients, drafted pleadings, motions, and briefs, conducted discovery, appeared at hearings
and trials, negotiated settlements, handled appeals and supervised law -student interns.
IOWA SUPREME COURT DAVENPORT, IOWA
Lao Clerk to Justice Linda K. Neuman
Researched and wrote bench memoranda on appeals of criminal, civil, administrative and
attorney discipline cases. During monthly "court week" at capitol in Des Moines, did
research, finalized opinions, and served as bailiff during oral arguments. Assisted with
research, writing and editing for speeches and other special projects.
Sunrmer'89 UNIVERSITY OF IOWA
1986-1988
1980s
1982-1983
IOWA CITY, IOWA
Research Assistant to Professor Mary L, Dadziak, College of Lacn>
Did legal and historical research. Tracked down cases, read articles and books, and wrote
memoranda. Edited drafts of scholarly articles and checked facts and citations. Read
French newspapers from 1930-1945 to research life of Josephine Baker in Europe for book.
UNIVERSITY OF IOWA IOWA CITY, IOWA
Associate Editor, Universihl News Ser vices
Covered law and business colleges, institute for Public Affairs and Division of Continuing
Education. Wrote news and feature articles for internal and external publications. Wrote
press releases and pitched university experts and stories to local, state, and national print
and broadcast media.
THE DAILY DISPATCH
MOLINE, ILLINOIS
Copy Editor, 2985
Edited stories and columns in news, features, editorial, business, farm and food sections;
wrote headlines and captions and designed page layouts.
Reporter/Hditor, 1984-1985 N
Worked three days a week in Rock Island bureau covering federal and ate c ts, police,
city, government, and schools. Two days a week, produced/edited "Ren 1kTder,� 12-p
zoned news supplement for Rock Island. Hired and supervised writer }1lannFcove
assigned stories and photos; did editing and page design. ��` 6 rte,
r
Business Reporter, 1980-1981
j
Covered industrial, banking, real estate, labor, retail and transportatior'rtsb�c`tor�f Quap
City economy. On weekends, did police and general assignment reporting. ro
RENDEZ-VOUS MAGAZINE
BRUSSELS, BELGIUM
Managing Editor
Responsible for editorial content of English-language monthly magazine. Recruited,
trained and supervised staff; assigned stories and artwork. Shot photos and wrote stories;
did copy editing, and designed pages.
1978-1980 CBS, INC.
1977-2006
1975-1976
1972-1973
1971-1972
NEW YORK, NEW YORK
Assistant Foreign Editor, CBS News, 1979-1980
One of four editors who assigned and supervised daily news coverage outside the U.S. by
CBS staff members in 12 foreign bureaus and stringers around the world. Responsible for
arranging coverage of international stories for use on regularly scheduled C13S neves and
radio programs, "60 Minutes," network documentaries and "specials."
Production Associate, CBS Reports (docwnentan/ division), 1978-19,79
Did research and handled production arrangements for "Inside Yesterday," an historical
documentary pilot program that aired in 1979 with Mike Wallace as correspondent.
Researcher, WCBS-TV, lall 1978
I Tired during "sweeps" to do research and off -air reporting for assignment desk and to
help produce special segments for evening newscasts.
FREELANCE WORK
UNITED STATES and EUROPE
Copy Editor Reporter and Writing Consultant
Edited and critiqued newspaper and magazine articles, book manuscripts, newsletters,
scholarly articles, non-fiction pieces and reports. Served as writing coach to students
working on special projects and dissertations. Judged writing and design contests. Wrote
news and features for magazines and newsletters. During summers of 2000 and 2001, did
stints on copy desks of Iowa City Press -Citizen and The Joplin (Mo.) Globe.
LEXINGTON SCHOOL DISTRICT
Teacher, Grade 4, Adams School
INTERNATIONAL SCHOOL OF LUSAKA
Teacher, Grade 4
LUSAKA BOYS' SCHOOL
7 eacher, Grade 5
LEXINGTON, MASSACHUSETTS
LUSAKA, ZAMBIA
LUSAKA, ZAMBIA
r.a
c�
1969-1971 INTERNATIONAL SCHOOL OF KUWAIT
'rxt�
VIVAI KUUgT
Teacher, elementary science and high school drama 1
VOLUNTEER WORK and PUBLIC SERVICE1- «
•Member, board of directors, Iowa City Friends of Historic PreservatizxJp1�- 014 rn
rese�secretary, 2017 -present Etia
• Member, Iowa City Historic Preservation Commission, 2013-2016 N
EDUCATION
• Member, Iowa City Board of Adjustment, 1996-1999; diairman, 1999-2000
• Volunteer Mediator, Sixth Judicial District Family Mediation Project, 1997-2001
• Volunteer Mediator, Johnson County Small Claims Court, 1997-1999
• State of Iowa Sixth District Judicial Nominating Commission, 1996-2000
• Participating Attorney, Iowa Volunteers Lawyer Project, 1992-1999
J.D., College of Law, University of Iowa, 1991
M.S., Graduate School of Journalism, Columbia University, 1978
B.A., College of Education, University of Iowa, 1970
4
I Advisory Board/Commission Application Form
' - 1 rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
4/3/2019
First Name
Michael
Last Name
Hajd u
Home Address*
828 Dearborn St
City
IOWA CITY
State
IA
Zip Code
52240
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
7852183943
Email Address*
mikeh441 @yahoo.com
Boards & Commissions
Select a Board or Commission you are interested in:
Historic Preservation Commission (HPC)
Historic Preservation Commission Category*
At -Large
Preference on first choice
If Tultiple boards are being applied for.
How long have you been a resident of Iowa City?*
Off and on 27 years. 3 years
this time
Occupation:*
Physician
Gender*
*This question is rrandatory in order for the City to comply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Derrographics sectionof the application below.
V Male
F Female
Experience and/or activities which you feel qualifyyou for this position:*
Have lived in Historic homes most of my life.
What is your present knowledge of each advisory board you are interested in?*
I have a reasonable idea of the role and duties of the commission.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate family ties, during their tenure or for one year thereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
64
Country of Origin
USA
Sexual Orientation
heterosexual
Religion
None
Do you have a disability?
No
Ethnicity
Hungarian
Race
White
Gender identity
Heterosexual
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
I
` - 1
Advisory Board/Commission Application Form
rY
I
This application is a public document and as such can be reproduced and distributed for
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY
considered for any vacancy during that time.
UNESCO CITY Of LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
5/8/2018
First Name
H
Last Name
Pedelty
Home Address*
1111 E Burlington ST
City
IOWA CITY
State
IA
Zip Code
52240
1. Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
319-325-3674
Email Address*
hpedelty@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Historic Preservation Commission (HPC)
Historic Preservation Commission Category*
At -Large
2. How long have you been a resident of Iowa City?*
25.5 years
3. Occupation:
Librarian
4. Gender*
*This question is rrandatory in order for the City to comply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Derrographics sectionof the application below.
V Male
F Female
5. Experience and/or activities which you feel qualify you for this position:*
I've owner occupied two properties in two historic districts (not at the same time) over the last 10 years. I'm an
avid admirer or the work being done to preserve these properties among the general blandness of new
construction. I'm a huge fan of the Univercity program, which I bought my current house from and look forward
restoring the exterior.
6. What is your present knowledge of each advisory board you are interested in?*
I read the agendas and minutes fairly regularly.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will
be asked to resign from one if appointed to another.
7. Do you currently have a conflict of Interest?*
No
8. Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
9. Age
44
10. Country of Origin
USA
11. Sexual Orientation
Heterosexual
12. Religion
non -denominational
13. Do you have a disability?
No
14. Ethnicity
English/German Mix
15. Race
Caucasian
16. Gender identity
Male
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
I)�
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
Drop-down
I Advisory Board/Commission Application Form
' - 1 rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
5/6/2019
First Name
Jordan
Last Name
Sellergren
Home Address*
1729 N Dubuque Rd
City
IOWA CITY
State
IA
Zip Code*
52245
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
3195207701
Email Address*
jsellergren@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Historic Preservation Commission (HPC)
Historic Preservation Commission Category*
At -Large
Preference on first choice
If Tultiple boards are being applied for.
How long have you been a resident of Iowa City?*
June 2012
Occupation:*
Art Director, Little Village
Gender*
*This question is mandatory in order for the aty to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Demographics sectionof the application below.
F Male
fJ Female
Experience and/or activities which you feel qualifyyou for this position:*
I'm an amateur historic preservation enthusiast. We purchased/saved our 1935 American Foursquare on N
Dubuque Rd in March 2018 after renting since August 2014 as the Palisades subdivision was built up around
it. Its historic barn in near -perfect condition was torn down and sold for parts. I would like to do what I can to
fight for and prevent other homes and structures from being destroyed.
What is your present knowledge of each advisory board you are interested in?*
From what I understand, commission members will attend weekly meetings at City Hall to discuss property -
owner proposals to update historic homes, review historic landmark designations and work on behalf of the
e)astence and preservation of historic structures in Iowa City.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
36
Country of Origin
USA
Sexual Orientation
Religion
Do you have a disability?
Ethnicity
Race
Gender identity
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
W
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
I
` - 1
Advisory Board/Commission Application Form
rY
I
This application is a public document and as such can be reproduced and distributed for
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY
considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
5/7/2018
First Name
Frank
Last Name
Wagner
Home Address*
519 S 1 st Ave
City
IOWA CITY
State
IA
Zip Code
52245
1. Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
3193217910
Email Address*
frankfwagnerphd@yahoo.com
Boards & Commissions
Select a Board or Commission you are interested in:
Historic Preservation Commission (HPC)
Historic Preservation Commission Category*
At -Large
2. How long have you been a resident of Iowa City?*
Lifelong
3. Occupation: *
General Contractor
4. Gender*
*This question is rrandatory in order for the City to comply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Derrographics sectionof the application below.
V Male
F Female
5. Experience and/or activities which you feel qualify you for this position:*
I have been a lifelong historic preservation advocate. Specifically I am a general contractor who works almost
exclusively on homes that fall under the "historic" category in Iowa City. I enjoy helping clients restore their
historic home and/or build additions that are sympathetic to their home's historic character.
6. What is your present knowledge of each advisory board you are interested in?*
I am very familiar with the duties and obligations of the historic preservation commission having served multiple
terms as an at -large member.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will
be asked to resign from one if appointed to another.
7. Do you currently have a conflict of Interest?*
No
8. Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
9. Age
54
10. Country of Origin
United States
11. Sexual Orientation
12. Religion
13. Do you have a disability?
No
14. Ethnicity
15. Race
16. Gender identity
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
ra e�_?Vor
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
Drop-down
I Advisory Board/Commission Application Form
' - 1 rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
4/3/2019
First Name
Austin
Last Name
Wu
Home Address*
422 S. Dubuque St. Apt. 21
City
IOWA CITY
State
IA
Zip Code
52240
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
319-654-4394
Email Address*
austin-wu@uiowa.edu
Boards & Commissions
Select a Board or Commission you are interested in:
Historic Preservation Commission (HPC)
Historic Preservation Commission Category*
At -Large
Preference on first choice
If Tultiple boards are being applied for.
How long have you been a resident of Iowa City?*
3 years
Occupation:*
University student, research assistant
Gender*
*This question is mandatory in order for the aty to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Demographics sectionof the application below.
V Male
r Female
Experience and/or activities which you feel qualifyyou for this position:*
Previous advocacy work in my hometown of Cedar Rapids with Save CR Heritage in 2018
Knowledge of city procedures and context behind designating local historic landmarks and districts during my
time as University of Iowa Student Liaison -Alternate from 2018-19
Personal interest in recording Iowa City history as seen in then -and -now photos on my Instagram page
(@theaustinwu)
What is your present knowledge of each advisory board you are interested in?*
It is to my knowledge that the Historic Preservation Commission conducts studies in order to identify and
designate historic districts and landmarks. It makes recommendations to the city council and other parts of city
government in order to preserve buildings of significant historic, cultural, and architectural value to the city.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate family ties, during their tenure or for one year thereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
20
Country of Origin
United States
Sexual Orientation
Heterosexual
Religion
Agnostic
Do you have a disability?
No
Ethnicity
Chinese/Korean
Race
Asian
Gender identity
Cisgender
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
O.tlf,1.1 ''weC
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
Item Number: 16.d.
+r
P_
W�rm�M
CITY O� IOWA CITY
www.icgov.org
May 21, 2019
Historic Preservation Commission (Jefferson 3Q - One vacancy to fill a
three-year term, July 1, 2019 - June 30, 2022. (New District formed - first
term not filled)
ATTACHMENTS:
Description
Vacancy Notice/Coversheet
Board Demographics/Attendance
Kiple, Lyndi -Application
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
HISTORIC PRESERVATION COMMISSION
Four Vacancies — Three Year Term
July 1, 2019 — June 30, 2022
(1)At Large Representative
(1) Brown St. Representative
(1) Jefferson St. Representative
(1) Summit St. Representative
• Duties of the Historic Preservation and Land Marks Commission include: conducting studies for
the identification and designation of Historic Districts; reviewing and acting upon all applications
for Certificate of Appropriateness; cooperating with property owners and city agencies regarding
remedy of dangerous conditions.
• Furthering the efforts of historic preservation in the City by making recommendations on
preservation issues, when appropriate, by encouraging the historical, architectural or cultural
value, and by encouraging persons and organizations to become involved in preservation
activities.
• Applicants for district representatives to the Historic Preservation Commission must reside in the
district that is specified.
• This Commission meets the second Thursday of each month at 5:30 p.m.
Iowa City appointed members of the boards and commissions must be 18 years of age and live in
Iowa City. The City of Iowa City encourages diversity in the appointment to boards and commissions.
Applications must be received by 5:00 p.m., Tuesday, May 14, 2019. An application can be
completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the
Clerk's office.
Questions about the Iowa City Historic Preservation Commission should be directed to Jessica
Bristow, Sr Planner at 356-5243. Application forms are available from the Clerk's office upon request or on
the City website at www.icgov.org.
Board/Commission Application Cover
Board/Commission: Historic Preservation Commission —Jefferson St.
One vacancy to fill a three-year term
07/01/2019 - 6/30/2022
It is hereby established, as a formal policy of the City Council of Iowa City, that each application for reappointment to
a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be
limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve.
Council Announcement Date: 4/2/2019
Application Deadline: 5/14/2019
Council Appointment Date: 5/21/2019
Date of Non -Gender Appointment: 7/2/2019
Gender Balance Requirement:
Current Gender Balance:
Gender
Female
After date above Council may appoint without regard to gender
4 -Female, 1 -Male
Female:2 Male:5
Name and Address
Kiple, Lyndi
115 N Dubuque St #1 Address is effective 7/26/19
Historic Preservation Commission -
Current members
Name
Term ending
FF years as
resident of
IC
Occupation
Gender
Age*
Country of
Origin*
Sexual
Orientation*
Religion*
Disability* Ethnicity*
Gender
Identity* Race* Unique Identifiers*
Kevin Boyd (At large) -Chair
6/30/2020 -2nd Term
25
Natl Political
Director
M
37
USA
LG BT
Not
practicing
White
Gosia Clore (Longfellow)
6/30/2020 -2nd Term
5
Research
Scientist
F
Thomas Agran (Northside)
6/30/2020 -2nd Term
8
Artist
M
30
USA
Straight
Caucasian
GT Karr (At large)
6/30/2020 -1st Term
38
Business Owner
M
38
USA
Hetrosexual
Christian
Caucasian
Quentin Pitzen (At large)
6/30/2021 -1st Term
44
Contractor
M
66
USA
Hetrosexual
White
Helen Burford (College Green)
6/30/2021 -1st Term
17
Retired
F
69
USA
Jewish
Caucasian
Lee Shope (Woodlawn)
6/30/2021 - 1st Term
59
Retired IT
M
77
USA
Male
Christian
American
Male White
VACANT (East College St.)
6/30/2021
VACANT (At -Large)
6/30/2022
VACANT (Brown St)
6/30/2022
VACANT (Jefferson St)
6/30/2022
VACANT (Summit St)
6/30/2022
Please note: The information provided is the information
provided on the
application at the time of submission.
* Information is voluntary
HISTORIC PRESERVATION COMMISSION
ATTENDANCE RECORD
2018-2019
NAME
TERM
EXP.
4/12
5/10
6/14
7/12
8/9
8/23
9/13
10/11
11/08
12/13
1/10
2/14
3/14
AGRAN, THOMAS
6/30/20
X
X
X
O/E
X
X
X
O/E
X
X
O/E
O/E
X
BAKER, ESTHER
6/30/18
X
X
X
--
--
--
--
--
--
--
--
--
--
BOYD, KEVIN
6/30/20
X
X
X
X
X
X
X
X
X
X
X
X
BUILTA, ZACH
6/30/19
X
X
X
X
X
X
X
X
X
X
X
X
X
BURFORD, HELEN
6/30/21
--
--
--
X
X
O/E
X
O/E
X
X
X
X
CLORE, GOSIA
6/30/20
X
X
X
X
O/E
O/E
X
O/E
X
X
O/E
X
X
DEGRAW, SHARON
6/30/19
X
X
X
X
O/E
X
X
X
X
X
X
O/E
X
KARR, G. T.
6/30/20
X
X
X
O/E
X
X
X
X
X
X
X
X
X
KUENZLI, CECILE
6/30/19
X
X
X
O/E
X
X
X
X
X
X
O/E
X
MICHAUD, PAM
6/30/18
X
X
X
--
--
--
--
--
--
--
--
--
--
PITZEN, QUENTIN
6/30/21
--
--
--
X
X
X
X
X
X
X
X
X
X
SHOPE, LEE
6/30/21
--
--
--
X
X
X
O/E
X
X
O/E
X
X
SWAIM, GINALIE
6/30/18
X
X
X
--
--
--
--
--
--
--
--
--
--
WAGNER, FRANK
6/30/18
X
X
X
--
--
--
Advisory Board/Commission/Committee Application
This application is a public document and as such can be reproduced and distributed for
CITY Of IOWA CITY the public. This application will be considered for twelve months only and automatically
UNESCO CITY OFLITERATURE considered for any vacancy during that time.
NOTE: Must be 18 years of Age and live within city limits of Iowa City to apply
Date of Application _ May 1, 2019
Which Board or Commission(s) are you interested in Historic Preservation (Jefferson St.)
Which one do you prefer?
Applicant Information:
First Name Lyndi
Home Address
City Iowa City
115 N. Dubuque Street, Unit I
Contact phone number
State IA
712-898-8174
Last Name wple
(Effective July 26, 2019)
Zip Code 52242
Email Address lyndi-kiple@uiowa.edu
1. Is your home address (listed above) within the corporate limits of Iowa City? YES X NO
2. How long have you been a resident of Iowa City? seasonally since 2017
3. Occupation:
student
4. Gender`
*This question is mandatory in order for the City to comply with the State's gender balance requirement
treats gender as binary "Gender Identity" may be provided in the demographics section of the application
below
[] Male
k,
W1 Female
0
�Oty e1% �4&
5. Experiences and/or activities which you feel qualify you for this position:
I am studying museum studies and I have a deep interest in physical history and its value to the
present. I have experience working in museums and educating people about the relevance of
protecting history. I have been visiting Iowa City since 2009 and I have always loved returning
because of its unique historic charm. I understand the city, its students, and its heart.
G. What is your present knowledge of each advisory board you are interested in?
I learned about this commission and its work through the first episode of the podcast, Iowa City
Matters. I listened to the challenges and the successes of the team in preserving historic
neighborhoods in the city. I also heard about this very position. It peaked my interest because I
feel I could offer a new perspective and a great passion to the group.
Please contact the city attorney at 319-356-5030 to discuss questions or concerns regarding a potential
conflict of interest. The following describe some but not all potential conflicts.
Potential Conflict of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise
or have exercised any functions or responsibilities with respect to federally funded activities, or who are in
a position to participate in the decision --making process or gain inside information with regard to such
activities, may obtain a financial interest or benefit from a federally -assisted activity, or have a financial
interest in any contract, subcontract, agreement with respect to the proceeds of the federally—assisted
activity, either for themselves or those with whom they have business or immediate family ties, during their
tenure or for one year thereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a
city Board or Commission from having an interest in a city contract. Section 362.5
City Council Resolution #15-300 established a policy that the following persons shall not be eligible for
appointments to Boards and Commissions.
A council member's spouse, domestic partner or partner in cohabitation, children, step children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-
law, sister-in-law, grandparents, and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent,
poster child, persons who are parents of the same child, and persons whom the employee is in an intimate
relationship.
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one
reappointment to a full term in order to increase the opportunities for new applicants to serve.
................................................................................................................................
i. Do you currently have a conflict of interest? YES NO X
Please identity any potential conflicts between membership on the advisory board and your personal
interests, including financial interests and your duties to an employerl List all businesses in which you or
your spouseldomestic partner, have an ownership interest (for example, sole proprietor, partner, a%a or more
of corporation's stockholdings).
List potential conflicts of interest (See above for information regarding conflict of interest)
Please indicate if there are none.
BUSINESS NAME
BUSINESS ADDRESS --�
'INV AX
\off
G�C\A
�o
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
S. Do you currently serve on another Iowa City board or commission? YES NO X
The City Council values all types of diversity on its boards and commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the board and commission is representative of the community and the groups(s)
which it serves, please provide your information for the following:
Demographic Information:
9. Age 20
United States of America
lU. Country of Origin _
11. Sexual Orientation heterosexual
12. Religion Christian
13. Do you have a disability? YES NO X
Caucasian
14. Ethnicity _
15. Race Caucasian
16. Gender Identity cisgender
Note:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social
and economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise finance
and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an appointee. if you
fail to answer all the questions, except demographics, Council will not consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving. Contact information is attached.
(rev. 11127/18)
+r
P_
W�rm�M
CITY O� IOWA CITY
www.icgov.org
May 21, 2019
Historic Preservation Commission (Summit St.
year term, July 1, 2019 - June 30, 2022. (Term
ATTACHMENTS:
Description
Vacancy/Coversheet
Board/Demographics/Attendance
Kuenzil, Cecile -Application
Item Number: 16.e.
- One vacancy to fill a three -
expires for Cecile Kuenzil)
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
HISTORIC PRESERVATION COMMISSION
Four Vacancies — Three Year Term
July 1, 2019 — June 30, 2022
(1) At Large Representative
(1) Brown St. Representative
(1) Jefferson St. Representative
(1) Summit St. Representative
• Duties of the Historic Preservation and Land Marks Commission include: conducting studies for
the identification and designation of Historic Districts; reviewing and acting upon all applications
for Certificate of Appropriateness; cooperating with property owners and city agencies regarding
remedy of dangerous conditions.
• Furthering the efforts of historic preservation in the City by making recommendations on
preservation issues, when appropriate, by encouraging the historical, architectural or cultural
value, and by encouraging persons and organizations to become involved in preservation
activities.
• Applicants for district representatives to the Historic Preservation Commission must reside in the
district that is specified.
• This Commission meets the second Thursday of each month at 5:30 p.m.
Iowa City appointed members of the boards and commissions must be 18 years of age and live in
Iowa City. The City of Iowa City encourages diversity in the appointment to boards and commissions.
Applications must be received by 5:00 p.m., Tuesday, May 14, 2019. An application can be
completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the
Clerk's office.
Questions about the Iowa City Historic Preservation Commission should be directed to Jessica
Bristow, Sr Planner at 356-5243. Application forms are available from the Clerk's office upon request or on
the City website at www.icgov.org.
Board/Commission Application Cover
Board/Commission: Historic Preservation Commission — Summit St.
One vacancy to fill a three-year term
07/01/2019 - 6/30/2022
It is hereby established, as a formal policy of the City Council of Iowa City, that each application for reappointment to
a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be
limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve.
Council Announcement Date: 4/2/2019
Application Deadline: 5/14/2019
Council Appointment Date: 5/21/2019
Date of Non -Gender Appointment: 7/2/2019
After date above Council may appoint without regard to gender
Gender Balance Requirement: 4 -Female, 1 -Male
Current Gender Balance: Female: 2 Male: 5
Gender Name and Address
Female Kuenzli, Cecile 151 Term ending 6/30/19
705 S. Summit St
Historic Preservation Commission -
Current members
Name
Term ending
FF years as
resident of
IC
Occupation
Gender
Age*
Country of
Origin*
Sexual
Orientation*
Religion*
Disability* Ethnicity*
Gender
Identity* Race* Unique Identifiers*
Kevin Boyd (At large) -Chair
6/30/2020 -2nd Term
25
Natl Political
Director
M
37
USA
LG BT
Not
practicing
White
Gosia Clore (Longfellow)
6/30/2020 -2nd Term
5
Research
Scientist
F
Thomas Agran (Northside)
6/30/2020 -2nd Term
8
Artist
M
30
USA
Straight
Caucasian
GT Karr (At large)
6/30/2020 -1st Term
38
Business Owner
M
38
USA
Hetrosexual
Christian
Caucasian
Quentin Pitzen (At large)
6/30/2021 -1st Term
44
Contractor
M
66
USA
Hetrosexual
White
Helen Burford (College Green)
6/30/2021 -1st Term
17
Retired
F
69
USA
Jewish
Caucasian
Lee Shope (Woodlawn)
6/30/2021 - 1st Term
59
Retired IT
M
77
USA
Male
Christian
American
Male White
VACANT (East College St.)
6/30/2021
VACANT (At -Large)
6/30/2022
VACANT (Brown St)
6/30/2022
VACANT (Jefferson St)
6/30/2022
VACANT (Summit St)
6/30/2022
Please note: The information provided is the information
provided on the
application at the time of submission.
* Information is voluntary
HISTORIC PRESERVATION COMMISSION
ATTENDANCE RECORD
2018-2019
NAME
TERM
EXP.
4/12
5/10
6/14
7/12
8/9
8/23
9/13
10/11
11/08
12/13
1/10
2/14
3/14
AGRAN, THOMAS
6/30/20
X
X
X
O/E
X
X
X
O/E
X
X
O/E
O/E
X
BAKER, ESTHER
6/30/18
X
X
X
--
--
--
--
--
--
--
--
--
--
BOYD, KEVIN
6/30/20
X
X
X
X
X
X
X
X
X
X
X
X
BUILTA, ZACH
6/30/19
X
X
X
X
X
X
X
X
X
X
X
X
X
BURFORD, HELEN
6/30/21
--
--
--
X
X
O/E
X
O/E
X
X
X
X
CLORE, GOSIA
6/30/20
X
X
X
X
O/E
O/E
X
O/E
X
X
O/E
X
X
DEGRAW, SHARON
6/30/19
X
X
X
X
O/E
X
X
X
X
X
X
O/E
X
KARR, G. T.
6/30/20
X
X
X
O/E
X
X
X
X
X
X
X
X
X
KUENZLI, CECILE
6/30/19
X
X
X
O/E
X
X
X
X
X
X
O/E
X
MICHAUD, PAM
6/30/18
X
X
X
--
--
--
--
--
--
--
--
--
--
PITZEN, QUENTIN
6/30/21
--
--
--
X
X
X
X
X
X
X
X
X
X
SHOPE, LEE
6/30/21
--
--
--
X
X
X
O/E
X
X
O/E
X
X
SWAIM, GINALIE
6/30/18
X
X
X
--
--
--
--
--
--
--
--
--
--
WAGNER, FRANK
6/30/18
X
X
X
--
--
--
I Advisory Board/Commission Application Form
' - 1 rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
5/13/2019
First Name
Cecile
Last Name
Kuenzli
Home Address*
705 South Summit St.
City
IOWA CITY
State
IA
Zip Code
52240
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
319-338-7362
Email Address*
cecile.kuenzli@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Historic Preservation Commission (HPC)
Historic Preservation Commission Category*
Summit St.
Preference on first choice
If Tultiple boards are being applied for.
How long have you been a resident of Iowa City?*
49 years
Occupation:*
Retired teacher
Gender*
*This question is mandatory in order for the aty to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Demographics sectionof the application below.
F Male
fJ Female
Experience and/or activities which you feel qualifyyou for this position:*
I am currently serving on the HPC so this application is to serve a second term on the commission.
Beyond that, I was the president of the Longfellow Neighborhood Association for several years many years
ago.
What is your present knowledge of each advisory board you are interested in?*
As I currently serve on the Historic Preservation Commission I am aware of its policies and procedures.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate family ties, during their tenure or for one year thereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
Country of Origin
Sexual Orientation
Religion
Do you have a disability?
No
Ethnicity
Race
Gender identity
Female
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
Item Number: 16J.
+r
P_
W�rm�M
CITY O� IOWA CITY
www.icgov.org
May 21, 2019
Historic Preservation Commission (Brown St.) - One vacancy to fill a three-
year term, July 1, 2019 - June 30, 2022. (Term expires for Sharon DeGraw)
ATTACHMENTS:
Description
Vacancy Notice/Coversheet
Board Demographics/Attendance
DeG raw, Sharon -Application
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
HISTORIC PRESERVATION COMMISSION
Four Vacancies — Three Year Term
July 1, 2019 — June 30, 2022
(1)At Large Representative
(1) Brown St. Representative
(1) Jefferson St. Representative
(1) Summit St. Representative
• Duties of the Historic Preservation and Land Marks Commission include: conducting studies for
the identification and designation of Historic Districts; reviewing and acting upon all applications
for Certificate of Appropriateness; cooperating with property owners and city agencies regarding
remedy of dangerous conditions.
• Furthering the efforts of historic preservation in the City by making recommendations on
preservation issues, when appropriate, by encouraging the historical, architectural or cultural
value, and by encouraging persons and organizations to become involved in preservation
activities.
• Applicants for district representatives to the Historic Preservation Commission must reside in the
district that is specified.
• This Commission meets the second Thursday of each month at 5:30 p.m.
Iowa City appointed members of the boards and commissions must be 18 years of age and live in
Iowa City. The City of Iowa City encourages diversity in the appointment to boards and commissions.
Applications must be received by 5:00 p.m., Tuesday, May 14, 2019. An application can be
completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the
Clerk's office.
Questions about the Iowa City Historic Preservation Commission should be directed to Jessica
Bristow, Sr Planner at 356-5243. Application forms are available from the Clerk's office upon request or on
the City website at www.icgov.org.
Board/Commission Application Cover
Board/Commission: Historic Preservation Commission — Brown St.
One vacancy to fill a three-year term
07/01/2019 - 6/30/2022
It is hereby established, as a formal policy of the City Council of Iowa City, that each application for reappointment to
a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be
limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve.
Council Announcement Date: 4/2/2019
Application Deadline: 5/14/2019
Council Appointment Date: 5/21/2019
Date of Non -Gender Appointment: 7/2/2019
After date above Council may appoint without regard to gender
Gender Balance Requirement: 4 -Female, 1 -Male
Current Gender Balance: Female: 2 Male: 5
Gender
Female
Name and Address
DeGraw, Sharon 11t Term ending 6/30/19
519 Brown St
Historic Preservation Commission -
Current members
Name
Term ending
FF years as
resident of
IC
Occupation
Gender
Age*
Country of
Origin*
Sexual
Orientation*
Religion*
Disability* Ethnicity*
Gender
Identity* Race* Unique Identifiers*
Kevin Boyd (At large) -Chair
6/30/2020 -2nd Term
25
Natl Political
Director
M
37
USA
LG BT
Not
practicing
White
Gosia Clore (Longfellow)
6/30/2020 -2nd Term
5
Research
Scientist
F
Thomas Agran (Northside)
6/30/2020 -2nd Term
8
Artist
M
30
USA
Straight
Caucasian
GT Karr (At large)
6/30/2020 -1st Term
38
Business Owner
M
38
USA
Hetrosexual
Christian
Caucasian
Quentin Pitzen (At large)
6/30/2021 -1st Term
44
Contractor
M
66
USA
Hetrosexual
White
Helen Burford (College Green)
6/30/2021 -1st Term
17
Retired
F
69
USA
Jewish
Caucasian
Lee Shope (Woodlawn)
6/30/2021 - 1st Term
59
Retired IT
M
77
USA
Male
Christian
American
Male White
VACANT (East College St.)
6/30/2021
VACANT (At -Large)
6/30/2022
VACANT (Brown St)
6/30/2022
VACANT (Jefferson St)
6/30/2022
VACANT (Summit St)
6/30/2022
Please note: The information provided is the information
provided on the
application at the time of submission.
* Information is voluntary
HISTORIC PRESERVATION COMMISSION
ATTENDANCE RECORD
2018-2019
NAME
TERM
EXP.
4/12
5/10
6/14
7/12
8/9
8/23
9/13
10/11
11/08
12/13
1/10
2/14
3/14
AGRAN, THOMAS
6/30/20
X
X
X
O/E
X
X
X
O/E
X
X
O/E
O/E
X
BAKER, ESTHER
6/30/18
X
X
X
--
--
--
--
--
--
--
--
--
--
BOYD, KEVIN
6/30/20
X
X
X
X
X
X
X
X
X
X
X
X
BUILTA, ZACH
6/30/19
X
X
X
X
X
X
X
X
X
X
X
X
X
BURFORD, HELEN
6/30/21
--
--
--
X
X
O/E
X
O/E
X
X
X
X
CLORE, GOSIA
6/30/20
X
X
X
X
O/E
O/E
X
O/E
X
X
O/E
X
X
DEGRAW, SHARON
6/30/19
X
X
X
X
O/E
X
X
X
X
X
X
O/E
X
KARR, G. T.
6/30/20
X
X
X
O/E
X
X
X
X
X
X
X
X
X
KUENZLI, CECILE
6/30/19
X
X
X
O/E
X
X
X
X
X
X
O/E
X
MICHAUD, PAM
6/30/18
X
X
X
--
--
--
--
--
--
--
--
--
--
PITZEN, QUENTIN
6/30/21
--
--
--
X
X
X
X
X
X
X
X
X
X
SHOPE, LEE
6/30/21
--
--
--
X
X
X
O/E
X
X
O/E
X
X
SWAIM, GINALIE
6/30/18
X
X
X
--
--
--
--
--
--
--
--
--
--
WAGNER, FRANK
6/30/18
X
X
X
--
--
--
r
Advisory Board/Ccmim, ission/Committee Application
This application is a public document and as such can be reproduced and distributed for
CITY OF tMA CITY the public. This application will be considered for twelve months only and automatically
UPISSCOa"r-sLTE - RATRf. considered for any vacancy during that time.
NOTE: !Aust be IS years of Age and live within city limits of Iowa City to apply
Bate of Applik ation m a 1 3. 2 019
Which Board or Commission(s) are you interested in _ � i_ S ttr i G _ ?re se rUCti•C lq G o hi m i SS i a'1
Which one do you prefer? _ J . C
1, Heart 1-nTorm tion:
BROWN -a)7% RiF T -
First Name S (l1 Q.P'o en - - - Last Name D-eCXa,..LA) ..
Home Addressm.........
CAN, Mate I A_ zip trade5 22 Li
Contact phony number 3 1q 9 3(o ...O C'�. Email t iddr+yss $ 41 ar
L. is your home address (listed above) within the corporate limits of Iowa City? YL S ✓ No
2. How long have you been a resident of Iowa City? _20 VtaxS
3. Occupation: 1preSS Printer i gobk Vj St6WLK
4. Gender* q
2019
r --ET r it}' 'C [ tit the .. ri n,, a= t iii C�', z
t
f✓
x r t -t�t.�
o Clerk
Male JGtl a City, Iowa
Female
. Experiences and/or activities which you feel qualify you for this positron.
l i v e i n eL In owu low► 1 i h )ri 00 o n 13vau Nn $A -re e-4-- -r awl
i rtj-CrcSkd : V1-�al�:►'�� Q av1
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abax} j�erch sl�lts, w►►naVAl
W In 1< S t rv-'r"( o n t+ PG +V'(
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44AA e4.SV +inarea 1^I Cass a"d. f.) r^
ih a. t-4!&tvkACe. h•vne
6. "� Tat is your present knowledge o each adr isory_ board you aro interested in"?
0 -on v e r LI E w, : Ii�nr w,'+ti t- N -J' S {-o✓ c G Pre s'err vee Wo r _
�dr+.%wA.�ss;u►l ; ►, Tow In'¢''15efwk Q S a 1+ PC
corn +-in ✓e t Yea it $ .
Please contact. the city attorney at 319-35,r -5030 to discuss questions or concerns regardiag a potential
cola4lict oC illierest. The fol ov<ing describe some but not all p tenth -1 co_wfflets.
Potential Conflict of interest
The Housing and Community Development Commission makes recommendations tc��t�Yel�t}� ount it
regarding the distribution of federal CBDG/HOME funds. The general rule is that no per top ercise
or have exercised any functions or responsibilities with respect to federally funded ac��� � � in
a position to participate: in the decision --making process or gain inside information with regard to such
activities, may obtain a financial interest or benefit from. a federally -assisted activity, or have a financial
interest in any contract, subcontract, agreement with respect to the: proceeds of the federally—assisted
activity, either for themselves or those with whore they have business or immediate family ties, during their
tenure or for one year thereafter.
Section 362.5 of the Cache of Iowa generally prohibits, with certain important exceptions, a member of a
city Board or Commission from hax ing an interest in a city contract. Section 362.5
City Council Resolution 15-300 established a policy that the following persons shall not be eligible for
appointments to Boards and Commissions.
A, council member's sponse, domestic partner or partner in cohabitation, children, step children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, slaughter-ir-
law, sister-in-law, grandparents, and grandchildren, aunt, uncle, niece, nephew, 'fist cousin. foster parent,
poster child, persons who are parents of the same child, and persons whom the employee is in an intimate
relationship.
Res. 15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. if reappointed, an individual would be limited tcj one
reappointment to a full term in order to increase the opportunities for new applicants to senc:.
..............a..........'...........i...e..........t.[......I.....r............#..........is...................... ^A#.... ...........
7. Do you currently have a conflict of interest? YES NO
Please identify any potcntlai conflicts between membership on the advisory bortr i and your porsonai
interests, including financial interests and your deities to an er plea erl List all businesses in which you or
your oouse/do mestic partner. have an owner h: p interest (for example. style proprietor. partner. % or mare
of corporation's stockholdings),
List potential conflicts of interest (See above for information regarding conflict of interest)
Please indicate if there are none.
B BU914S9 N Ml
BUSINESS ADDRESS
_ _...... ..._...........� �-
%ftowN STREET lowX crT
CoLnin'.! po!icy ;'s no"', to perin't an ind;%-'idi-;o�to!crve on. tv-.o Boer& en sanje
time. Y-Z;L w'+ beaskeLo riaislgn From cwi ?i .4174poin%lc;� ionrother.
8. Do you currently serve on another Iowa City board or commission? YES NO
The City Council values all types of diversity on its boards and commissions. Your responses on this pagk:
provide valuable information to the Council in achieving that goal. Copnon sffeG
In order to ensure that the board and commission is representative of the community and the groups(s)
which it serves, please provide your information for the following -
Demographic Informafion*
9. '-ve 51- MAY 13 2019 't'' tgp
10. Country of Origin
City Clerk
11. Sexual Orientation Iowa City, Iowa
. ...........
12. h oh f,
13. Do you have a disability? YES_ NO
14Ethnicity _DAA.VCk%,AVS cxe.f M A—AnIR-M-5,51i &,h j P61 i 0% if f4 0A Avn.
15. Race -e
16. Gender Identity IF
Note:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of vanous racial, religious, cultural, social
and economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise finance
and one person who receives rental assistance. (Resolution)
Signature of Applicant* PAYMwkJ—
Misrepresentations on this application will constitute just cause for removal of an appointee. If you
fail to answer all the questions, except demographics, Council will not consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving. Contact information is attached,
(rev. 11/27/18)
Item Number: 16.g.
i
CITY OE IOWA CITY
www.icgov.org
May 21, 2019
Housing & Community Development Commission -Two vacancies to fill a
three-year term, July 1, 2019 - June 30, 2022. (Term expires for Christine
Harms, Paula Vaughan)
ATTACHMENTS:
Description
Vacancy/Coversheet
Board Demographics/Attendance
Builta, Zac -Application
Conaway, Samuel -Application
Coulter, Joe- Application
Drabek, Matt- Application
Erb Firmstone, Liz -Application
Kealey, Lyn Dee Hook- Application
Mohammed, Nasr - Application
Mohammed, Wifag -Application
Schemahorn, Kade -Application
Stamus, Lynne -Application
Taylor, Angel - Application
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
HOUSING & COMMUNITY DEVELOPMENT COMMISSION
Two Vacancies — Three Year Terms
July 1, 2019 — June 30, 2022
• Duties of the Housing and Community Development Commission include assessing and
reviewing policies and planning documents related to the provision of housing, jobs, and
services for low- and moderate -income residents;
• reviewing policies and programs of the Public Housing Authority and Community
Development Division and make recommendations regarding the same to the City Council;
• reviewing and making recommendations to the City Council regarding the use of public funds
to meet the needs of low- and moderate -income residents; housing policies and programs,
and seeking public participation in assessing needs and identifying strategies to meet these
needs; recommending to the City Council from time -to -time amendments, supplements,
changes, and modifications to the Iowa City Housing Code.
• The Housing and Community Development Commission will have monthly meetings.
Iowa City -appointed members of boards and commissions must be at least 18 years of age and live in
Iowa City. The City of Iowa City encourages diversity in the appointment of citizens to boards and
commissions. When possible, Council will appoint persons with expertise in construction and/or
finance, a person receiving rental assistance, and a member of the Local Homeless Coordinating
Board.
Applications must be received by 5:00 p.m., Tuesday May 14, 2019. An application can be completed
and submitted on the City of Iowa City website at www.icgov.org.or by contacting the Clerk's office.
Questions about the Iowa City Housing and Community Development Commission should be directed
to Kirk Lehman, Community Development Planner at 356-5247.
I (.
Late Handouts Distributed
Board/Commission Application Cover
5-a o--
Board/Commission: Housing and Community Development Commif ,``ljlCDC)
Two vacancies to fill a three-year full term ��
7/1/2019 - 6/30/2022
It is hereby established,as a formal policy of the City Council of Iowa City,that each application for reappointment to
a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be
limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve.
Council Announcement Date: 4/2/2019
Application Deadline: 5/14/2019
Council Appointment Date: 5/21/2019
Date of Non-Gender Appointment: 7/2/2019
After date above Council may appoint without regard to gender
Gender Balance Requirement: 1-Female, 1-None
Current Gender Balance: Female: 3 Male: 4
Gender Name and Address
Male Builta, Zac 1st Term expiring on HPC 6/30/19
920 E Burlington St Apt 1
Male Conaway, Samuel
2643 Westwinds Dr Apt#4
Male Coulter,Joe
1818 N Dubuque St
Male Drabek, Matt
815 N Johnson St
Female ; Erb Firmstone, Liz
265 N Westminister St
Female Kealey, Lyn Dee Hook
1900 Ridgeway Dr
Male Mohammed, Nasr
505 Westwinds Dr
Female Mohammed, Wifag
758 Westwinds Dr Apt 4
Male Schemahorn, Kade
1111 Keokuk St
Female Stamus, Lynne
218 Russell Ave
Female Taylor, Angel
2247 Plaen view drive
Board/Commission Application Cover
Board/Commission: Housing and Community Development Commission(HCDC)
Two vacancies to fill a three-year full term
7/1/2019- 6/30/2022
It is hereby established,as a formal policy of the City Council of Iowa City,that each application for reappointment to
a City Board or Commission will be considered without regard to incumbency. If reappointed,an individual would be
limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve.
`7
Council Announcement Date: 4/2/2019
Application Deadline: 5/14/2019
Council Appointment Date: 5/21/2019
Date of Non-Gender Appointment: 2/2019
A r date above Council may appoint without regard to gender
Gender Balance Requirement: 1-Female, 1-None
Current Gender Balance: Female: • Male:4
Gender Name and Address
Male Builta, Zac rt Term expring 6/30/19
920 E Burlington St Apt 1
Male Conaway, Samuel
2643 Westwinds Dr Apt#4
Male Coulter,Joe
1818 N Dubuq - St
Male Drabek, Mat
815NJoh on St
Female Erb Fir r tone, Liz
265 estminister St
Female Ke.ley, Lyn Dee Hook
1900 Ridgeway Dr
Male / Mohammed, Nasr
• 505 Westwinds Dr
Female Mohammed, Wifag
758 Westwinds Dr Apt 4
Male Schemahorn, Kade
1111 Keokuk St
Female Stamus, Lynne
218 Russell Ave
Female 1 Taylor,Angel
1 2247 Pli,ry drive i
Housing & Community Development - Current members
Name
Term ending
# years as
resident of IC
Occupation
Gender
Age*
Country of
Origin*
Sexual
Orientation*
Religion*
Disability*
Ethnicity*
Gender
Identity*
Race*
Unique Identifiers*
Charles Eastham
6/30/2020 -1st Tei
45
M
John W McKinstry
6/30/2020 - 2nd Ti24
Retired Pastor
M
66
USA
Heterosexual
Mainline
Protestant
Midwestern
Caucasian
Vanessa Fixmer-Oraiz
6/30/2020-1st Tei
4.5
Planner
F
38
USA
Queer
Spiritual
Filipino-
American
Megan Alter
6/30/2021-1st Tei
23
ACT Manger
F
48
USA
Straight
None
N European
Female
White
Mitchell Brouse
6/30/20211stTeri
6
Planner JC
M
27
USA
Straight
Male
White
Maria Padron
6/30/2021-1st
Term +unexpired
10
Designer
F
42
Argentia
Heterosexual
None
Hispanic
Female
Mixed
Peter Nkumu
6/30/2022
Unexpired + Full
Term
16
Johnson County
M
51
Democratic
Republic of
Congo
Straight
Christian
Non white
Male
Black
African
VACANT
6/30/2022
VACANT
6/30/2022
Please note: The information provided is the information provided on the application at the time of submission.
* Information is voluntary
Housing and Community Development Commission
April 24, 2019
Page 3 of 3
Housing and Community
Development Commission
Attendance Record
Name
Terms Exp.
7/10
9/20
10/11
11/15
12/20
1117
2121
3114
4/18
4/24
Alter, Megan
7/1/21
X
X
X
X
X
X
X
X
O/E
X
Brouse, Mitch
7/1/21
X
X
X
X
X
X
X
0/E
X
X
Eastham, Charlie
7/1/20
X
X
X
X
X
X
X
X
X
X
Fixmer-Oraiz, Vanessa
7/1/20
X
O/E
X
X
X
O/E
X
X
O/E
X
Harms, Christine
7/1/19
X
X
X
X
X
X
X
X
X
X
Lamkins, Bob
7/1/19
O/E
O/E
X
O/E
O/E
McKinstry, John
711/17
X
X
X
X
X
X
X
X
O/E
X
Nkumu, Peter
6/30/22
X
X
Padron, Maria
7/1/20
X
X
O/E
O/E
X
X
X
X
O/E
X
Vaughan, Paula
7/1/19
X
X
X
X
X
X
X
X
X
X
4 Not on the Commission
Key:
X
= Present
0
= Absent
O/E
= Absent/Excused
---
= Vacant
I Advisory Board/Commission Application Form
' - 1 rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
5/13/2019
First Name
Zac
Last Name
Builta
Home Address*
920 e burlington st apt 1
City
IOWA CITY
State
IA
Zip Code*
52242
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
3194324172
Email Address*
zac-builta@uiowa.edu
Boards & Commissions
Select a Board or Commission you are interested in:
Housing and Community Development
Commission(HCDC)
Select a Board or Commission you are interested in:
Historic Preservation Commission (HPC)
Historic Preservation Commission Category*
At -Large
Preference on first choice
IF rrultiple boards are being applied for.
Housing and Community Development Commission
How long have you been a resident of Iowa City?*
9 years
Occupation:*
research assistant/lab manager
Gender*
*This question is rrandatory in order for the City to comply with the state's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Demographics sectionof the application below.
W Male
F Female
Experience and/or activities which you feel qualifyyou for this position:*
I believe that my time living as a low income/at risk of homelessness resident of Iowa City has given me a
unique perspective. My living situations have fluctuated my entire life but especially the last decade in Iowa City
where my work or school was so varying. I have lived and dealt with multiple rental property businesses and
have dealt with a multitude of the problems that come into living in some of these locations. I was almost
evicted earlier this year after having been laid off from my work. I was able to secure work after using some of
the resources that Iowa City offers such as general assistance and the food bank for food.
While I was handling these obstacles I was also completing my third year as a commissioner on the historic
preservation commission where I served as vice chair for the last half year(I became vice chair before all of the
disaster that was my life really started kicking in and everything fell apart) and continued to be a contributing
member to the commission despite the personal and housing problems that I was facing. I enjoyed serving the
community as a member of this commission and thought it might be interesting to broaden my horizons and try
to serve the city and use my e>periences and perspective to improve conversations on lower income housing,
homelessness, and underemployment on the HCD.
What is your present knowledge of each advisory board you are interested in?*
The Housing and Community Development commission appears to be a commission that represents the
residents of Iowa City in regards to lower income housing and building a community that can help provide jobs
and opportunity to everyone regardless of socioeconomic class. This could be done through outreach,
programs, jobs assistance etc.
The Historic Preservation Commission is a group of representatives that review proposals from city residents
for updating, replacing, or repairing houses that are of historical value to the community. Other tasks this
commission take responsibility for are helping decide on historical preservation districts in the Iowa City area
and designating different houses and buildings as historically important to the character and architecture of
the city. Its because of this commission that the rich character of Iowa City has been preserved for so long
without letting an abundance of modern development and construction take away from that character.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
Yes
Board current serving on*
Historic Preservation Commission (HPC)
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
Country of Origin
Sexual Orientation
Religion
Do you have a disability?
Ethnicity
Race
Gender identity
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
I Advisory Board/Commission Application Form
' - rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
5/1/2019
First Name
Samuel
Last Name
Conaway
Home Address*
2643 Westwinds Dr. Apt #4
City
IOWA CITY
State
IA
Zip Code
52246
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
3199300791
Email Address*
saconaway4@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Housing and Community Development
Commission(HCDC)
Select a Board or Commission you are interested in:*
Community Police Review Board (CPRB)
Preference on first choice
If rrultiple boards are being applied for.
Housing and Community Development Commission
How long have you been a resident of Iowa City?*
26 Years
Occupation:*
PATH Provider for Johnson County/BSW Abbe Center
Gender*
*This question is rrandatory in order for the City to comply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Derrographics sectionof the application below.
V Male
F Female
Experience and/or activities which you feel qualifyyou for this position:*
I work with individuals experiencing homelessness and at risk of homelessness that have a serious mental
illness and a serious mental illness and co-occurring substance abuse disorder. I work on assisting my clients
obtaining housing within Johnson County and primarily the Iowa City Metro Area. I have knowledge of the rental
market within Johnson County.
What is your present knowledge of each advisory board you are interested in?*
I am not as familiar with the Housing and Community Development board; however I feel I would be a great
advocate for less served populations. From my brief understanding, it is the role of the board to advocate for
people under served in Iowa City area and develop plans for sustainable housing as well as allocating money
for local social service agencies to improve or procure housing for clients; either living in a shelter or a
habilitation/transitional housing.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
31
Country of Origin
United States
Sexual Orientation
Cisgender
Religion
Non -religious
Do you have a disability?
No
Ethnicity
Hispanic
Race
White
Gender identity
NA
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
I Advisory Board/Commission Application Form
' - 1 rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
1/22/2019
First Name
Joe
Last Name
Coulter
Home Address*
1818 N DUBUQUE ST
City
IOWA CITY
State
IA
Zip Code*
52245
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
319 594 9191
Email Address*
coulter.joe.d@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Housing and Community Development
Commission(HCDC)
Preference on first choice
If Tultiple boards are being applied for.
How long have you been a resident of Iowa City?*
34 years
Occupation: *
Professor Emeritus
Gender*
"This question is mandatory in order for the Oty to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" xray
be provided in the Demographics sectionof the application below.
V Male
r Female
Experience and/or activities which you feel qualifyyou for this position:*
Previous Service: Ad Hoc Diversity Committee
Human Rights Commission
Current: City Managers Roundtable
What is your present knowledge of each advisory board you are interested in?*
Meetings/discussions with HCDC staff, Kirk Lehmann., and HCDC Member Charles Eastham.
Reviews of HCDC Minutes.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate family ties, during their tenure or for one year thereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
74
Country of Origin
United States
Sexual Orientation
Male
Religion
Native
Do you have a disability?
No
Ethnicity
Race
White/American Indian
Gender identity
Male
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
I Advisory Board/Commission Application Form
' - 1 rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
1/30/2019
First Name
Matt
Last Name
Drabek
Home Address*
815 N Johnson St
City
IOWA CITY
State
IA
Zip Code*
52245
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
502-693-2926
Email Address*
matt.drabek@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Housing and Community Development
Commission(HCDC)
Preference on first choice
If Tultiple boards are being applied for.
How long have you been a resident of Iowa City?*
11+ years
Occupation: *
Content Specialist/Non-Profit Educational Management
Gender*
"This question is mandatory in order for the 0ty to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Demographics sectionof the application below.
rJ Male
r Female
Experience and/or activities which you feel qualifyyou for this position:*
I've lived in Iowa City 11+ years, first as a student and faculty member of the University of Iowa, and later
as an employee of one of Iowa City's largest non -university employers. As someone who has experienced
Iowa City both as a new resident and as a member of the community, I hope to be able to speak with people
of very different backgrounds and situations.
I've organized in the community around several issues, mostly notably issues of gender and sexuality, though
more recently issues of housing. I'm currently the research organizer of a local group working with tenants in
Iowa City. Among other things this involves reviewing local reports on housing needs, existing housing supply,
income and rental price changes over time, and racism and racial discrimination in housing. This work gives
me a good sense, at the outset, of the scope of existing issues.
What is your present knowledge of each advisory board you are interested in?*
I know the Housing and Community Development Commission as a group that works for serving the housing,
employment, and service needs of lower income residents of Iowa City. It does this through reviewing existing
offerings, making recommendations regarding the use of funds, and publicizing and building connections
between the community and city government and programs. I see this commission as having a particularly
community -grounded and collaborative role, including collaboration with other city entities (e.g., Housing
Authority).
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
35
Country of Origin
USA
Sexual Orientation
Queer
Religion
None
Do you have a disability?
No
Ethnicity
White
Race
White
Gender identity
Man
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
I Advisory Board/Commission Application Form
' - rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
5/8/2019
First Name
Liz
Last Name
Erb Firmstone
Home Address*
265 N Westminster St
City
IOWA CITY
State
IA
Zip Code
52245
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
3195415292
Email Address*
lizfirmstone@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Housing and Community Development
Commission(HCDC)
Preference on first choice
If rrultiple boards are being applied for.
How long have you been a resident of Iowa City?*
9 years
Occupation:*
Real Estate Professional
Gender*
"This question is mandatory in order for the CJty to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Demographics sectionof the application below.
F Male
r1 Female
Experience and/or activities which you feel qualifyyou for this position:*
I have always been keenly interested in community development and looking for ways to improve and enhance
the amenities and services that government can offer that have a positive impact on the community and the
people who live in it. I stay informed and have been an active volunteer in the various cities in which I have
lived. I served on the Park and Recreation Board in South Elgin, IL and have management and teaching work
experience in large corporations as well as experience running my own business. I would be happy to share my
resume with you upon request. Most importantly, I care deeply about the community I call "home" and wish to
make it the best it can be!
What is your present knowledge of each advisory board you are interested in?*
General knowledge as an interested community member who follows trends and developments within Iowa City.
I had the pleasure of meeting with Stefanie Bowers and Tracy Hightshoe this past February at which time they
suggested that the Housing and Community Development Commission would be a good fit for me.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate family ties, during their tenure or for one year thereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
48
Country of Origin
United States
Sexual Orientation
Religion
None
Do you have a disability?
No
Ethnicity
Race
Caucasian
Gender identity
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
I Advisory Board/Commission Application Form
' - 1 rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
4/30/2019
First Name
Lyn Dee Hook
Last Name
Kealey
Home Address*
1900 Ridgeway Drive
City
IOWA CITY
State
IA
Zip Code*
52245
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
3193254232
Email Address*
lyndeekealey@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Housing and Community Development
Commission(HCDC)
Preference on first choice
If Tultiple boards are being applied for.
Housing and Community Development then Library, Board
of Trustees
How long have you been a resident of Iowa City?*
2006
Occupation:*
Social Worker LISW
Gender*
"This question is rrandatory in order for the aty to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" xray
be provided in the Derrographics sectionof the application below.
F Male
I7 Female
Experience and/or activities which you feel qualify you for this position:*
I have had my Master's Degree in Social Work (Integrated Practice) since 1995 (24 years). I have been
working as a social worker on the burn/trauma unit since that time. I have also covered the ER, surgical
intensive care unit as well as other floors and clinics. I work with all age groups (pediatrics and adults).
My social work background has led me to work with all cultural groups that are represented in Iowa City and
beyond. I work regularly with people who do not speak English and who need complex health care and/or may
have financial needs as well.
I do crisis intervention and management on a daily basis. I setup long-term plans for patients as well. I have led
support groups; been on the executive committee of our department for many years; ;much program
development and been on the board for the Iowa Chapter of the National Association of Social Workers. I have
supervised many BSW and MSW SW interns as well as trained new staff. I have presented at national
conferences.
My patient population is extremely complex with patient and family situations that are devastating. The stress is
high and constant. Working in this type of environment is wrought with controversy (at all levels). I feel that this
background is something that will assist me in working with other commission members, city staff as well as the
community at large.
I truly love identifying, discussing and implementing ideas within groups/agencies/systems. I look forward to
bringing my skills to this city.
What is your present knowledge of each advisory board you are interested in?*
I have read through the minutes of HCDC for 2019 and it appears that the commission makes
recommendations that are submitted to the City Council on financial assistance and aid (housing, jobs and
services) that will benefit moderate to low income residents of Iowa City. This commission meets monthly and is
a three year commitment.
I have also read through the notes from 2019 for the Library Board. My understanding for this board is that this
is a six year commitment that they meet monthly. It is semi -autonomous. State Law provides that the Board will
direct, plan and control the affairs of the library.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate family ties, during their tenure or for one year thereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
55
Country of Origin
United States
Sexual Orientation
heterosexual
Religion
Lutheran/Protestant
Do you have a disability?
No
Ethnicity
Caucasian
Race
White
Gender identity
female
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
I Advisory Board/Commission Application Form
' - 1 rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
5/13/2019
First Name
Nasr
Last Name
Mohammed
Home Address*
505 Westwinds Dr
City
IOWA CITY
State
IA
Zip Code
52246
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
5156125795
Email Address*
oshar2008@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Housing and Community Development
Commission(HCDC)
Preference on first choice
If Tultiple boards are being applied for.
How long have you been a resident of Iowa City?*
6 Years
Occupation: *
QA Associate
Gender*
"This question is mandatory in order for the Oty to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" xray
be provided in the Demographics sectionof the application below.
V Male
r Female
Experience and/or activities which you feel qualifyyou for this position:*
Member of Sudanese Community Center, Former member of Phi Theta Kappa, participating in the Habitat for
Humanity Women Build Project.
What is your present knowledge of each advisory board you are interested in?*
Housing and Community Development Commission is responsible for reviewing policies related to housing in
Iowa City and making recommendation to the City Council members to make the correct and fair decisions.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
39
Country of Origin
Sudan
Sexual Orientation
Heterosexuality
Religion
Islam
Do you have a disability?
No
Ethnicity
African American
Race
Black
Gender identity
Male
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
I Advisory Board/Commission Application Form
' - 1 rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
5/13/2019
First Name
Wifag
Last Name
Mohammed
Home Address*
758 Westwinds Dr Ap4
City
IOWA CITY
State
IA
Zip Code
52246
Is your home address (listed above) within the corporate limits of Iowa City?*
Not Sure
Contact Phone Number*
9733937738
Email Address*
mohammedWfag@yahoo.com
Boards & Commissions
Select a Board or Commission you are interested in:
Human Rights Commission
Select a Board or Commission you are interested in:
Civil Service Commission
Select a Board or Commission you are interested in:
Housing and Community Development
Commission(HCDC)
Preference on first choice
IF maltiple boards are being applied for.
Human rights
How long have you been a resident of Iowa City?*
2 years
Occupation:*
Hospitality double tree hotel
Gender*
*This question is rrandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Demographics sectionof the application below.
r Male
V Female
Experience and/or activities which you feel qualifyyou for this position:*
Have workexperience for 10 years of activist of human rights in sudan
What is your present knowledge of each advisory board you are interested in?*
It's inter cultural and biolangular community as I used to live with and communicate during my life in the USA
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate family ties, during their tenure or for one year thereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
41
Country of Origin
Sudan
Sexual Orientation
Female
Religion
Muslim
Do you have a disability?
No
Ethnicity
Black
Race
African
Gender identity
Female
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
ila�
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
I Advisory Board/Commission Application Form
' - 1 rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
4/30/2019
First Name
Kade
Last Name
Schemahorn
Home Address*
1111 Keokuk St
City
IOWA CITY
State
IA
Zip Code
52240
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
5038698462
Email Address*
citizenkade@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Housing and Community Development
Commission(HCDC)
Preference on first choice
If Tultiple boards are being applied for.
How long have you been a resident of Iowa City?*
6 years
Occupation: *
User Experience Design
Gender*
"This question is mandatory in order for the CJty to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Demographics sectionof the application below.
17 Male
r Female
Experience and/or activities which you feel qualifyyou for this position:*
Long time interest in what makes policies both effective and just in the areas of urban planning, housing, and
community development.
Professional training and experience in the following areas:
- Qualitative research and data analysis
- Systems thinking and design
- Participatory workshop facilitation
- Data visualization
Regular volunteer at Fairweather Lodge, associated with Shelter House
I try to approach my responsibilities with honesty, integrity, attention, and care.
What is your present knowledge of each advisory board you are interested in?*
Only the publicly available information about the commission, including information sent via the email
subscription.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate family ties, during their tenure or for one year thereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
34
Country of Origin
United States
Sexual Orientation
Straight
Religion
Agnostic
Do you have a disability?
No
Ethnicity
Not Hispanic or Latino
Race
White
Gender identity
Male
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
It
IMR�W Advisory Board/Commission/Committee
CITY of 10WA CITY Application Form
UNESCO CITY OF LITERATURE
This application is a public document and as such can be reproduced and distributed for the
public. This application will be considered for twelve months only and automatically
considered for any vacancy during that time.
Advisory Board/Commission/CommitleeNa,neNC> !S 3 �C ni L,.1000.e4' Cornr��SS�"i
Date of Application
Name U 02 M 5
Home Address ZC/jj (�
,
Contact phone number 3 /�% - _� i ;2,
Your home address must be within the corporate limits of Iowa City?
How long have you lived in Iowa City? /,.,
r
y„
Occupation: 62 Z�
Gender: Male Femaie
Experiences and/or activities which you feel qualify you for 's osi ' n:
I%t_L,
a �t ✓ u��rr .e_� esti Et t 2A -z -c. X 'Fn
°
t Gd �t�LFr
hat is yCfYil /GG L��Pi
V c res owledge of this advisory board? �NA>(—
C
a� x
67(
�� 1
✓.J
Please contact the city attorney at 319-356-5030 to discuss questions or concerns regarding a
potential conflict of interest.
Potential Conflict of Interest
The Housing and Community Development Commission makes recommendations to the City
Council regarding the distribution of federal CBDGlHOME funds. The general rule is that no
persons who exercise or have exercised any functions or responsibilities with respect to federally
funded activities, or who are in a position to participate in the decision—making process or gain
inside information with regard to such activities, may obtain a financial interest or benefit from a
federally -assisted activity, or have a financial interest in any contract, subcontract, agreement with
respect to the proceeds of the federally—assisted activity, either for themselves or those with whom
they have business or immediate family ties, during their tenure or for one year thereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a
member of a city Board or Commission from having an interest in a city contract. Section 362.5
City Council Resolution 915-300 established a policy that the following persons shall not be
eligible for appointments to Boards and Commissions.
A council member's spouse, domestic partner or partner in cohabitation, children, step children,
cAildren for whom the Council Member assumes parental responsibility, mother, father, son-in-law,
daughter-}urlaw, sister-in-law, grandparents, and grandchildren, aunt, uncle, niece, nephew, first
cSLsinT%Ster parent, poster child, persons who are parents of the same child, and persons whom the
e�loyeegin an intimate relationship.
LLJ t:.j .
- }>..
.J " c> t--
RM. #1,15''30-I1 states that each application for reappointment to a City Board or Commission will be
cF&derk:Svithout regard to incumbency. If reappointed, an individual would be limited to one
rpo nit�ont to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of interest? YES NO
List potential conflicts of interest (See last r.2Me for information regarding conflict of interest)
Please indicate if there are none.
BUSINESS NAME BUSINESS ADDRESS
Do you currently serve on another Iowa City board or comunissro ? YES_ NO
If so which one do you prefer?
The City Council values all types of diversity on its boards and commissions. Your responses on
this page provide valuable information to the Council in achieving that goal,
In order to ensure that the board and commission is representative of the community and the
groups(s) which it serves, please provide your information for the following:
Age—Ll
Country of Origin
Sexual Orientation
Religion ,"fl
Do you have a disability? YES_4,,�1N0
Race, Color or Ethnic Group _,Gt.��
*Note.
The Human Rights Commission strives to ensure the Commission is representative of the
community. Therefore appointment shall take into consideration persons of various racial,
religious, cultural, social and economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and
intent, when possible to have at least one person with expertise in construction, at least one
person with expertise finance and one person who receives rental assistance. (Resolution)
Signature of
Misrepresentations on this application will constitute just cause for removal of WSh'
If you fail to answer all the questions, Council will not consider your application.=,I;
You are encouraged to contact individual Council Members to express
serving. Contact information is attached.
I
` - 1
Advisory Board/Commission Application Form
rY
I
This application is a public document and as such can be reproduced and distributed for
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY
considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
5/4/2018
First Name
Angel
Last Name
Taylor
Home Address*
2247 Plaen view drive
City
IOWA CITY
State
IA
Zip Code
52247
1. Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
3195941403
Email Address*
angeltaylor99@hotmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Human Rights Commission
Select a Board or Commission you are interested in:
Housing and Community Development
Commission(HCDC)
Select a Board or Commission you are interested in:
Civil Service Commission
2. How long have you been a resident of Iowa City?*
40 years
3. Occupation: *
Realtor
4. Gender*
"This question is mandatory in order for the aty to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Demographics sectionof the application below.
F Male
r1 Female
5. Experience and/or activities which you feel qualifyyou for this position:*
Advocacy, served on housing commission board
6. What is your present knowledge of each advisory board you are interested in?*
I'm pretty familiar with both human rights & the housing commission board
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate family ties, during their tenure or for one year thereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will
be asked to resign from one if appointed to another.
7. Do you currently have a conflict of Interest?*
No
8. Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
9. Age
10. Country of Origin
11. Sexual Orientation
12. Religion
13. Do you have a disability?
Yes
Please explain:
ADHD & OCD
14. Ethnicity
African American
15. Race
Black
16. Gender identity
Female
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
Drop-down
Item Number: 16.h.
i
CITY OE IOWA CITY
www.icgov.org
May 21, 2019
Library Board of Trustees - Three vacancies to fill a six-year term, July 1,
2019 - June 30, 2025. (Term expires for Diane Baker, Janet Freeman and
Jay Semel)
ATTACHMENTS:
Description
Vacancy Notice/Coversheet
Board Demographics/Attendance
Ford, Justin -Application
Freeman, Janet -Application
Gaynor, Alison - Application
Johnk, Derek -Application
Olmstead, Harry -Application
Rocklin, Thomas -Application
Shultz, Hannah -Application
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD:
BOARD OF LIBRARY TRUSTEES
Three Vacancies: Six -Year Term
July 1, 2019 - June 30, 2025
• The Board of Library Trustees is a semi -autonomous body of nine persons empowered by State
Law to plan, direct, and control all affairs of the Public Library. This includes having control of
funds allocated or given to the library, determining long-range goals of Library service, adopting
written policies to govern operation of the Library, and employing a competent staff to help plan
and implement the Board's service goals.
• Iowa City appointed members of boards and commissions must be 18 years of age and live in
Iowa City. The City of Iowa City encourages diversity in the appointment of citizens to boards
and commissions.
• The Library Board meets the fourth Thursday of each month at 5:00 p.m.
Iowa City -appointed members of boards and commissions must be at least 18 years of age and live in
Iowa City. The City Iowa City encourages diversity in the appointment of citizens to boards and
commissions.
Applications must be received by 5:00 p.m., Tuesday, May 14, 2019. An application can be
completed and submitted on the City of Iowa City website at www.icgov.org or by contacting the City
Clerk's office.
Questions about the Iowa City Board of Library Trustees should be directed to Elsworth Carman, Library
Director at 356-5200.
Board/Commission Application Cover
Board/Commission: Library, Board of Trustees
Three vacancies to fill a six-year term
7/1/2019 - 6/30/2025
It is hereby established, as a formal policy of the City Council of Iowa City, that each application for reappointment to
a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be
limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve.
Council Announcement Date: 4/2/2019
Application Deadline: 5/14/2019
Council Appointment Date: 5/21/2019
Date of Non -Gender Appointment: 7/2/2019
After date above Council may appoint without regard to gender
Gender Balance Requirement: 2 -Male, 1 -None
Current Gender Balance:
Female: 4 Male: 2
Gender
Name and Address
Male
Ford, Justin
407 Magowan Ave
Female
Freeman, Janet V Term ending 6/30/19
1 Oaknoll Ct
Female
Gaynor, Alison
75 Penford Dr
Male
Johnk, Derek
1405 Keokuk St
Male
Olmstead, Harry
1259 Shannon Dr. Apt #102
Male
Rocklin, Thomas
2 Forest Glen
Female
Shultz, Hannah
3005 Creighton St
Library Board of Trustees - Current members
# years as
Name Term ending I resident of IC Occupation
Gender
Age*
Country of
Origin*
Sexual
Orientation*
Religion*
Gender
Disability* Ethnicity* Identity*
Race' Unique Identifiers*
Software
Wesley Beary 6/30/2021 Unexpired 7 Architect
M
35
USA
Heterosexual
Agnostic
European
American Male
John Beasley 6/30/2021 -1st Term 54 Attorney
M
Monique Washington 6/30/2021 -1st Term 24 Clerk III
F
Kellee Forkenbrock 6/30/2023 -1st Term 17 Education
F
38
USA
Heterosexual
Catholic
Black
Carol Kirsch 6/30/2023 -1st Term 22.5 Retired Librarian
F
65
USA
Heterosexual
Christian
Caucasian
Robin Paetzold (JC REP) 6/30/2023 -1st Term
F
VACANT 6/30/2025
VACANT 6/30/2025
VACANT 6/30/2025
**Note: IC City Council appoints the JC Rep
Please note: The information provided is the information provided on the application at the time of submission.
* Information is voluntary
Board or Commission: ICPL Board of Trustees
ATTENDANCE RECORD
12 Month
KEY:
X = Present
O = Absent
O/E = Absent/Excused
NM = No meeting
Meeting Date
Name
Term
Expiration
5/24/18
6/28/18
7/26/18
8/23/18
9/27/18
10/25/18
11/15/18
12/20/18
01/24/19
2/28/19
3/28/19
4/25/19
Diane Baker
6/30/19
x
x
x
x
x
x
x
x
x
O
x
x
Wesley Beary
6/30/21
Not on Board
X
X
X
X
X
O/E
X
O/E
X
John Beasley
6/30/21
X
X
X
X
X
X
X
X
X
X
O
X
Kellee
Forkenbrock
6/30/23
X
O/E
X
X
O/E
X
X
O/E
X
X
X
X
Janet Freeman
6/30/19
X
X
O/E
O/E
X
X
O/E
X
X
O/E
X
X
Adam Ingersoll
7/30/18
X
X
X
X
Off Board
Carol Kirsch
6/30/23
X
X
X
O/E
X
X
X
X
X
X
X
X
Robin Paetzold
6/30/23
X
X
X
X
X
X
X
X
X
X
O/E
X
Jay Semel
6/30/19
X
X
X
X
X
X
X
O/E
X
X
X
X
Monique
Washington
6/30/21
X
O
O
X
O/E
X
X
O
X
X
O/E
X
KEY:
X = Present
O = Absent
O/E = Absent/Excused
NM = No meeting
1� r _ Advisory Board/Commission Application Form
This application is a public document and as such can be reproduced and distributed for
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF UTERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
8/13/2018
First Name
Justin
Last Name*
Ford
Home Address*
407 magowan ave
City
IOWA CITY
State
IA
Zip Code
52246
1. Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
7739831486
Email Address*
justincford@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Library, Board of Trustees
2. How long have you been a resident of Iowa City?*
3 years
3. Occupation: *
Environmental specialist
4. Gender*
*This question is rrendatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Darrugraphics sectionof the application below.
FJ Male
r" Female
5. Experience and/or activities which you feel qualify you for this position:'
I have overseen large projects and budgets for both government and private groups, but more importantly my
family have been avid library users for years. Many years ago it was the Iowa City Library that was a principle
reason we decided to choose Iowa city for my wife's internship. My children have used the library from birth,
many of those years have included the ICPL. I have experienced many other library systems around the
country and I have deep love for what libraries bring to our cities.
6. What is your present knowledge of each advisory board you are interested in?*
I am aware that the current boards responsibilities are to support the library staff, by providing leadership in
regards to goals, policies, and staffing as well as performing oversight of the use of monies, to ensure that the
community is well served by the library. The board also has a role as a liaison to represent the library within
the larger city government and community.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate family ties, during their tenure or for one year thereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will
be asked to resign from one if appointed to another.
7. Do you currently have a conflict of Interest?*
No
8. Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
9. Age
39
10. Country of Origin
Unites Sates
11. Sexual Orientation
Straight
12. Religion
A/theist
13. Do you have a disability?
No
14. Ethnicity
NA
15. Race
White
16. Gender identity
Male
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
ffiAW
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
Drop-down
r
Advisory Board/Commission/Committee Application
This application is a public document and as such can be reproduced and distributed for
CITY OF IOWA CIN the public. This application will be considered for twelve months only and automatically
UNESCO CITY OF LITERATURE considered for any vacancy during that time.
NOTE: Must be 18 years of Age and live within city limits of Iowa City to apply
Date of Application 2z 1
Which Board or Commission are you interested in.�,� J�
Applicant Information:
First Name -5 Last Name
Home Address 1 9pe— ."C LA `"-
City State - =-K.— Zip Code
Contact phone number 19 J" L_:? 4- Email Addressi
1. Is your home address (listed above) within the corporate limits of Iowa City? YES NO
2. How long have you been a resident of Iowa City?
3. Occupation: I
Ck
4. Gender* a
"Thisuestion is mandatory ry in order for the City to comply with the State's gender balance requirement whi<rb a
treats gender as binary "Gender Identity" may be provided in the demographics section of the application, 1 . w
Male o o
Female -
5. Experiences and/or activities which you feel qualify you for this position:
�� �l�Y-�r'Qc,�� 'tri-� ' ,��,,�r•,i
6. What is your present knowledge of each advisory board you are interested in?
2- /�n V -M C, LY�
T ,dam
'
P
Please contact the city attorney at 319-356-5030 to discuss questions or concerns regarding a potential
conflict of interest. The following describe some but not all potential conflicts.
Potential Conflict of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise
or have exercised any functions or responsibilities with respect to federally funded activities, or who are in
a position to participate in the decision—making process or gain inside information with regard to such
activities, may obtain a financial interest or benefit from a federally -assisted activity, or have a financial
interest in any contract, subcontract, agreement with respect to the proceeds of the federally—assisted
activity, either for themselves or those with whom they have business or immediate family ties, during their
tenure or for one year thereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a
city Board or Commission from having an interest in a city contract. Section 362.5
City Council Resolution #15-300 established a policy that the following persons shall not be eligible for
appointments to Boards and Commissions.
A council member's spouse, domestic partner or partner in cohabitation, children, step children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-
law, sister-in-law, grandparents, and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent,
poster child, persons who are parents of the same child, and persons whom the employee is in an intimate
relationship.
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one
reappointment to a full term in order to increase the opportunities for new applicants to serve.
....
....................................................................................................
7. Do you currently have a conflict of interest? YES NO X
Please identify any potential conflicts between membership on the advisory board and your personal
interests, including financial interests and your duties to an employer/ List all businesses in which you or
your spouse/domestic partner, have an ownership interest (for example, sole proprietor, partner, 5% or more
of corporation's stockholdings).
List potential conflicts of interest (See above for information regarding conflict of interest)
Please indicate if there are none.
BUSINESS NAME I BUSINESS ADDRESS
APR 2 6 2019
City Clerk
Iowa City, Iowa
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
8. Do you currently serve on another Iowa City board or commission? YES NO x
If yes, which one do you prefer?
The City Council values all types of diversity on its boards and commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the board and commission is representative of the community and the groups(s)
which it serves, please provide your information for the following:
Demographic Information•
9. Age
-71-
10. Country of Origin
11. Sexual Orientation -3 an �Dr�
12. Religion uw-�–"– �
13. Do you have a disability? YES NO
14. Ethnicity �,`�,.n 1,�.•..
15. Race
16. Gender Identity
Note:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social
and economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise finance
and one person who receives rental assistance. (Resolution)
Signature of Applicant* p"`�,r7pr
Misrepresentations on this application will constitute just cause for removal of an appointee. If you
fail to answer all the questions, except demographics, Council will not consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving. Contact information is attached.
MW
APR 2 6 2019
City Clerk
Iowa City, Iowa
I Advisory Board/Commission Application Form
' - 1 rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
4/29/2019
First Name
Alison
Last Name
Gaynor
Home Address*
75 PENFRO DR
City
IOWA CITY
State
IA
Zip Code
52246
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
8476067199
Email Address*
aakittrell@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Library, Board of Trustees
Preference on first choice
If Tultiple boards are being applied for.
How long have you been a resident of Iowa City?*
since June 2015
Occupation: *
writer and editor
Gender*
*This question is rrandatory in order for the City to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Derrographics sectionof the application below.
r Male
rJ Female
Experience and/or activities which you feel qualify you for this position:*
I have a BA in English from St. Mary's College in Notre Dame, Ind., and an MA in English from Vanderbilt
University in Nashville, Tenn. I worked for several years as a daily journalist at newspapers in Moline, III., and
Kansas City, Mo. I was the city copy desk chief at The Kansas City Times when the paper won a Pulitzer Prize
for its coverage of the 1981 hotel skywalks collapse that killed 114 and injured 216. Since March 1988, 1 have
been a founder and co-owner of Gaynor Communications, Inc., which provides writing, editing and project
management services for corporate clients. I have been a life-long reader and lover of libraries, which I
consider one of Ben Franklin's very best ideas.
What is your present knowledge of each advisory board you are interested in?*
I have never served on a board like this before. But now that my children are grown, I am interested in giving
back. And the library seemed to me like a perfect place.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
66
Country of Origin
us
Sexual Orientation
heterosexual
Religion
none
Do you have a disability?
No
Ethnicity
English and German
Race
caucasian
Gender identity
female
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
I Advisory Board/Commission Application Form
' - rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
4/30/2019
First Name
Derek
Last Name
Johnk
Home Address*
1405 Keokuk Street
City
IOWA CITY
State
IA
Zip Code
52240
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
3195736451
Email Address*
derek.johnk@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Library, Board of Trustees
Preference on first choice
If Tultiple boards are being applied for.
How long have you been a resident of Iowa City?*
5 years
Occupation:*
IT Consultant
Gender*
*This question is rrandatory in order for the City to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Derrographics sectionof the application below.
V Male
F Female
Experience and/or activities which you feel qualify you for this position:*
Former Iowa City Telecommunications Commission Member and Chair (including coordination with ICPL staff
Bond) (3 years)
Former ICPL Art Committee Member (3 years)
Very dedicated advocate and user of ICPL from 2002-2006, and 2015 -Present.
Strong interest in increasing access and usage of public library services
What is your present knowledge of each advisory board you are interested in?*
I am aware of the size and charge of the ICPL Board of Trustees, and have reviewed previous meeting
minutes, and it appears to align well with my expectations and want to make a difference in this space.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
34
Country of Origin
United States
Sexual Orientation
Straight
Religion
Non -Religious
Do you have a disability?
No
Ethnicity
White
Race
White
Gender identity
Male
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
l� -4 Advisory Board/Commission Application Form
It Advisory
This application is a public document and as such can be reproduced and distributed for
the public. This application wtll be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF UTERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
8/14/2018
First Name
Harry
Last Name
Olmstead
Home Address*
1259 Shannon Drive, Apartment 102
City
IOWA CITY
State
IA
Zip Code
52246
1. Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
319-855-2666
Email Address*
Harry03@aol.com
Boards & Commissions
Select a Board or Commission you are interested in:*
Community Police Review Board (CPRB)
Select a Board or Commission you are interested in:*
Library, Board of Trustees
Select a Board or Commission you are interested in:*
Senior Center Commission
2. How long have you been a resident of Iowa City?*
10 years
3. Occupation: *
Retired Teacher
4. Gender*
'This question is rrandatory in order for the Gly to comply w ith the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rrey
be provided in the Derrographics sectioiof the application below.
PF Male
r Female
5. Experience and/or activities which you feel qualify you for this position:*
I believe knowledge, experience, and experience develop leadership skills. Educationally I went to Layton
School of Art Photograph major 1973 2 year certificate. University of Wisconsin -Milwaukee BS Education and
Recreational Therapy 1975. University of Alabama at Birmingham Rehabilitation Counseling (3 credits shy of
Masters. Teach for America 1991 - 1974 Special Education LD & BD.
I also have served on the Iowa Human Rights Commission 6 years (2 years as chair), Iowa City Housing and
Community Development Commission 3 years (1 year as chair), Johnson County Para -transit Board 5 years (2
years as vice -chair, Johnson County Liviable Community 4 years (3 years as chair of Transportation sun -
committee, University of Center for Human for 6 years to present (4 years as vice -chair), State of Iowa
Olmstead Consumer Task Force 5 years (1 year as vice -chair & 2 years co-chair of Medicaid Privatization sub-
committee.
6. What is your present knowledge of each advisory board you are interested in?*
Having serving on several Iowa City Commissions I have a working knowledge of how boards serve the citizens
and City Council. I have given a presentation to the Iowa City Senior Center Co! mission also I've attended 3
years of the annual report and public forum of the Iowa City Police Review Board.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally -assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate family ties, during their tenure or for one year thereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will
be asked to resign from one if appointed to another.
7. Do you currently have a conflict of Interest?*
No
8. Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
9. Age
68
10. Country of Origin
United States of America
11. Sexual Orientation
Straight
12. Religion
Quaker
13. Do you have a disability?
Yes
Please explain:
I'm a person with a right above the knee and and use a pourer wheelchair for mobility.
14. Ethnicity
United States of America
15. Race
White
16. Gender identity
Male
"NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant
`l..t't1' 1 5: 01-/1WdM. Z11
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
Drop-down
I Advisory Board/Commission Application Form
' - rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
3/21/2019
First Name
Thomas (Tom)
Last Name
Rocklin
Home Address*
2 Forest Glen
City
IOWA CITY
State
IA
Zip Code
52245
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
319-331-1951
Email Address*
trocklin@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Library, Board of Trustees
Preference on first choice
If Tultiple boards are being applied for.
How long have you been a resident of Iowa City?*
33 years
Occupation:*
Retired from the University of Iowa; part-time consulting
Gender*
*This question is rrandatory in order for the City to corrply with the state's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Derrographics sectionof the application below.
V Male
F Female
Experience and/or activities which you feel qualify you for this position:*
I have lived in Iowa City for nearly 33 years and been a devoted library user and supporter for all of that time.
My late wife, three sons, and I went to the library every Saturday morning when the children were young, and
we are still remembered by some of the staff as the family that brought a large cardboard box to carry all the
books we checked out.
During those 33 years, I have had the opportunity to serve in a number of roles that have helped me develop
skills that will be useful in serving on the ICPL Board of Trustees.
• I served in a number of administrative roles at the University of Iowa, including department chair, vice -provost,
and for the last almost 10 years of my career as the vice president for student life.
• I served for nine years on the Goodwill of the Heartland Board of Trustees, including time as vice -chair of the
board, chair of the program committee, and chair of the audit committee.
• I served, twice, as co-chair of the "21 Makes Sense" campaign that successfully protected the ordinance
passed by the City Council in 2010 that limited bar entrance to those legally old enough to consume alcohol.
• I am a principal in McFadden, Rocklin, and Associates, LLC, (http://mcfaddenrocklin.com) a consulting firm
providing strategic advice and leadership guidance to universities and to consortia of academic libraries.
These experiences and others have helped me develop knowledge and skills that will serve me well as a
member of the Iowa City Public Library Board of Trustees. These include:
• An appreciation for the excellence of the Iowa City Public Library and the central role it plays in creating the
culture and quality of life that has kept me in Iowa City for over half my lifetime.
• An ability and commitment to collaborate with others to achieve an organization's goals.
• A recognition of the diversity of our community and a commitment to inclusive decision making and to
addressing systemic inequities.
• An understanding of the respective roles of an organization's management team and of its board of trustees.
• An ability to identify and ask key strategic questions and to evaluate proposed tactics to achieve strategic
goals.
• A broad understanding of budget strategy and process.
• An understanding of the components of effective organizational leadership.
I would be honored to use my knowledge, skills, and commitment as a member of the Iowa City Public Library
Board of Trustees.
What is your present knowledge of each advisory board you are interested in?*
I have discussed service on the Library Board of Trustees with a current trustee and with a member of the City
Council. I understand, I believe, the way in which the board functions and the workload and time commitment of
the trustees. I understand that the board is semi -autonomous and governs the library, including fund allocation
and policy, and hires and evaluates the library's director.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate family ties, during their tenure or for one year thereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
62
Country of Origin
USA
Sexual Orientation
Heterosexual
Religion
Unitarian/Jewish
Do you have a disability?
No
Ethnicity
White
Race
White
Gender identity
cis male
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
T ibckl14
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
I Advisory Board/Commission Application Form
' - rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
5/1/2019
First Name
Hannah
Last Name
Shultz
Home Address*
3005 Creighton St
City
IOWA CITY
State
IA
Zip Code
52245
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
3195417357
Email Address*
morrison.shultz@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Library, Board of Trustees
Preference on first choice
If Tultiple boards are being applied for.
How long have you been a resident of Iowa City?*
1.5 now, 12 total
Occupation:*
Public Health Communciations & Program Management
Gender*
*This question is rrandatory in order for the City to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Derrographics sectionof the application below.
r Male
rJ Female
Experience and/or activities which you feel qualify you for this position:*
ICPL is a steady fixture in my life. When I was growing up, every Friday night we would stop at the library, pick
up a couple of movies, find our books for the week, go through all of the new CDs, then we'd go pick up a
pizza. As a university student, I would frequently visit the public library for quiet study space and meetings with
classmates. I now am a regular visitor of the bookmobile and library, looking forward to Wednesday afternoons
when I stop at the library, then go to the farmer's market on my bike ride home, usually precariously balanced.
After finishing college, I moved a couple of times before making my way back to Iowa City. In each new city, I
got a library card before updating my driver's license. I am a voracious reader and huge advocate of libraries
as community centers, resource centers, and essential spaces. I am absolutely confident my quality of life and
the quality of my community would suffer without a strong public library.
I have a strong non-profit history with experience being a part of and working closely with boards of directors
and committees. I have a particular interest in how to make all spaces and policies more equitable. In my work
with local, national and global organizations, I have been instrumental in transitioning our organizations to a
more systemic, strategic way of operating and planning, and helped introduce missing perspectives to
strengthen our work and improve our outcomes.
What is your present knowledge of each advisory board you are interested in?*
I have reviewed the agendas and minutes of past board of trustees meetings. I am familiar with the library's
initiatives and programs.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
30
Country of Origin
us
Sexual Orientation
straight
Religion
Do you have a disability?
No
Ethnicity
Race
white
Gender identity
female
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
Item Number: 16.i.
+r
P_
W�rm�M
CITY O� IOWA CITY
www.icgov.org
May 21, 2019
Telecommunications Commission - One vacancy to fill a three-year term, July
1, 2019 - June 30, 2022. (Term expires for Paul Gowder)
ATTACHMENTS:
Description
Vacancy Notice/Coversheet
Board Demographics/Attendance
Austin, Andrew - Application
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
TELECOMMUNICATIONS COMMISSION
One Vacancy: Unexpired plus a Three -Year Term
Upon appointment — June 30, 2022
• The duties of the Telecommunications Commission include serving as a review board to
resolve disputes between any subscriber or potential subscriber and the cablevision company
• reviewing and auditing reports by the cable company to the City as required by the Cable
Television Ordinance; working with the public, the media, the City, and the cablevision
company for the purpose of making recommendations on various issues;
• monitoring and promoting community programming and the use of the local access channels
by a wide range of individuals, institutions, and organizations;
• informing and educating citizens on matters related to cable TV and other communications
systems;
• and monitoring and reviewing State and Federal legislative and regulatory action or change.
• Iowa City -appointed members of boards and commissions must be at least 18 years of age
and live in Iowa City. The City of Iowa City encourages diversity in the appointment of citizens
to boards and commissions.
• The Telecommunications Commission meets the fourth Monday of each month at 5:30 p.m.
Iowa City appointed members of the boards and commissions must be 18 years of age and live in
Iowa City. The City of Iowa City encourages diversity in the appointment to boards and commissions.
Applications must be received by 5:00 p.m., Tuesday, May 14, 2019. An application can be
completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the
Clerk's office.
Questions about the Iowa City Telecommunications Commission should be directed to Ty Coleman,
Media Production Services Coordinator, at 356-5454. Application forms are available from the Clerk's
office upon request or on the City website at www.icgov.org.
Board/Commission Application Cover
Board/Commission: Telecommunications Commission
One vacancy to fill an unexpired plus three-year full term
Upon appointment - 6/30/2022
It is hereby established, as a formal policy of the City Council of Iowa City, that each application for reappointment to
a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be
limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve.
Council Announcement Date: 4/2/2019
Application Deadline: 5/14/2019
Council Appointment Date: 5/21/2019
Date of Non -Gender Appointment: 7/2/2019
Gender Balance Requirement:
Current Gender Balance:
Gender
Male
After date above Council may appoint without regard to gender
1 -Female
Female:1 Male:3
Name and Address
Austin, Andrew
100 Catlett Hall Rm 804
Telecommunications Commission - Current members
Name
Term ending
# years as
resident of IC
Occupation
I Gender
Age*
Country of
Origin*
Sexual
Orientation*
Religion*
Disability*
Ethnicity*
Gender
Identity*
Race*
Unique Identifiers*
Matthew Brenton
6/30/2020 -1st Term
15
IT Security
Analyst
M
33
USA
Heterosexual
Atheist
Caucasian
James Pierce
6/30/2020-1st Term
1
Student
M
24
USA
Gay
Non-religious
White
Male
White
Gina Reyes
6/30/2021 Unexpired
25
Electrical
Engineer
F
44
USA
Adam Stockman
6/30/2021-1st Term
37
Dir Operation
Iowa Lions Eye
Bank
M
39
USA
Heterosexual
Agnostic
White
Male
VACANT
6/30/2022 Unexp +
1st Term
Please note: The information provided is the information provided on the application at the time of submission.
* Information is voluntary
PRELIMINARY
Iowa City Telecommunications Commission
0312512019 Meeting Minutes
Page 4 of 4
TELECOMMUNICATIONS COMMISSION
12 -MONTH ATTENDANCE RECORD
(x) = Present
(o) = Absent
(o/c) = Absent/Called (Excused)
Gowder
Bergus
Brenton
Johnk
Pierce
04/23/2018
x
x
x
x
x
05/21/2018
x
o/c
x
x
x
06/25/2018
x
x
x
o/c
x
07/23/2018
Meeting not held due
to lack of quorum.
vacant
vacant
08/27/2018
Meeting not held due
to lack of quorum.
vacant
vacant
9/24/2018
x
vacant
x
vacant
x
Paterson
10/22/2018
x
o
x
vacant
x
11/26/2018
Meeting not held due
to lack of quorum.
vacant
12/17/2018
x
o
x
vacant
x
01/22/2019
Meeting not held due
to inclement weather
and lack of quorum.
vacant
Stockman
02/25/2019
x
vacant
x
x
o/c
Reyes
03/25/2019
resignation
o/c
x
x
x
(x) = Present
(o) = Absent
(o/c) = Absent/Called (Excused)
I Advisory Board/Commission Application Form
' - 1 rY
I This application is a public document and as such can be reproduced and distributed for
�wYl®gym
the public. This application will be considered for twelve months only and automatically
CITY OF IOWA CITY considered for any vacancy during that time.
UNESCO CITY OF LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
2/11/2019
First Name
Andrew
Last Name
Austin
Home Address*
100 Catlett Hall RM 804
City
IOWA CITY
State
IA
Zip Code*
52242
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
8153557448
Email Address*
andrew@austin.yt
Boards & Commissions
Select a Board or Commission you are interested in:
Telecommunications Commission
Preference on first choice
If Tultiple boards are being applied for.
How long have you been a resident of Iowa City?*
7 months
Occupation: *
Student / Entrepreneur
Gender*
*This question is rrandatory in order for the City to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Derrographics sectionof the application below.
V Male
F Female
Experience and/or activities which you feel qualifyyou for this position:*
I run a website design business, have worked in IT consulting for three years, and will be renting a home in
Iowa City for at least four more years. I follow telecommunications issues and policy on a national and local
level, and would enjoy the opportunity to provide my input on these important issues.
What is your present knowledge of each advisory board you are interested in?*
I am familiar with the overall responsibilities of the telecommunications advisory board.
Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict
of interest. The following describe some but not all potential conflicts.
Potential Conflicts of Interest
The Housing and Community Development Commission makes recommendations to the City Council
regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or
have exercised any functions or responsibilities with respect to federally funded activities, or who are in a
position to participate in the decision-making process or gain inside information with regard to such activities,
may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any
contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the
proceeds of the federally -assisted activity, either for themselves or those with whom they have business or
immediate familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same
time. You will be asked to resign from one if appointed to another.
Do you currently have a conflict of Interest?*
No
Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
Age
18
Country of Origin
United States
Sexual Orientation
Gay
Religion
Athiest
Do you have a disability?
No
Ethnicity
White
Race
Gender identity
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.