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HomeMy WebLinkAbout2006-11-14 Appointment ~ NOTICE THE CITY COUNCil OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOllOWING BOARD: AIRPORT ZONING BOARD OF ADJUSTMENT One vacancy - Unexpired + 5-yr Term Ending December 31, 2011 The powers and duties of the Airport Zoning Board of Adjustment are: 1. To hear and decide appeals where it is alleged there is an error in any order, requirement, decision, or determination made by an administrative official in the enforcement of the Airport Zoning Chapter. 2. To hear and decide special exceptions to the terms of the Airport Zoning Chapter upon which such board is required to pass under the Airport Zoning Chapter. 3. To authorize upon appeal in specific cases such variance from the terms of the Airport Zoning Chapter as will not be contrary to the public interest, where owing to special conditions a literal enforcement of the provisions of the Airport Zoning Chapter will result in unnecessary hardship, and so that the spirit of the Airport Zoning Chapter shall be observed and substantial justice done. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets at the call of the Chairperson. Applications must be received by 5:00 p.m., Wednesday, November 8, 2006. The City Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Johnson County/Iowa City Airport Zoning Board of Adjustment should be directed to Randy Hartwig, Airport Commission Chair at 337-2101. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in-law, sister- in- law, step-father, step-mother, step- child, aunt, or uncle. (Resolution 85-354) Males: 3 Females: 0 Council Announcement Date: June 13, 2006; August 1, 2006; September 5, 2006; September 19, 2006 Application Deadline: Wednesday, 5:00p.m., November 8,2006 Council Appointment Date: November 14, 2006 AIRPORT ZONING BOARD OF ADJUSTMENT One Vacancy - Unexpired + 5-yr Term Ending December 31, 2011 Carl Williams resigned No applications as of Wednesday, November 8, 2006 IKl Denotes applicant completed the Confidential page of the application. ~ NOTICE THE CITY COUNCil OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOllOWING BOARD: AIRPORT ZONING COMMISSION One vacancy - Six-yr Term January 1, 2006 - December 31,2011 Duties of the Airport Zoning Commission are: 1. To recommend amendments to the current Iowa City Airport Zoning regulations, including the repeal thereof. 2. To recommend the adoption of new Airport Zoning regulations. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets as required. Applications must be received by 5:00 p.m., Wednesday, November 8, 2006. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Airport Zoning Commission should be directed to Randy Hartwig, Airport Commission Chair at 337-2101. --_,,~,---~---------'----'-'~-~--'--'----'-'----'-''''~_._~-'---"~-"'- --""-.,.-.,.--"---------.-----.----------------.-.---'--_.~~.._.__.- Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in. law, sister- in. law, step-father, step-mother, step- child, aunt, or uncle. (Resolution 85-354) Males: 4 Females: 0 Council Announcement Date: September 20, 2005; November 1, 2005; December 13, 2005; January 23, 2006; February 28, 2006; March 21, 2006; April 18, 2006; June 13, 2006; August 1, 2006; September 5,2006; September 19, 2006 Application Deadline: Wednesday, 5:00p.m., November 8, 2006 Council Appointment Date: November 14, 2006 AIRPORT ZONING COMMISSION One Vacancy - Six-year Term January 1, 2006. December 31, 2011 Term expires for Mark Anderson No applications as of Wednesday, November 8, 2006 lRl Denotes applicant completed the Confidential page of the application. Spouses and relatives of City Council Members and members of comparable ~ County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother. in. law, father. in. law, brother, sister, brother. in. law, sister. in. law, step-father, step. mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 0 Females: 0 Council Announcement Date: October 3,2006 Application Deadline: Wednesday, 5:00 p.m., November 8, 2006 Council Appointment Date: November 14, 2006 ANIMAL CARE TASK FORCE Four vacancies . Term ending June 30, 2009 (2) Iowa City Residents, (1) Coralville Resident, (1) Johnson County Resident {2110wa Citv Teresa Kopel [&J 1701 Flatiron Ave Michelle Hickman [&J 950 E Davenport St Patricia Farrant [&J 1050 Woodlawn Maura Venzon [&J 812 Eastmoor Dr Adele Holoch [&J 2317 Plaen View Drive Roxanne Schomers [&J 317 Shrader Road Catherine Moore [&J PO Box 572 David Thompson [&J 827 Brown St Joy Bayshore [&J 1014 Oakcrest St #9 Lisa Drahozal Pooley [&J 1133 Briar Dr {11 Johnson Countv Jane McCune [&J 8 Woodland Heights (11 Coralville Paula Kelly [&J 2046 9th St #102 K. Lindsay Eaves-Johnson [&J 2035 South ridge Dr Teresa [eri) Howard [&J 2201 13 St [&J Denotes applicant completed the Confidential page of the application. NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: Animal Care Task Force Four Vacancies - Term ending June 30, 2009 (2) Iowa City Residents (1) Coralville Resident, (1) Johnson County Resident Individuals serving on the Animal Care Task Force play an important role in evaluating local community issues relating to animals within our regional area. Task force members will work to develop programs and make recommendations to governing bodies with relation to local animal issues that will improve the community as a whole. Applications must be received by 5:00 p.m., Wednesday, November 8, 2006. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Animal Care and Adoption Center Advisory Board should be directed to Misha Goodman, Animal Services Division Supervisor at 356-5295. Iowa City --_.~_.~._.~-----_._.,-,_._-----_._------".~---'-_.~~-_._._-"._---,.~-_.~--------,_._-----------~-------_.-"---~-------- CITY OF IOWA CITY ANIMAL CARE TASK FORCE PPLlCATION FORM I ~ ! -....= -lit ~~W!l:1lt ""-:, ~J'"'~ ........- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ALL TERMS END JUNE 30, 2009. Check which vacancy applying for: ~Iowa City Residence DCoralville Residence DJohnson Co. Residence NAME -r-F::.R.E<'A R. KopeL HOME ADDRESS 1'101 FUr-T.:V<.P>.j A-rJ8 :It!'iJA. cz-r,/ I / .::z:4. 52.2<-10 I~ your home address (listed above) within the corporate limits of Iowa City? 0 Yes D No Is your home address (listed above) within the corporate limits of Coralville? DYes [21' No Is your home address (listed above) within the corporate limits of Johnson County? DYes D No How long have you been a resident? _11 years OCCUPATION Research Assistant EMPLOYER University of Iowa PHONE NUMBER: HOME 319-339-0812 BUSINESS 319-353-4463 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: See attached ,~ 0 L"" c-:~ ~o a, D '"',-,. -" n ___' ..........-i -< -Tl - '0) '" r- =:.:i /--, m ..:;--< " Tl j!" ".. ('~ o2;,~ ::r:: '~J </' m ;; .1:- ..,.. 'vtisrepresentations on this application will constitute just cause for removal of an appointee. If you fail (0 answer all the questions, Council may not consider your application. Animal Care Task Force Application WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? See attached WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? See attached POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. Jarticular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that 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. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. (5 ~',~ ~ (-) CO) --1 -11 I have no conflicts of interest. C) ._":.J ::.._ .:-.....1 ". -- ~T. "..-. N 0' ?'::: :'-'--} . I, ;~l ~ ,/'( 0) IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? I!I Yes GJ; No .- DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? 0 Yes ~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) 'v1isrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application Name of City Board/Commission/Committees Animal Care Task Force I ~ ! -~= -..... ;t~.ti;!:~ ",-... ".'i\{__ ....~ ~ CITY OF IOWA CITY Date 10/25/06 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name IE-~~ IZ. J.<.oP E-L--- 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. A copy of Section 362.5 is attached (see page 6). 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). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS NONE r; <~:;> c':':> ~>G C) } , II ~ . , r "'iC, en . ~, ::;; . " CT\ : 1 ~7:: co -~ :J> J:- NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Applicant Signature ,a;;:~ q,~ Address /701 ~L.A-U(.)IJ,,-J AI/E. "f/"}[vPr C7=-T~..TA .5;-YJLfo -5'110:3 / 'IIisrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application __._______________.__.__.__.__.__.___._~_~~_____"_...."________.,_.._______._..______._______.~._.__._M....__.____~_____..___~__~____._.__..__.~'_._ Animal Care Task Force Application Teresa R. Kopel EXPERIENCE AND/OR ACTMTIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I have been an active and involved volunteer at the Iowa City/Coralville Animal Care and Adoption Center since the beginning of 2004. My husband and I foster cats and kittens for the ICAC, and all but one of our cats have been adopted there. I am a member of the Johnson County Humane Society, the Humane Society of the United States, and the American Society for the Prevention of Cruelty to Animals. I subscribe to Animal Sheltering magazine to stay on top of issues in the field. I am deeply committed to promoting animal welfare, and am terribly concerned about the problem of companion animal overpopulation. I have an understanding of many of the issues, and am committed to learning even more. My husband and I have sent in several editorials to the Press Citizen about these issues. In my profession as a research assistant, I have experience reviewing policies and procedures in order to see that a project or institution runs as efficiently as possible. I have been working in research since 1992. I know how important it is to keep an open mind in trying to determine what factors are important, and to develop solutions to the problems encountered. I have extensive experience working on a team, both professionally and in my other volunteer and service experience. I have served in leadership capacities in my other volunteer experience, currently chairing a Region that includes 8 states and 2 Canadian provinces. I have served on study groups and presented the fmdings both orally and in written reports. I am very comfortable speaking in public, especially about issues of great concern to me. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I attended a meeting about a year ago as a representative of the Johnson County Humane Society, at the invitation ofMisha Goodman, the ICAC director. At that meeting we discussed starting a comprehensive county-wide effort to address the issues of companion animal overpopulation, feral colonies in the county, the need for more comprehensive spay and neuter solutions, etc. I have been eagerly awaiting some type of follow-up to that initial meeting, and have asked Misha about it several times over the last year. Misha and I have had many conversations over the last several years about the issues that will be addressed by the task force. I have often asked about the possibility of changing city and county regulations regarding animal licensing, spay and neuter, etc, wondering if legislation couldn't be introduced to help solve the problems in the county. Misha replied that things could certainly be done, but the ICAC staff was usually so busy dealing wi~h the daily business of running the ICAC, they didn't really have time to do the tT,d of ~ research and long-term planning needed to effectively address the issues. I s~~e; Tasls Force as a valuable resource, with the time and expertise needed to investigat~~tive-': and creative solutions to the problems we face in all of Johnson County. . -. -. r;}, ~c~. ~-< e:~, ~ WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS AD~~Y:'l: BOARD (OR STATE REASON FOR APPLYING)? -<;/' '? The concerns that will be addressed by the task force are the same issues that colieern m~ and because of that, I have done extensive reading in the area. I have considerable knowledge of some of the issues facing the ICAC because of my volunteering. I have taken every class available at the ICAC, in order to be as useful and flexible as possible in my time there, and in fact volunteered to train other volunteers during a time when no "T\ - "~ -n -, \....J Animal Care Task Porce Application Teresa R. Kopel one else was available to do so. I study the issues on my own time, and study the website often so that I can effectively talk to potential adopters about animals they're interested in. I try to help get as many animals adopted to good homes as possible, and foster in order to give the special needs animals a better chance of surviving and finding a home. But I have seen many animals euthanized during the last several years. I have held wonderful, loving, adoptable animals while they were euthanized because they did not find a home before they ran out of time or the ICAC ran out of space. The fact is that it is a losing proposition - there will never be enough homes for all of the animals born each year. We must address the problem at the source. We must develop ways to encourage people to spay and neuter their animals in order to reduce the munbers needing to find homes. We must encourage responsible pet ownership, including the idea that adoption of a companion animal is a serious commitment for the life of the animal. I am losing patience with hoping that people will be enlightened and want to do the right thing for animals. We need to make it easier for those who have the desire but not the means, and we may need to force those who have the means but not the desire. Euthanasia, "happy death", should be a last resort when an animal is suffering from an untreatable illness, or is a threat to public safety. It should never be used as an alternative to spaying, neutering, and responsible pet ownership. I would like to be of service in helping to find effective strategies to solve these extremely difficult and important problems, and I believe that I have the skills to be useful. I know I have the desire! "" 0 = <;:-;;:, c~ ~i: 0 0 '.> -. C? "Tl ~, - " (-) "" ,- --" r.....' 0' , . . .:"< , iT] re! p , . .---1 C) :rj ::!ii: \ . 7' _/ .- ro <:: ;J.> .j:- .::- CITY OF IOWA CITY ANIMAL CARE TASK FORCE APPLICATION FORM I ~ 1 !~~!:'t '--" -V'~ ---~ CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FORANYVACANCY DURING THAT TIME. ,..., c:. ALL TERMS END JUNE 30, 2009. ~ G. ~ Check which vacancy applying for: 010wa City Residence OCoralville Residence OJOh~~:Co.s.eSid~ --.,-...... 0 , NAME Michelle L Hickman HOME ADDRESS 950 E Davenport Str~ijpwa-Gity, K1 S2 92 = ',_J IS your home address (listed above) within the corporate limits of Iowa City? ~ Yes b No Is your home address (listed above) within the corporate limits of Coralville? DYes D No Is yoUfhome address (listed above) within the corporate limits of Johnson County? DYes DNo How long have you been a resident? 30 years OCCUPATION Realtor-Licensed Assistant to Robin Sueppel EMPLOYER Lepic Kroeger Realtors PHONE NUMBER: HOME (319) 338-5629 BUSINESS (319) 330-5603 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: Over the years I have been involved in various animal related activities. I have volunteered with Best Friends Animal Society last October 2005 in the wake of hurricane Katrina where I spent a week at Saint Frances Animal Sanctuary in Tylertown, Mississippi and we cared for the animals that were displaced or homeless. More recently I have volunteered with Friends of the Animal Center Foundation at Paws in the Park, Thornberry off-leash dog park, and at the Realtor dog wash which raised funds for Friends of the Animal Center Foundation. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 1 of6 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? The Animal Care Task Force is a new committee that is going to help the welfare of Johnson County animals. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I am applying for this position to become more involved in my community and I am interested in making a difference in the lives of animals and people. I have 3 dogs of my own and recognize how much it takes to care for pets as well as how much joy a pet can bring to one's life. I would like to see more education in the community about pet adoption. which pet is right for you, and how to care for a pet, such as spay and neuter programs, heartworm prevention, and general exercise, obedience, and care. I would like people to make the Animal Care Center the first stop when they are considering a pet. I would like to see pet stores that offer animals for adoption or sale work with the Animal Care Center to ensure that the pet will be properly cared for and licensed. POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. " particular, if you are applying to be a member of a board or commission which makes recommendations .0 the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that 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. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. None c::::'l =0 0" IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? I!::I Yes D~' ~::J <"" /......, DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSI~? D~~es I!::I No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the ~me time.) o ~~) C) -'iC~! o c-~, -l 0) o -n Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 2 of 6 Name of City Board/Commission/Committees Animal Care Task Force I ~ 1 ~~~~'t "-.'" ....,~ ..,.. .. J CITY OF IOWA CITY Date~ BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name Michelle L Hickman 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. A copy of Section 362.5 is attached (see page 6). 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). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS l\.ln tJ"f:' .--, ~. '<:,-, Q"'" ~ >"'-~; ( , 11 -, ~' w c) ~. 0 _-<f-. .. -u Ii r, ;El ~ \.._J ~ '"'> .- ::;- o- W NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additio al business. Applicant Signature Address 950 E Daven rt Street, Iowa C ,IA Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 3 of 6 Page 1 of 1 Marian Karr From: Chellhick@aol.com Sent: Friday, November 03,200610:40 AM To: 'City Council Subject: RE: Animal Care Task Force Dear Council Members: My name is Michelle Hickman and I am applying for a position on the Animal Care Task Force Committee. I am a life-long resident of Iowa City, and I am currently empioyed at Lepic Kroeger Realtors as a licensed assistant to Robin Sueppel. I am interested in the Animal Care Task Force because I want to become more involved in my community, and to make a difference in the lives of animals and people. Please feel free to contact me with questions about myself or my application at 319-330-5603, or by email at chellh~l<@gQL.c.Qm. Thank you for your time and consideration, M. Hickman Michelle Hickman Licensed Assistant to Robin Sueppel Lepic Kroeger Realtors 2346 Mormon Trek Blvd Iowa City, IA 52246 Direct: 319-248-0522 Cell: 319-330-5603 Fax: 1-866-308-0987 Email:Chellhick@aol.com Licensed to Sell Real Estate in the State of Iowa 11/3/2006 oen' cl"." Ltl, U V -I hi I: 4/ I! I --= -...... ~~~i!:~ ~.~.........-.m.t. ~~ . CITY OF IOWA CITY CITY OF IOWA CITY ANIMAL CARE TASK FORCE \PPLlCATION FORM "I -~ ~-,fl L_ i "\ i !:,__.- - r Individuals serving on BOardS!COmmiSSiOnS!COmmittel0\BW'9,i:\j&p~rt'~nt role in advising the Council on matters of Interest to our community and Its future. ~ , 'u \ ',.,' i' I" }lvA After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E, Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FORANY VACANCY DURING THAT TIME. ALL TERMS END JUNE 30, 2009. Check which vacancy applying for: v Iowa City gesidence _Coralville Residence _Johnson Co, Residence NAME Po..t'.... ~c..~(;1- A . (: I.l.rr-o...r'\, of HOME ADDRESS I 0 S'u We 0 & ( o.....vV\. !;; 1. 2- 1.4 !,- I" your home address (listed above) within the corporate limits of Iowa City? .JL:::Yes No Is your home address (listed above) within the corporate limits of Coralville? Yes v No Is your home address (listed above) within the corporate limits of Johnson County? Yes"/ No How long have you been a resident? M 0 v-c. +-k""", 3 0 'i "-0.-;"-.1 OCCUPATION Ass lS~",-,.,:t Vl<.t.. P....~,Hde-.T 1L.L.t ( EMPLOYER (T I ~~. PHONE NUMBER: HOME "63.1 - :L 'l L R' BUSINESS "3 3. 1 - i V- 0 <1 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: . Twenty-five years as a leader in the Johnson County Humane Society. . Manager of the JCHS Spay Neuter Program and Feral Cat Project. . Currently planning launch of a statewide program (SPAY /lOW A) in cooperation with SNAP of Muscatine. Program will facilitate access to low-cost spay/neuter resources for qualifying Iowans. . Eight years service (four as chair) on the Iowa City Deer Task Force. '~isrepresentations on this application will constitute just cause for removal of an appointee. If you fail .0 answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 1 of 6 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? . Familiar with the responsibilities, operation, imd challenges faced by the Center. . Understand current issues and challenges in animal welfare, locally, statewide, and nationally. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? . Broad perspective on companion animal issues, especially overpopulation and spay/neuter. . History of creative approaches to problem solving in this arena. .-) ~ ,...',. ','\ \ POTENTIAL CONFLICTS OF INTEREST c<' F', -c ......., -:=:: "r: J.. '..._./ Please identify any potential conflicts between membership on the advisory boa~ ~d ):Our personal interests, including financial interests and your duties to an employer. :;;::. ., particular, if you are applying to be a member of a board or commission which makes recommendations (0 the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. Q :~O ,::;~:', f .-) ~. c.~ -.:.: 11 You should also know that 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. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. ,,{a- IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? va Yes 0 No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? 0 Yes J4 No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 2 of 6 - -_._._._-,.._..-.__.._--_._~----_..._--~--_._~- .._----_.__.__._~---------,_._._----_._--------_._~_.._._~--.~------_._-_._--" Name of City Board/Commission/Committees A I'\. ' "'" oJ. C<-V"C \ 0-. k ~ I--cVl."" I ~ ! =~~_...... ~~W!!=~ "10::... ~.,' ..... .. J CITY OF IOWA CITY Date~ 3 uf 0' BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name _Po-..+-y, ~;... A, F a-- ~..... /1'-'r-'t- 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. A copy of Section 362.5 is attached (see page 6). 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). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS Not'lE- n C~ r.:::... .c- -- ?:r; .~'- / :) ~ II .~ - -" =:':c - -- - ~iT' -u , -j:" :--1 ~:=! :::.-::.. - -~ -- ).> ~ NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Applicant Signature g ~ ,.:. Address ('0 cSt) W cocll Ii. ~._" ~ ....j- l' '-' '^-"v ~, -, lo,^" c_ CA \ St..l.-~ ~ ~'" , . lisrepresentations on this application will constitute just cause for removal of an appointee. If you fail ,0 answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 3 of 6 . ~--..~----_._~-- --.,-.----.------.---..-..-----. -----_._,_....__.,-----,-_._._-'".~._._-------"._._.~-_._-_._-----~---- CITY OF IOWA CITY ANIMAL CARE TASK FORCEr-i! ;~~ APPLICATION FORM ?;-j:-1'; [I" ?:. - '- I II' ~_ u I ~ I !~~~'t "'-~~r'~ ......,... .. CITY OF IOWA CITY ,^',:'.'... ~ - ; - ..'/ Individuals serving on Boards/Commissions/Com~itt~,~ plaY;8,Ir[ftlpfiJ:ant role in advising the Council on matters of Interest to our community and Its future. iOVVh'" .. ,j. :p, After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FORANYVACANCY DURING THAT TIME. ALL TERMS END JUNE 30, 2009. Check which vacancy applying for: IZl.Jowa City Residence OCoralville Residence OJohnson Co. Residence NAME Maura Venzon HOME ADDRESS 812 Eastmoor Drive Iowa City, IA IS your home address (listed above) within the corporate limits of Iowa City? [{] Yes 0 No Is your home address (listed above) within the corporate limits of Coralville? 0 Yes 0 No Is your home address (listed above) within the corporate limits of Johnson County? 0 Yes 0 No How long have you been a resident? 3 years OCCUPATION Accountant EMPLOYER Ahrens Concrete Finishers PHONE NUMBER: HOME (319) 354-6083 BUSINESS (319) 354-3170 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I have had a dog my entire life, including now. My husband and I have 2 wonderful dogs, and would love to give back to the Johnson County area so that hopefully more people can be exposed to great cats, dogs and other types of pets. I am also a volunteer at the BookEnd at the Iowa City Public Library, and love donating my time to activities that I'm really passionate about. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 1 of 6 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? Its a new advisory board, seeking 5 new applicants to help with the over population of animals in Johnson County, evaluate guidelines, evaluate the shelter management, educate citizens, review licensing procedures, and, provide a year end report and address any other animal concerns in community. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I'm applying because I think I can bring a pet owners perspective to the group. I have a fierce love and devotion to my pets and would do almost anything to keep them safe. I think that having a person like this on the board would really give a voice to the animals-and their owners. A pet isn't just an amimal to a lot of people, its a family member and really important to their life's happiness. Anything I can do to help make sure people can preserve this happiness would be a great achievement. POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. '1 particular, if you are applying to be a member of a board or commission which makes recommendations (0 the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that 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. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. S ~ '::::-) None ~Q ---11 I 00 ,1 ;:-~:"i:-:: ""j IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? 0 Yes 0 i'tif"' .. DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSI~? 0 ~es iii No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 2 of 6 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING J ~ I f~~~tt -..:;::.... _.J~ ......,.. .. CITY OF IOWA CITY Name of City Board/Commission/Committees Animal Care Task Force Date 10/31/2006 Name Maura Venzon 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. A copy of Section 362.5 is attached (see page 6). 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). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS None ,~ C::J 0 C. -- , _:r' ~- c:' 1\ ~..-: ...;;:: /' c-; . ~, - - ?>'. , I -0 '..-'1 7-:"~~~ ,i,,- ',j ~..,;/ ~, .Y C" NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Applicant Signature ~ 1.I~ 1 0\'3\ \e lR Address 812 Eastmoor Drive Iowa City, IA Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 3 of 6 CITY OF IOWA CITY ~NIMAL CARE TASK FORCE APPLICATION FORM I ~ ! -""' = -...... ~~W!!='"!. -..::::.... ....I~ ...,.... .. CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FORANY VACANCY DURING THAT TIME. . r-,,} ALL TERMS END JUNE 30, 2009. 9 ~ ;.::C) '''__0" Check which vacancy applying for: 0Iowa City Residence DCoralviile Residence DJohn;~;;:60. Re'siden;;E/ ~:,.,_, I -== --_ L C"'l I HOME ADDRESS \ 0 \....1 OAK.C..PF<...\,,' 8T. fl. q ~ '"i (., r~ =_.. ~... ---1 ~ A -,~ <...! :::-. C) Ea--yesTI No DYes G3"No NAME :rOY ""eA)'.:5I-t::>R.E. . s your home address (listed above) within the corporate limits of Iowa City? Is your home address (listed above) within the corporate limits of Coralville? Is your home address (listed above) within the corporate limits of Johnson County? ra Yes D No .:rOHIoJ'.>::.\J CL'.. 5'1 o=Al2.~ How long have you been a resident? \.II-.li vaa::.. i'j W(S - 3 t E.A11.~ I .reWA cil'/ - OJ.. '(EAQ.::' . . SEC.RE- .AR- 'I OCCUPATION AI..... sE.LF- EMPI.D'iE.O /'0..5. EMPLOYER- ~~'rn:.Q.'i 01" ~"'-i .IoWA o~c.AloJiCEQ.. "t-JO 5f>1'cr... pW\IoJI-JEJe.., "35"'-\- "'-dO.' pll.~6"ilai PHONE NUMBER: HOME 368- 'lIq ~ BUSINESS ~3\-O",,1.- f>u,.(....,E.~!. EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ;. CR.EATiVE. PIlCOc8"1 SOl-vQ(t, 't~. oJ I OvJ/V <wsitJes~ l>E.visING sci-VTio\V~ 'TO 5P....Cc.A"-'O oR,GANi Z.O '-'" tJi'EOS) 2. E.><~EN<.E. iN wLlAIlCRATivL. EfTOR.TS(~"NOi...,(, I"lEfVl6ER... OF .ro'^-'A c.ii'f <J\R-SHAR.e:, A :\01(l'\k\ cOOPCAATi liE.) 3, MEMBEe. OF "fV.Xl ^",iMAL.. "'-'iU-FAA.E. (J1l<:'CPS (8f..~r F~UJi)S ,ANiMAh .50U'eT'1 iN UTAH "f ",,-,iTEO I\t0{Mp..LIJA1lCi.JS (Y.:SG-o ll\J .$A.uU\ME:i<..rtO, loA) ^NO koiJ<...J;..0J...-E...06i:i\GL.E... .At30L'T c:.Ff'qLTS nE.i,..,,(r MAO~ /-fA.iv",v.;;iOe. (", ",,,,"MAL.wE.l-FARE .~ ~6,:)CVE. ..,. IICi..LO,,,rEGL ...., 3\'" A~""ci~~~ Sf'cA ("-'feA.:!.,S) """-'0 ,"1>< '''' M^"T~H I PET cBvN.AL. S fI'oT"C<0 iN ...<A0/~dt'i (:> '1~1. .' .... ., . ",N()wu=04t:.. CF 1''''......AL..l2.cHAVICfv 'l" N,=.s "rHllD\.J(",11 ~"AT'.5,rTl""'(, c3lli'N~S ,'-> .5"\'" fAAN\cI;<C .5 -(~''1E1'''~) ....'-'0 CAi<X. OF 1'1'1 OW,.; """M^L~ (?YEARS) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 1 of 6 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? WH1\T .I R.EAD c,,", THe rec-cJ, GiU., w~3 .'1AGE. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? THE:. c.j.....O wr\'1 CF APPR.(;""'ACi{t'ft...JG r..lV;'MAL W~^~ 1S..JT ~'t...J(r {"'-J .::it::-i-H,.JSo...; CO.. AtVD A t0EJ.;.J1 CReI'.TivE., (OL-LAi3aCAAl"(Vt::.. APPKCI\Cti Mus:r BE. IJ6Ii,S,m. /.32.(f\...){,.. 0,-..1 Cl-1E. Jlrf.JIlVJAL.. C,,\'Q.E. T^'SK-'f="OI~C;L v.;c\...JU) 6'L AtJ C(}POI~1L'#.J'l'i -ro {~C. PM....1 of ^ (YlU(/1' ~ffiOOO ~FFOi,\:, ~{"O-ri-\(NK. ANu A<-T lv.J D;FFEQ.etJ, VV/"'l~; .0 ..seE.. lo....lHA"\ CAr.J 6'6 .().(~c.. it>.J::'TEJ\Q e,f SI\'i(N(,. lliA.T iT 0.."-',. ~~ .lX'rJ-~ cR... Tl1Ai .. 6uT wi:.'\J'C... A~W/\'t.s PONe ITUl.<E.1"\-{(~Jli -"'0 (IV\PRO\Jt::.., A\..L '-O.Y1\)0~OJ"~ 01."" -n-\c AN~M1\'- w~Lrp..1U::. ~'1.S-'ev\ (....; ~-\NS(;N ~C"._;Tu i",\A.k.(.. ",HU(,~ O\f"f="EQE..t.....(L ..~ 'H\'C:... <:::ilUI\W,'tl C\'" WFE;, ~'F, (lOlnv"~<;" ANiM^~' J: f4.rv\. "'1"'lQ.i~ "n-tA\" ""Tl1-\'\. TI\.S.~ r-c":>.c..i:: tt^~ 6t:C10 O~^'N\l.EO jIt.....,Q w(.:UL() e,E- I\O\..K~"O 10 P,RJ"-'G f"'l ~nvn'l, 14JCc...;'-E()(,E \ PIlJJI.~cEM - SoI,viNe, "\<ALL;,, p"S~jO.0 MJD (O('o"\""n'I'"'1\3->' Ie ,,-,-,"-lL GN '\1\.(~ c.t-\I\Ll...ElNCtE C) :fc ~.;; ;S~ "'.. C) ~ " , I POTENTIAL CONFLICTS OF INTEREST :=;.! 0'\ ,.- Please identify any potential conflicts between membership on the advisory boa~ ~~d YJ;5.,Jr p~r~onal interests,including financial interests and your duties to an employer, S /':: co ,...I ~ ,. N .n particular, if you are applying to be a member of a board or commission which makes reccmlmendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that 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 A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. po~;e.~ COJI"Uc.,-r iIV 50.<1\0. ,^c.c:'\i"-'G ,iM\:OS, 11,0'1' HAVe- f~i~il..i 1'( iu e<XJ\l..\:..~i-\I'i)JLE. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? G:tYes 0 No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? 0 Yes l31\jo (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time,) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 2 of 6 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I ~ ! .:::~s_..... !__W!:"t. --.:::.... ....,~ ......- CITY OF IOWA CITY Name of City Board/Commission/Committees AIJ\ M A.l (' AQ.E .AS\.!.. f"(){lLE. Date I , I 0\1 \ 0 i. Name ::\O'j 1<.A'i ,<j-\() RE. 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 A copy of Section 362.5 is attached (see page 6). 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). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS A/(jl--Ji':' r~.) 0 c_, .- c-' 'J,;:.J c.; ~ .' -- . , I -- )~. v ;Tl l,' ~ f) ,:'c,:n _.. '.. </"', co ..,.-::::.. p ''0 - NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Applicant Signature f'-,7"'-"fl l'L "f'J...-v...J Address 101'-4 OAlGWEST ST. tI 'i. J:()UJA ('j T'( SJ.a"l(., Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 3 of 6 CITY OF IOWA CITY ~NIMAL CARE TASK FORCE APPLICATION FORM I ~ I -"" = -..... ~~e'ii!:~ --=:... .....,- ....._ n CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next fonnal Council meeting. Appointees serve as unpaid volunteers. This fonn may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ALL TERMS END JUNE 30, 2009. Check which vacancy applying for: 010wa City Residence DCoralville Residence DJohnson Co. Residence NAME Lisa Drahozal Pooley HOME ADDRESS 1133 Briar Dr. Iowa City 52240 IS your home address (listed above) within the corporate limits of Iowa City? [{] Yes 0 No Is your home address (listed above) within the corporate limits of Coralville? 0 Yes 0 No Is your home address (listed above) within the corporate limits of Johnson County? Q.. Yes ~ No How long have you been a resident? since 1983 ~~ :: ~3: -i1 ('j- I EMPLOYER UIHC, Spot~1~' -' PHONE NUMBER: HOME (319) 466-0821 BUSINESS ::; r: 0-~.- EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS F!QSi'no~ OCCUPATION Hospital Clerk, Dog Trainer Ii ,~ ......_) -Animal Center volunteer since 1999. I helped to revise the volunteer program, taught volunteer training for several years, and help and have helped to organize Center events, also for several years. I took some time off from employment to volunteer at the Center, during which time I had a chance to really see how an animal shelter works. -Co-founder and board member of the Friends of the Animal Center. I also assisted in creating and continue to maintain the IC/Coralville Animal Care and Adoption Center "Paws to Train" Dog Training Program, which is funded by FACF. -Strong organizational, research, and computer skills. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 1 of6 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? This task force is all about the quality of animal care and life in our community. The most important task at hand is to reduce animal overpopulation in the community and increase public education about animal issues. The task force will review policies and procedures as well to ensure best practices are in place at the Center and in the community. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I have been a Center volunteer for many years; there have been many improvements and happy adoptions during those years, but there is much more that can happen at the level of the Center, the city and the county. The path to improving the quality of animal care is many-faceted. It includes reducing the overpopulation of animals through low cost spay/neuter while raising the level of education and awareness of the publiC about animal issues - these efforts will help to reduce euthanasia in the Center, lower intake of animals, reduce relinquishment of pets as well as improve their quality of life in the community - and will save tax dollars in the long run. We need to provide protection for people and animals in the community by ensuring that we have and enforce appropriate ordinances. The best animal care would include improving the physical space of the Center as well as keeping up with animal shelter best practices in all aspects from medical care to volunteers, etc. The IC, Coralville and Johnson County communities are growing and our animal care service~eed tq~pand in scope and breadth along with them. I would be honored to be a part of this growth in any~. ::.,~ ~.'C) ".'.' L>-----;'. <"C "n POTENTIAL CONFLICTS OF INTEREST C) .- I ..-'-1',- 0" -.J i Please identify any potential conflicts between membership on the advisory board'a~ar yoU[, persPJ1al interests, including financial interests and your duties to an employer. 5 ;'-' :::c .:J' :_:.;: /.~ f..J 'n particular, if you are applying to be a member of a board or commission which mak~recommendations to the City Council about the allocation of City funds, please list any present affiliations yoU-have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that 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. A copy of Section 362.5 is attached (see page 6), If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030, I am a part time employee with Spot & Co, the dog training company that provides the training for the Center's Paws to Train program (funded by FACF). My salary last year was close to $5000.00 at Spot & Co. Although I run the Paws to Train program, I am not paid in any way for my work by Spot & Co, nor by FACF - it is purely volunteer. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? III Yes 0 No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? 0 Yes 111 No (It has been Council policy not to pennit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 2 of 6 Name of City Board/Commission/Committees Animal Care Task Force I! I &:~~~'t .~,.~.....;jfL ..." - ~ CITY OF IOWA CITY Date 11/7/2006 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name Lisa Drahozal pooley 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. A copy of Section 362.5 is attached (see page 6). List all businesses in which you or your spouse/domestic partner have an ownership interest (for example, sole proprietor, partner, 6% or more of corporation's stockholdings). Please Indicate If there are none. BUSINESS NAME BUSINESS ADDRESS NONE . . c5 r::" = <l) --...- -"f;:;' -n. --... ", ~.....' .".0::... ..!J -jG - -J i{-, -0 Tll ,- -." --, id- /~ w 'c7 > 0.> NOTE: A new form must be completed if the above information changes or an ownership interest is ,,,,,Ice<1"" odd"'''' ""!''''/,\ f ;g Applicant Signature ~ (;J ~ ~ Address 1133 Briar Dr, Iowa City, IA 52242 Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 3 of6 . CITY OF IOWA CITY ANIMAL CARE TASK FORCE . PPLICATION FORM I ~ I ~~~~Ilf: ~"'T" .....~ CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Retum the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY ANDAUTOMATICALL Y CONSIDEREl(!JORA~VACANCY DURING THAT TIME. ~ 0 "'"' J~ ~=-.; c.-_j ALL TERMS END JUNE 30, 2009. q = -,' _.1 i '-.; ......0 __< ,__u Check which vacancy applying for: 0Jowa City Residence DCoralville Residence DJoh~~:~o. ~sid~~ NAME Adele Holoch HOME ADDRESS 2317 Plaen View Dri~,I~wa~ity, IA-'", dd'll.. I.D ,~ "our home address (listed above) within the corporate limits of Iowa City? [{] Yes 0 No Is your home address (listed above) within the corporate limits of Coralville? DYes Ed' No Is your home address (listed above) within the corporate limits of Johnson County? GJ'Yes ONo How long have you been a resident? Four months OCCUpATION Research assistanVPhD student EMPLOYER University of Iowa PHONE NUMBER: HOME (319) 354-0577 BUSINESS (319) 541.7940 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: As a research assistant and a Ph.D. student in English at the University of Iowa, I am well-equipped to perform the evaluative and research-oriented tasks associated with the Animal Care Task Force. I am also a skilled writer, a creative thinker, and experienced with computers and web design, and I would be delighted to use those talents to reach out to the Iowa City/Coralville community via the Intemet and educational programs and to help author the task force's annual report. For professional and academic reasons, my husband and I are committed to staying in the Iowa City area for at least the next six years, so I would also be a stable member of and resource for the Animal Care Task Force, through and beyond the 2009 term expiration. 1isrepresentations on this application will constitute just cause for removal of an appointee. If you fail (0 answer all the questions, Council may not consider your application. Animal Care Task Force Application ...... ,- - .............. -~~--------------------_._.+_._-~--_. _..,~----,-,._.~---------------~_.-._-~_.__.. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? My knowledge of the board is based on the description posted on the City of Iowa City website. I understand it to be a task force that will meet a minimum of four times a year to review current Animal Center policies and lcedures, to create ways to reach out to the community through educational programs, and to develop new ways of addressing the animal overpopulation problem in the area. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I have been an animal lover all my life. I enjoy being able to provide a home where our own pets receive plenty of food and exercise, safe shelter from injury, and proper veterinary attention. I wish I could provide similar care to all area animals who are in need of love and shelter, and as a member of the Animal Care Task Force, I would be energetically dedicated to finding humane solutions to"the animal overpopulation problems here. POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. [. articular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that 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. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Seption 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. 0 t:; ~ 0..... None. ):;: -', -,:;::: 11 '-") ,'-'-". I co -./ . ~ " 'll '~~-l ~>" N IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? III Yes D5lilo Cl 1.0 DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? 0 Yes It! No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) 'isrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application Name of City Board/Commission/Committees Animal Care Task Force I ~ I ~~~!:8lt ....-::...........19__ ........ ~ CITY OF IOWA CITY Date 11/6/2006 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name Adele Holoch 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. A copy of Section 362.5 is attached (see page 6). 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). f1ease indicate if there are none. BUSINESS NAME BUSINESS ADDRESS None. r-...J -. = "" c~ ~/-' ~ , ---< )> --':~ ;;2 -n NOTE: A new form must be completed if the above information changes or an own-Elrshjp,interest is acquired in an additional business. :< t: -'Joro1 Applicant Signature t ~ (-/O(,~ ~~.~ ~ c-; \.0 Address 2317 Plaen View Drive, Iowa City, IA 'isrepresentations on this application will constitute just cause for removal of an appointee. If you fail (0 answer all the questions, Council may not consider your application. Animal Care Task Force Application CITY OF IOWA CITY ANIMAL CARE TASK FORCE APPLICATION FORM I ~ I ~~~~~'t ".. ~.,~ ...,.. ~ 1 . CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council On matters of interest to our community and its future. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FORANYVACANCY .DURING THAT TIME. ALL TERMS END JUNE 30, 2009. Check which vacancy applying for: [a,lowa City Residence DCoralville Residence DJohnson Co. Residence NAME Roxanne Schomers HOME ADDRESS 317 Shrader Road 'Is your horneacldress(li~ted ab?ve) within the corpor~telirnitspflo'1~ City? 0 Yes DNo Is your home~ddress(listed above) W1thfrithe corporatelfmifs'rif CoralVille? ." BYes ,DNo . Is your hom~ address (listed above) within the c6rpo;~t~'liri-ii~6f3()f1n~ririCriunty?D Yes 0 No ' How long have you been a. resident? 52 years OCCUPATION PayrOll Clerk EMPLOYER University of low a PHONE NUMBER: HOME . (319) 358-8301 . BUSINESS (319).335-2803 ' EXPERIENCEANP/ORACTIVITIES wHICH)'OU.r;:EE~;QLJALlFY YQU F9RTHIS POSITIQN: Have worked in non-profit l;e,ttings worki':l90n public ,aware,ne,ss ~ncl organiza\iqn; , I :havl3 alsH helfll3(! plan and execute fund raising events. I have started to work with the Iowa City Animal Shelter via the Christian Culture Community non~profit arm Ofthelowa City Nazarene Church, It has been decidedlhat we will continue our assistance as we are able to help the, shelter in special projects and with some of the unique needs that arise. It is:my job to maintain contact with the shelter.' At my work I raised awareness for the shelter and collected money and items to donate to the shelter. We were able to assist them with advertising as well. . . '.', '.;n' . , ", MisrepresentatI6its'or{~hM llppilCa~roiFyJin:C6iisth~te\j\Jg~'Clilise ~or'~mo'Val of an a~ile:,~>,6~i1 t9.ansv.'f.jr all the Ql,Je~t!O!)f' CqUf\C1!."?ay ,1191 gln~ld~~y()~r,~R?I!~t!()!1. . 9 -< i' .= Animal Care Task Force Application September 2006 -0 -.- i i i Page 1 of 6 .. 'n'; 0;':&' ..::;:,,/'-.. '" po :---1 ,...~+..-I N C> \.0 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I do not have much knowledge about the board except the understanding that it is a way to discuss and explore options for the continuing function of the shelter. I am, however, eager to leam. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I am an idea person. I like to find out what others are doing, how they did it and whether or not it worked for them. I would like to be able to address areas of growth and expansion for the shelter. I would like to make the shelter more handicap accessible as well as offering more seating to those interested in getting to know the animals available for adoption. I would like to see the shelter moving into a more public domain (ex. making Adopt-a-thon a tradition, bringing animals to individuals in support care, other events where both the animals and the shelter are brought into the community). I would also like to see a veterinary clinic for those that are unable to pay private individuals. This clinic could be subsidized using proceeds from donations but also by offering pet boarding for those on vacation. My long term goals include a new facility for the shelter, one that is larger and better able to administer to the needs of the Iowa City and Coralville community. POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations . ,to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that 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. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes 0 tIJ:> ", o ~ DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSI0!9?JD I?s 0 No (It has been Council policy not to permit an individual to serve on two Boards or Commission?"afjhe ~e tim6.) Misrepresentations on this application will constitute just cause for removal of an aPil9intee?tf yd., fril to answer all the questions, Council may not consider your application. 6 ~ :g C~J Animal Care Task Force Application September 2006 )> o 1..0 Page 2 of 6 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I ~ I !~~~tt -..;;::.... ..t' ..... -...-. CITY OF IOWA CITY Name of City Board/Commission/Committees Date Name Roxanne Schomers 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. A copy of Section 362.5 is attached (see page 6). 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). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS None NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Applicant Signature Q ~ aN\.~ "{V\ ~ '?-,c- ~ f"rv'("\ ~/ Address 317 Shrader Road o J ,"' <= ~ "[;;.-..,.- ,~ Misrepresentations on this application will constitute just cause for removal of an a~PfIQtee.:Jf:you1ai1 to answer all the questions, Council may not consider your application. c~l;) de> ,- _, Animal Care Task Force Application September 2006 Page 30f6 ;-5 :0 ==: :s: ^ r:y 5> a '-D ,--, '"j Marian Karr I=rom: ent: To: Subject: schomers@mchsi.com Wednesday, November 08, 20068:40 PM 'City Council; 'City Council Iowa City Animal Task Force My name is Roxanne Schomers,I recently put my name in for the Animal Task Force. As a long time resident of Iowa City, and a friend of the animals I would like to be apart of a team working towards a better situation for the animals and a way to serve the public need as well. Thank you for allowing me to apply. 1 -'"----------~--,,_.-,,_.._---_._._~------"~------.-"- _._--_._-,._._-~~_._-~._------_.-_...__.- CITY OF IOWA CITY ANIMAL CARE TASK FORCE APPLICATION FORM I ~ I -,.,= -.... ~~~I~~'t ~~....'!"J~ ~--'-I- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Comm~tees play an important role in advising the Council on matters 01 interest to our community and its future. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal. Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY ANDAUTOMATICALL Y CONSIDERED FORANYVACANCY DURING THAT TIME. ALL TERMS END JUNI: 30, 2009. Check which vacancy applying for: ~ City Residence DCoralville Residence NAME D. HOME ADDRESS . ~ ;::fOWl\- 52.1.44-0512 Is your home address (listed above) within the corporate limits of Iowa City? ~es D No Is your home address (listed above) within the corporate limits of Coralville? c::b'es ~o Is your home address (listed above) within the corporate limits of Johnson County? ~~ GNo 11 0-..... I How long have you been a resident? ~. .::.~ ~> co '11 OCCUPATION.nai.IEO .' EMPLOYER r'\~' ;l '.,_J PHONE NUMBER: HOME(~\V 1tWa. ()?J~ BUSINESS(t?\q)~~4-4f EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: .I'rf)ltr-fl 1tnC\ 1<2>1\JP.aI 0~ ~~<x:t\i\\.l ~ ~l1 \0 ..:t cor V It C()qnll'MXll'N 1J)O\~ro.1br '?eJlCe,rt\l\IStite...1 \"I~tr l~\ f'1't\rn-~ · ::t rFt.lt. doo.t,"~rtM-\ OI.'~ Q/f 'lbI\1l'\{cr UJO lCVCt'llfe ~ ~ ~ ,"'ilL 01 e6"llel', ~...1 ~e..~at.. A ~ooa.. deft\ Of \!()pI}{cl In UJort,L ves?I~~ ~~lliN' \ :r:. wer"'I-J~1 ~t IIr1\ 8tf~I(e ~I'II\M~.:J: })C1Q ~d At IV'A-ilog ~~ms ttl1l ML 1\l)m1~ iQ ftl) f>~:r~=\~~~~~;~~~~~~~~~~l' r :t\t ~ '11'1\1:I\ f\-s. 5t,Nfc.t. WO~I .J:. Wit:. oool'd.~ - ,,'-'-\,) , \" . - fd . ft Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions. Council may not consider your application. Animal Care Task Force Application September 2006 Page 1016 I'd Il.9IdSE:SIE: ...a~ua::J s~s~"'::J dSOIVO 90 80 ^o~ (~\f((ifle ~mf?e WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARU (OR STATE REASON FOR APPLYING)? :L ~\tY\ f\ W{C;l\ \dB\S 0 l h\.SO . ~ ~~-tJ*--cloI0~ ltL r~-\O ~t. -\ni<1~S WOf~, l fW:k) i9rj)ftr lji)oJlf.r WIlt M ~ Nt- ryxLWl~ ~~ I~ ~ \\Qtt*~ ~ U}itt1. &-oo18r ~ POTENTIAL CONFLICTS OF INTEREST ~ ~ ~ e:s wit\! ~ Ot41 { Please identify any potential conflicts between memhership on the advisory board nnd your personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member 01 a board or commission which makes recommendil~ons to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. 'Affiliation' includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.6 of tho 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. A copy of Section 362.5 is attached (see page 6). "'" II you are uncertain whether a potential conflict of interest exists or have questions aout S~on 362.5 of " C~ 'f1~ruOO roomd~' c~ -_"moo.t _ww ~~ ~ l~. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~es ~o ~ DO' YO'U CURRENTLY SERVE ON ANO'THER IOWA CITY BO'ARD O'R CO'MMISSIO'N? 0 Yes ~o (It has been Councill'oliG)' not to. permit an Individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 C~ Page 2 016 2.d 1l.9l>ISE:SIE: ..J"~U":) SlSl..J:) dSOIl>O 90 80 ^o~ Name of City :10J.!).h, C 1d\{ Board/Commission/Committees Name C^,-mf~oeJ 'ffno~R-U I! I ~~.g,_..... ~~:I~l::~ -..;:..... ....,~ -..~ CITY OF IOWA CITY Date H-o &-20QG BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Section 362.5 of the Code of Iowa generally prohibits. with cert~in important exceptions, a member of Q city Board or Commission from having an interest in a city contract A copy of Section 362.5 is attached (see page 6). 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). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS :22, ,~, 0 C::::J 0' :2: q ',. l:':~; -- ,~ ,.. 0:> . ~ -r' n -0 .-, - '0....1 - ~- -- ~ -'" N --- )> N NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an ad .. al bUSi~. Applicant Signature Address B Q1:;o Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Furce Application September 2006 Page 3 of6 E'd tl.9t-tSEstE .J"~U":l SlSl.J:l dSOlt-O 90 80 ^C~ CITY OF IOWA CITY ANIMAL CARE TASK FORCE APPLICATION FORM I ~ 1 -"",= -It !~W!!:'t -.::;:... ....,~ ...,.. .. 1 CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FORANYVACANCY DURING THAT TIME. ALL TERMS END JUNE 30, 2009. Check which vacancy applying for: !Zl.lowa City Residence OCoralville Residence OJohnson Co. Residence NAME David C Thompson HOME ADDRESS 827 Brown St '" your home address (listed above) within the corporate limits of Iowa City? [l] Yes D No Is your home address (listed above) within the corporate limits of Coralville? DYes D No Is your home address (listed above) within the corporate limits of Johnson County? DYes D No How long have you been a resident? 21 years OCCUPATION Prosthetist EMPLOYER none PHONE NUMBER: HOME 338-8713 BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: Lifelong pet owner. Long-term resident of Iowa City. t...." 6 ~~ = 5 <;;.1-' .....:..~ (j :;c -~-;~ - (:,::) .,~: i j r) I r~- ;-.... en 0' ""-1 . , m " I, :D =;: ,-1 C) , :7' '"~ -s: N II Misrepresentations on this application will constitute just cause for removal of an appointe:' If you fail to answer all the questions, Council may not consider your application. II Animal Care Task Force Application September 2006 Page 1 of6 WHAT IS YOUR PRESENT KNOWlEDGE OF THIS ADVISORY BOARD? none WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? Search for creative and practical solutions to problems such as: inadequate animal shelter use and over-crowding, need for annual deer hunts, and off-leash pets. POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. . , particular, if you are applying to be a member of a board or commission which makes recommendations LO the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that 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. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions ~ut Setaon 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. ~ () ~ , -~ <: n ,~-) .-.::. f ~ ~.. CD ,- . (J 0 Y7e., r- IT' (5 ;;~ 22 :Tl r--~1 \...../ <:: IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? III Yes &No ~ DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? 0 Yes iii No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 2 of6 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I ~ 1 -....= -lit ~~W!l:-r -.;;::.... ...t~ ........ - CITY OF IOWA CITY Name of City Board/Commission/Committees Date Name David C Thompson 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. A copy of Section 362.5 is attached (see page 6). 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). Please indicate ifthere are none. BUSINESS NAME BUSINESS ADDRESS none " ;-...} ~ ~~ "'" ']0-:0.0:' ." -""_: C~, '"' .~ - ~ , , I - -:-<:r-:: ~ :--0--1 ,Ii ~ rO'; 22 ;--~ ~/ ~ ~ NOTE: A new form must be completed if the above 'nformation changes or an ownership interest is acquired in an additional business. Applicant Signature Address 827 Brown S Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 3 of 6 Johnson Co. 10/13/2006 14:15 IC AREA ASSOC. OF REALTPRS 7 3544550 NO.716 [;l003 CITY OF IOWA CITY ANIMAL CARE TASK FORCE APPLICATION FORM F!! cr"'\ , '-j I ~ 1 -.....=- -It: ~~:IW~'t .....:;... --~~ .... ---- CITY OF IOWA CITY ZOOS OCT 16 PII 3: S7 ('\1"(-'./ .- '.) ::_:1-",( ;, ,,{'-., Individuals selVing on Boards/Commissions/Committees piay\Mt\i~ f9Wft! advising the Cauna on matteJs of interest to our community and its future. After a vacancy has been announced. the Council reviews aU apprlCations during the wor!< session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This fonn may be filled out manuaIIy (please use a black ink pen), typewriIten, or dt...huolically (PDF). Return the appticalion to City Clerk, 410 E Washington St., Iowa City, Iowa. THISAPPLICATION ISAPUBUC DOCUMENT AND AS SUCH CAN BE REPROOUCEDAND DISTRIBUTED FOR 1liE PUBl..IC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIOENTIAL. n THIS APPUCATION WIlLBECONSIDEREDFORTHREEMONTHSONLY ANOAUTOMATICAl.LY CONSIDERED FORNNVACANCY DURING THAT TIME. }l..!.L TERMS END JUNE 30, 2009. Check v.tJictI vacancy applying for. Olowa City Residence OCoraJvile Residence .I!lJohnson Co. Residenl;e NAME Jane McCune HQMEADDRESS 8 Woodland Heights, Iowa City, IA Is your home address (listed above) within the CO\fJU'ate limits of Iowa City? Dyes D No Is your home addreSS (1isted above) wilhin the corporate limits of CoraIvIlIe? Dyes D No Is your home address (listed above) within the corporate limits of Johnson County? GJ Yes D No How long have you been a resident? 31 years OCCUPATION Realtor EMPLOYER Blank & McCune, The Real Estate Company PHONE NUMBER: HOME CH9) 354-4004 BUSINESS (319) 354-9440 EXPERIENCE AND/OR ACnvmES WHICH YOU FEEL QUAUFY YOU FOR THIS POSmON: I belong to many organizations whose focus is on animal welfare issues such as ASPCA, International Fund For Animal Welfare, Alley Cat Allies, Humane Society of the U.S., Doris Day Animal Leque, Johnson County Humane Society, Friends of Animal Care Foun- dationT I have bee~ interested in animal issues for ma~y years. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions. Council may not consider your application. Animal care Task Force Applk:afion september 2006 Page 1 of6 10/13/2006 14: 15 IC AREA ASSOC. OF REALTPRS 7 3544550 NO.716 [;1004 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I understand this is a new task force which will develop programs to reduce animal over-population and educate the public on local animal issues and in general, addres animal concerns in Iowa City, Coralville, and Johnson County WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I feel that since I have been following animal organizations for many years & know what various societies are doing, this will help me to act in an advisory capacity. I also have personal experience with rescue animals for the past 35 years. o ~- -::> ~~ c=> c= C""' )> =--, r.;-) pOTE!IfTIAL CONFLICTS OF IfflEREST " -:.. I I Please idenlify any potential oonIIids between membership on the advisory boaIt1 ~t[~nal interests,ir1ckJ(fl!lg financial interests and your duties to an employer. ~, f,- -0 : Tl 0# == '::J In par1iculal:. if you are applying to be a member of a boall1 or commiSsiOn which mak~~mlfJendations to the City Counc8 about the allocation of City funds, please fISt any present: affiIiatlEins you:..have with agencies that apply for funding from the City. "Affiliation" includes being a board member or eilIPIoyee of the agency. other types of afIiIiations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, wilh certain Importal,t .' exceptions, a member of a ~ Board or Commission from having an interest in a city contract. A copy of . Section 362.5 is atlad1ed (see page 6). If you are uncerlain whether a potential conflict of ;"leresl: exists or have questions about Section 362.5 of the Code of Iowa. please am1act the City Attorney's ofIic:e at 356-5030. I IFYOUARENOTSELECTED, 00 YOU WANT TO BE NOTlAED? UI Yes 0 No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? 0 Yes iii No (It has been COuncil policy not to permit an indMGuaI to liente on two Boards or CO..I...~()ns at the same time..) MisrepresentatiOns on this application will constiMe just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your app6cation. Animal Care Task Force Application September 2006 Page20f6 Name of City Board/Commission/Committees Animal Care Task Force I! ! ~ii.'-': ~... *....i- .......... ~ ~ CITY OF IOWA CITY Date 10/13/2006 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name Jane McCune 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. A copy of Section 362.5 is attached (see page 6). 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). Please Indicate if there are none. BUSINESS NAME BUSINESS ADDRESS Blank & McCune, The Real Estate Companv 506 East College, Iowa City , Iowa ~~ <:i" co --n ,-, 7--:\ - -;.-- ,..., c1' C\ \ '-;..::.., (-.'-, ___/ ,_e :$ \--) :"- M-\ ?', ~:: ~? J ~<, ""'"7 <..f\ ~ -' NOTE: A new form must be completed if the above information changes or an owneiilhip interest is acquired in an additional business. Appl;"", S;gmrtu", :t: It.. y; ~ Address 8 Woodland Heig s Iowa C~, Iowa 52240 - Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 30f6 Coralville CITY OF IOWA CITY \NIMAL CARE TASK FORCE APPLICATION FORM ,e:,I! T"-) I ~ I --= -It ~~~Iji!:'t -..;::.... ...-'~ --.. _ l CITY OF IOWA CITY ^('6 /.1.'0' - i P;:--[ /: [;,2 Individuals serving on Boards/Commissions/Committees matters of interest to our community and its future. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. r', Gl ('/ (" -. 'i'~ , ~:\l1\ ii~WbHa~09'~in advising the Council on THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ALL TERMS END JUNE 30, 2009. Check which vacancy applying for: Dlowa City Residence OOCoralville Residence DJohnson Co. Residence NAMEJ]vL Il- K't2L.L'-( HOME ADDRESS ?"'DI.ff:, q fA 5t /<:JiD~ Coll/rLi/ ILL<;; " your home address (listed above) within the corporate limits oflowa City? 0 Yes lliNO Is your home address (listed above) within the corporate limits of Coralville? [R] Yes 0 No Is your home address (listed above) within the corporate limits of Johnson County? 0 Yes 0 No How long have you been a resident? _I 0 Lj ElIt (LS OCCUPATION VG ( frss, s r -4VU'" EMPLOYER {9l/6Hr t;YGS rJ-txX)!'/ PHONE NUMBER: HOME ~I~ -"56\.5' ~ 1'1 79' BUSINESS ~ I 9 - 3.$" I - 'i 2 'S'-b 1'-t/~S EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: -r(ttevt% 0 - ;r1U/~ L (.I;;?l)Tc; ()LV ~ (f1 em f6E r< ~ 00 PIG R.. Or::: (lta.~ fjrvO ftooPrto JU t.~rt=71.. _ FDflrv)(~ rr. SOt: I -t'L tu /)/l.1-1< R. frtfJQ Hit. M4N46r;;f? - FA-;f1lf..I/)-/l.. WI it..( COrtlll1 I I/(:I;:-~I ML-/S()fl.1.( /!,oA-ll(.J$ IhvO f~6"l/fr~1t1( A-PP}..I/6 S8J~fl.,j-l.. f(-i-1Jlm...-fLS FIZtyV) Ie.. /'r-tIIt,...,A-L Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 1 of6 --~'-"'-'~".'--'------_._._'----~~--~~--"--'--"-"'~'"---"-----~.._---~-_.,------_._---~_._-------,_.._----_.----_._~"'-,_..~--_.- WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? :JuSt' Lv~l'rl' t- f6e1+(.) 111.1 12G';,'5" R.~ Sf.- WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? -t ho.llol!. C<. f'4f.S;,,(\ or "... ;M,,< .'.,} S:o fkUC Cl ..:..- Ie- t "'j ~ J" + <," r r' . / r'i1 Ie, t-ed ("-'toRr. '];n-"^- ('<lV'lev." p...oTt'S$;''''' 0 '" Lc,r I'V"f / n CU/l"'<< tJ.)()/l,K./,v{,- n-r 11' Viii, CO,v/C lA.Ur //1IC'- ~D€.5 !l. 'I /f{](J/l. kl-tfe7Z6e]tJLY . ..,... "fJ-/G ~ smo/'V' lErl1pr/()I()S '''''AT /kco M,/J~ Se7lYI(fd,~ /'-WO/.<l - / ) /hV'1 I}-WJM-H.. /55vG. f'ts It Fu/l.Y1IE./C. :>OC IA-t. wMU:7Z CMa:.GIJ- tlV (,,I(.()(.JfIJ /}"1VO /9-,." PA-II?/(J!+ '1' veO( t: t;76l1- I k'?l/CG/J IF' (/oll./altlG I .., I/ ~ "" (}1t1 f/ I s~ L't poA4lF-lS. "'1 /.vIT/.1 r;Y(7 /l.()LG or- (1..//; Jlnuur~ If7V . r1I ILOCV c.lfJ/l()/l naz oP I'll CI'H1'>5/.KI ~ ~ 1"'#/;, /Ct1~ POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. . 1 particular, if you are applying to be a member of a board or commission which makes recommendations 10 the Citle Council about the allocation of City funds, please list any present affiliations you have with agencies tRat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that 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. A copy of Section 362.5 is attached (see page 6). r-.. ,-_ c:;:,. If you are uncertain whether a potential conflict of interest exists or have questions abO~i:eptiO~62.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. ';"3 ==} 52 --n ""TI Ti '-j ;2 <.::: IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes 0 No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? 0 Yes rsI No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) ~. N Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 2 of6 1 ~ I -....= -...... ~~:I~!::"!. '-... ....,~i.- ........ ~ CITY OF IOWA CITY To be viewed by City Council only and limited staff at Council discretion. II CONFIDENTIAL II Board/Commission/Committee Name: II-IU 1M trL CJl-fZ r;:; r )}5(C Fa r2 u;; Name: PltliLA- f-( NL '-t Have you been convicted of a crime other than a simple traffic misdemeanor in the last ten (10) years?(conviction will not necessarily disqualify an applicant from appointment) DYES Cjl NO If yes, please explain and include the type of offense and the place and date of conviction, i'J :2:0 ~, C.:l c--.:::,> eo-" .~...: 'r, ::-) -,... -:.-, -,." "~:-j j: ,-, C) ~-~ ~ ~:~~) Will this conviction or the circumstances leading to the conviction affect your ability to pe!'!'6rm the duties of a member of the Board or Commission? )> - N DYES o NO o NOT APPLICABLE Please complete all fields, print, and submit pages 1-4 to the City Clerk's Office. You may keep pages 5-6 for your files. Applicant Signature ~ lO (sll CX:J Date Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 4 of6 CITY OF IOWA CITY ANIMAL CARE TASK FORCE "PPLlCATION FORM I ~ j -....= -It f~W!:'t~ ~ ~-'~ ...,..~ CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FORANYVACANCY DURING THAT TIME. "'-) C) F~ ALL TERMS END JUNE 30, 2009. :'~ C c~ Check which vacancy applying for: Dlowa City Residence IZ!Coralville Residence OJ~~~i6n CQ~Re~~Ce NAME K. Lindsay Eaves-Johnson HOME ADDRESS 2035 Southridge Driv~i~522401 :T! ~. ! :-;,:::~ - - 'oJ ;;:;:-/" - -. )> Ul Ie your home address (listed above) within the corporate limits of Iowa City? 0 y:S- 0 No Is your home address (listed above) within the corporate limits of Coralville? [{] Yes D No Is your home address (listed above) within the corporate limits of Johnson County? 0 Yes ONo How long have you been a resident? 4 years in Coralville, 5 in Johnson Cnty OCCUPATION Educator (Community College and University) EMPLOYER Kirkwood IC and UI PHONE NUMBER: HOME (319) 354-9392 BUSINESS (319) 325-1699 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I have volunteered with the Iowa City Animal Center and Adoption Facility since -2002, attaining rank of ''Red-dog'' volunteer. In this capacity, I have variously: walked dogs, trained shelter dogs through "Paws to Train", helped at events such as "Paws in the Park" and "Holiday with the Hounds", and was one of the founding coordinators of the "Through the Cat's Eye" event this past spring. In addition, I have been active in the Johnson County animal community by enrolling my two dogs each in obedience training through Spot and Company and by certifying myself and male setter as Pet Partners through Delta Society. I worked at Just Dogs Play Care when it opened. I currently foster for Illinois Birddog Rescue and am an advocate for spaying and neutering. I was a minutes-taker for Iowa City and understand the requirements of this position. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail (0 answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 1 of 6 --------_._---~-,~,._._-_._._-~---------------'--~"..-._----------_.._-_.~-- WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I understand that you are looking for people interested in making a difference in the community for animals. Duties may include seeking to reduce local pet populations in a positive way, and reviewing current ordinances. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? As a college community, we have special issues, such as animals that are often left behind at the end of the academic year when their owners move. The number of semi-feral cats is also relatively high. By providing spay and neutering services, as well as responsible pet ownership materials to college students in particular, I believe we can make an impact on animal welfare in the community. I have competed in debate and public speaking events from grade school through college and am able to mount arguments in a cogent and convincing manner. I know many of the players in the canine community and look forward to meeting people involved more in the care of other species, as well. I am also active in the Iowa City "human" community (co-president of Agudas Achim Sisterhood, member of the Iowa City Creative Economy group, founding member of the Iowa City Darwin Day organization) and believe that I can help spread awareness of animal issues to the community at large. I am full of energy, creativity and passion. POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. particular, if you are applying to be a member of a board or commission which makes recommendations IU the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that 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. A copy of Section 362.5 is attached (see page 6). ___ r......' If you are uncertain whether a potential conflict of interest exists or have questions ~ut Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. ); Q 2:i I have no conflicts of interest that are known to me. \~ ~~ ::s . -:-1 ;--'1 ....1 ~~ ~... IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? III Yes 0 No - DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? 0 Yes III No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) 'v1isrepresentations on this application will constitute just cause for removal of an appointee. If you fail (0 answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 2 of 6 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I! I -,..= -It :t~w;!:'t '-... ~_I~ ....-..~ CITY OF IOWA CITY Name of City Board/Commission/Committees Animal Care Task Force Date 11/112006 Name K. Lindsay Eaves-Johnson 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. A copy of Section 362.5 is attached (see page 6). 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). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS N/A N/A ~o, c-:> ';:';;.1 -- ~i': ~:-:: C) '. ::. ~<., _~.l ::: . ....: -() . :. I--'-~ -- . ~:;; - ., )> ';!2 NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Applicant Signature V ~ I--.. Sa ~ ~'-" ,) Address 2035 Southridge Drive, 52241 Misrepresentations on this application will constitute just cause for removal of an appointee, If you fail LO answer all the questions, Council may not consider your application, Animai Care Task Force Application September 2006 Page 3 of 6 ---~~-,"---,--'---~--~--'-'~-----'-'---~-~-"----'-'-'._-------------"',.,.._,.__.._---~- NOV-03-2006 12:57 HOLMES MURPHY 319 364 2132 P.01/04 CITY OF IOWA CITY ANIMAL CARE TASK FORCE APPLICATION FORM I! I ;;:;t::.......... :f__~!!~ "-'" ....,~ ..... -- CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its future. After a vacancy has been announced. the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen). typewritten, or electronically (PDF). Retum the application to City Clark, 410 E. Washington St, Iowa City,lowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FORANYVACANCY DURING THAT TIME. ALL TERMS END JUNE 30, 2009. 0 Iii .....- Q', ~~r.." Check which vacancy applying for: Olowa City Residence 0Coralville Residence DJohnso~ ReSIlience ~.'...,_ -.",' ".c -r-l NAME Teresa (Teri) Howard HOME ADDRESS 2201 13th St., Coralville~\A. c.:)'~ ;"'..: ;--"""1 ~C('".3' ,II , --I r_'. " ..J;-:" ,-----, :::: ;~~~ ~ <.j Is your home address (listed above) within the corporate limits of Iowa City? [EYes ~NO Is your home address (listed above) within the corporate limits of Coralville? 0 Yes 0 No Is your home address (listed above) within the corporate limits of Johnson County? 0 Yes ONo How long have you been a resident? 21 vears OCCUPATION Senior Claims Specialist EMPLOYER Holmes Murphy & Associates PHONE NUMBER: HOME 351-3160 BUSINESS (319) 896-7720 EXPERIENCEAND/ORACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I am an experienced dog owner and have five dogs of my own. I have rescued four dogs in the past five years and performed pet foster care for multiple dogs since 2002. I am also knowledgeable of the Iowa City Animal Shelter. its procedures and guidelines and Its staff. I am also familiar with the surrounding city and county shelters as well as their policies and procedures because I have fostered/rescued dogs from their counties. As a paralegal, I am familiar with all areas of the law. I have experience in legel investigation and am comfortable reading and analyzing c:ontracts. statutes and city ordinances. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 1 of6 .,,~--_._-_..~,-"_.~--_._----,._--,.. NDV-03-2006 12:57 HOLMES MURPHY 319 364 2132 P.02/04 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? !hIs task force was established to identify solutions to the animal overpopulation problem. The committee's charge will be to review ordinances, evaluate shelter guidelines, develop programs to reduce animal overpopulation and to educate the community on local animal issues and concerns. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I am applying for the task force because I want to help the community control the animal overpopulation problem that the Iowa City Sheller struggles with continuously. I do not believe that the community is aware of the number of animals that are euthanized, the length of the typical shelter stay for an animal, the number of animals thai are brought to the shelter, or how many animals are required to be placed in foster care due to the lack of room at the sheller. I also do not believe the community is aware of the amount of financial and social resources that we as a community use to combat thi.s problem. I hope that my experience in foster care and dog rescue, as well as my legal education and ability to work well in a group will help make this task force successful. POTENTIAL CONFLICTS OF INTEREST Please Identify any potential conflicts between membership on the advisory board and your personal interests,induding financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations . ,to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" Includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that 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 contra~ A copy of Section 362.5 is attached (see page 6). 0 ~ :';fo ?: If you are uncertain whether a potential conflict of interest exists or have questions abt)ut~ec~ 3E?:Ui of the Code of Iowa, please contact the City Attorney's office at 356--5030.. C:' , c'.o ,-- -\'~ .' . .-' , "iT, - ~. f!; ~? --- --.-:u.. ) :;:::::::::l::;::;! '....A' ~/..... N <:: po None (.51 N IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? III Yes 0 No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? 0 Yes [l1 No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If yau fail to answer all the questions, Council may not consider yo!-,r application. Animal Care Task Force Appiication September 2006 Page 2 of6 NOV-03-2006 12:58 HOLMES MURPHY 319 364 2132 P.03/04 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I ~ I ~~~~~'t -..;;;.... --..'-~ _". ....... - CITY OF IOWA CITY Name of City Board/Commission/Committees Animal Care Task Force Date Name Teresa (Teri) Howard 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. A copy of Section 362.5 Is attached (see page 6). 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). Please indicate If there are none. BUSINESS NAME BUSINESS ADDRESS None N/A . r'~.' <-'::.' Q ci' --r.- .<-.-,- .... ,.-, \1 ""'t:--...:::-; ..;.;, (j " .', r- :,' "-~ , , \~.._,.. - , _..""-, " NOTE: A new form must be completed if the above information changes or an own~~,~ip il"lteresUs acquired in an additional business. ~C'I ~>; <::' -~ ):7 r~-Ho~ (j. rv Applicant Signature Address 2201 13th St.. Coralville, IA Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Animal Care Task Force Application September 2006 Page 3 016 \'\c- Page I of I Marian Karr From: terihoward@mchsLcom Sent: Tuesday, November 14, 2006 9:38 AM To: 'City Council Subject: Animal Care Task Force Hello to each of you. This is a follow-up to the application I submitted to the City ofIowa City for a position on the Iowa City Animal Care Task Force last week. As a Coralville resident, I am excited about this opportunity and welcome each of you to contact me with any questions that you have about my application. I am a driven, enthusiastic person with a well- rounded education that would really enhance this group. My experience with dog rescue and my knowledge of the Iowa City, Cedar Rapids and surrounding area animal shelters and their procedures would also be a great asset to this task force. There is so much to be done to improve the shelter, as well as to educate the public about the animal overpopulation issue. I sincerely hope that I am chosen for this task force because I really want to help make an impact in our community. I thank you for your consideration and welcome any questions that you have of me. Thank you again. Teresa (Teri) Howard Coralville resident 319-331-6112 11/14/2006 Cl[J NOTICE THE CITY COUNCil OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOllOWING BOARD: BOARD OF ADJUSTMENT One vacancy - Five-Year Term January 1, 2007 - January 1, 2012 Duties: In appropriate cases and subject to appropriate conditions and safeguards, the Board may make special exceptions to the terms of the Zoning Chapter in harmony with the general purpose and intent of the ordinance and in accordance with general or specific rules contained therein. The Board may grant variances to the Zoning Chapter only in the case of "unnecessary hardship." The hardship must be substantial, serious, real, and of compelling force, as distinguished from reasons of convenience, maximization of profit or caprice. The Board may also hear and decide appeals where it is alleged there is an error in any order, requirement, decision, or determination made by a City official in the enforcement of the Zoning Chapter. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets the second Wednesday of each month at 5:00 p.m. Applications must be received by 5:00 p.m., Wednesday, November 8, 2006. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Board of Adjustment Commission should be directed to Bob Miklo, Senior Planner at 356-5240. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in-law, father- in- law, brother, sister, brother- in-law, sister- in-law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 2 Females: 2 Council Announcement Date: September 19, 2006 Application Deadline: Wednesday, 5:00 p.m., November 8,2006 Council Appointment Date: November 14, 2006 BOARD OF ADJUSTMENT One vacancy - Five Year Term January 1,2007 - January 1,2012 Term expires for Karen Leigh No applications as of Wednesday, November 8,2006 [8] Denotes applicant completed the Confidential page of the application. ---_._--,._--_._--_.,-,_._-----,._.._-~_."._-_._-_. c:::I NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF APPEALS One Vacancy- Five-Year Term January 1,2007 - December 31,2011 It is the duty of members of the Board of Appeals to hold appeal hearings on matters concerning the Uniform Building Code, Uniform Plumbing Code, National Electric Code, Uniform Mechanical Code, Uniform Fire Code, the Dangerous Building Code, and the Iowa City Housing Code. Members must be qualified by experience and training to pass upon matters pertaining to building construction. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets the first Monday of each month at 4:30 p.m. or at the call of the Building Official. Applications must be received by 5:00 p.m., Wednesday, November 8, 2006. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions regarding the Board of Appeals should be directed to Tim Hennes, Sr Building Inspector at 356-5122. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in-law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 6 Females: 0 Council Announcement Date: September 19, 2006 Application Deadline: Wednesday, 5:00 p.m., November 8,2006 Council Appointment Date: November 14, 2006 BOARD OF APPEALS One vacancy - Five Year Term January 1, 2007 - December 31, 2011 Term expires for Stephen Buckman No applications as of Wednesday, November 8,2006 o Denotes applicant completed the Confidential page of the application. ~ NOTICE THE CITY COUNCil OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOllOWING COMMISSION: HOUSING & COMMUNITY DEVELOPMENT COMMISSION One Vacancy - Unexpired Term Ending September 1, 2008 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. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. 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. The Housing and Community Development Commission will have monthly meetings. Appiications must be received by 5:00 p.m., Wednesday, November 8, 2006. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered shouid contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Housing and Community Development Commission should be directed to Tracy Hightshoe, Community Development Planner at 356-5244. iji@jjijjg & Community Development Commission Attendance Record 2006 Term Name Expires 01/19 02/16 03/09 03/23 03/29 04/20 07/20 08/15 09/21 Brian Richman 09/01/07 X X X X X X X X X Hollv Jane Hart 09/01/07 ---- -- -~ ---- ---- ---- u__ X X X Jerrv Anthon;- 09/01/08 X X X X X X X X X Kellv Mellecker 09/01/08 OlE X X X X X X ---- ---- Lori Bears 09/01/07 X DIE X -- un .--- ---- ---- ---- Marcv De France 09/01/09 ---- ---- ---- ---- un -.-- X X DIE Matthew Havek 09/01/07 DIE X X X DIE X X X DIE Michael Shaw 09/01/06 X X X X X X X X X Thomas Niblock 09/01/08 X X X DIE DIE X DIE DIE DIE William Greazel 09/01/06 DIE X X X X X X DIE X Yolanda Soears 09/01/06 ---- X ---- ---- __n --- ---- u__ ---- Key: X Present o Absent DIE ~ Absent/Excused NM = No Meeting = Not a Member Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in-law, sister- in-law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 6 Females: 2 Council Announcement Date: September 19,2006 Application Deadline: Wednesday, 5:00 p.m., November 8, 2006 Council Appointment Date: November 14, 2006 HOUSING & COMMUNITY DEVELOPMENT COMMISSION One Vacancy - Unexpired Term Term ending September 1, 2008 Kelly Mellecker resigned Andy Douglas [R] 2721-0 Muscatine Ave [RJ Denotes applicant completed the Confidential page of the application. "'\' ri [',:'// ",' ; ,_, 1"'\ Individuals serving on Boards/Commissions play an i~9:f~~"nSol:"in\2~~ng the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. CITY OF IOWA CITY 'II c:'\ ADVISORY BOARD/COMMISSION\) APPLICATION FORM 2Q[:f) ::'.'1 -8 Pi'i ll: 36 THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF. THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME _H ()....); VI) ""d es,."ofVlv.."':t; (j/e.v1. TERM 0""107 - Sept oS NAME A'I\d.'1 Oo"'~ \~5 HOME ADDRESS 2. 7 2..1- 'V JIA, '1 ') c..",+; n<.. Ave. Is your home address (listed above) within the corporate limits of Iowa City? ~s ZIP S~~ '10 DNo How long have you been a resident of Iowa City? OCCUPATION w(',+.a PHONE NUMBER: HOME 3, g - () 8 2 8 . EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ::c "'''' .. I"',-~,,-U(S~ '* Jel"''' Ci'j w,1Vl 0., I~")~di) 1~+Q1'/'j~ l,,,,,,,,d e".yy....~ wi'j\l \))v-t'J .J Silt;") etv..,ry "",d r~€"7' fa< SN~~\ '1e..0 ) J. c.o.J~J J(}('lOV6:; .L_ Gt; ~~5 0..) C<. I-C,ofW W "'- 1<fO>./ o'e""5V"'P"'-r. . . r . ~ rece-\t /~, "-? J'~ ,:>~~le.! w.1'\- 0\ (..\.ro~i( i\\v,esS i I ,Je.heue>"""'-. '" f<'s.J~ '" c ;1f."v<"'e~ l.vr..l-lto""e 100"-5"',. . WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? tJ<>+ ~'"e. 1 \..~ ')f6~ """'" ... ~r...<( CDOV\~.J ,.,.~..,h~ ob:Mht .w6 \~"f'<d .,f "1"'- .'Ie. << eo.,,,,,,:,,'>"'" i''''17 ,VI l-df...., ~"e 11-< vse. of !)\oe.r. Q.ra...~. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. HCDC Application June 2006 Page 1 of 8 -,-_.,.._~-----------,.-_._--------_. ------~~~--- WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? k5 'I IM-Mtowt r~ ""~ h J~~b:\''7 j: C<>\Sf'fl>jr -R-",., I tJ\M '4~"C{ ~~~,,*il,(.. G"'-~\\~ ~ N!JI..~ ..f f-,vd,) 4"",-k \'Ov<iI'J. 1J.\~ 'f ~,17 I"I~~""S IM1\A Qt~l<S" p",'o\CC "'."'SIV) i't'J;\<k.\'I5,;;:: \-c'jl{ *' ~c>!kto iJfec.t ~~ co~cerll5 ~Opl""~1Vf I "'''''c -r. ~eNC. liueJ ,,^ " ~"""~ ,;r. .L,-r~;- C.4'1tf1"'5 ".,wv, '^'? ut~ H' '::P\~ 1"I';ljlltt- }"It.. Je..,.d1~ 1?~V'l5 ow! ~()'y:;1!""'1( "''; v<e.tlo-s ..\I"."u i'-' dev'e\~f C\ ')~ c",lt~rol sus;\1"Y. ~ Co.<5'";)u- "'17<-1J "'I ",.wo>c."'k f>r eC!)I,,?;=\I.1"~.sf!)A.91>><' h.,..,"'j "'r11Ad<~""7 wedf, POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that 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. A copy of Section 362.5 is attached (see page 7). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. '~; IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? DYES DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYES CllNO ..,.0 0 ...,..-:': """..- ,-, l~...-" Il -- ...: 0 '- 1 C) co ~ :--;-.1 '::-<<:_, -0 ,- , 00 r-I. -,--' ....-.... ....1 r, S ~., ~ - .::..... W C7' / (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. HCDC Application June 2006 Page 2 of 8 .__._~-"-------- BOARD. COMMISSION. & COMMITTEES BUSINESS LISTING Name of City +_ Board/Commission ~ 0 v ~ ", \I ') Name AYldj Oe,^~) C.S Section 362.5 0 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. A copy of Section 362.5 is attached (see page 7). Date \1-05-"& 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). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS No'fle... , 0 ;~;:J C~ ;~;s~~ is ~ ~ ":J -'. I :; "i, , '-'J "- -I -~.- , ,.- , r-,~;:" -- , .I <. - .~ .. 00 NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an add" ional business. Signature Address Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. HCDC Application June 2006 Page 3 of 8 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective March 8, 2006 Household 30% Median Income 50% Median 60% Median 80% Median Income Median Size (Poverty Level) Income Income (low income) Income 1 $15,250 $25,400 $30,480 $40,650 $50,800 2 17,450 29,000 34,800 46,500 58,000 3 19,600 32,650 39,180 52,300 65,300 4 21,800 36,300 43,560 58,100 72,600 5 23,550 39,200 47,040 62,750 78,400 6 25,300 42,100 50,520 67,400 84,200 7 27,050 45,000 54,000 72,050 90,000 8 28,800 47,900 57,480 76,700 95,800 ATTACHMENT TO APPLICATION FOR THE HOUSING AND COMMUNITY DEVELOPMENT COMMISSION IN ORDER TO ENSURE THAT THE HOUSING AND COMMUNITY DEVELOPMENT COMMISSION IS REPRESENTATIVE OF THE COMMUNITY AND THE GROUP(S) WHICH IT SERVES, AS REQUIRED BY THE U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT, PLEASE INDICATE IF YOU ARE A MEMBER OF ANY OF THE FOLLOWING CATEGORIES: D Senior Citizen (62 or older) cz( Handicapped or Disabled D Person of Color mReceive Rental Housing Assistance [0" Lower Income (see table) D Member of the Local Homeless Coordinating Board Your response is voluntarv, and you may wish instead to elaborate on or indicate areas in which you can make a special contribution to the Commission in another section of this form. When possible, Council will appoint a person or persons with expertise in construction and/or finance, a person receiving rental assistance, and a person from the Local Homeless Coordinating Board. If you have expertise in construction or finance, please describe your experience and/or training. o ~..-.\ :"'-- \.. '" :>::::: .~~~ D~ il CJ I -",,' CD :.,< ~ r--'-' '-- "._~, -".' S:/'-::: ~ , \ \ ,'-1 ,_J -0 :~ r w en HCDC Application June 2006 page 4 of 8 CI:J NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: HUMAN RIGHTS COMMISSION Three Vacancies - Three-Year Terms January 1, 2007 - January 1, 2010 The duties of the members of the Human Rights Commission are to receive and to determine the merits of human rights complaints alleging unfair or discriminatory practices in the area of employment, credit, public accommodation, education, and housing. The Commission shall provide conciliation and the enforcement necessary to further the anti-discriminatory goals of the Human Rights Ordinance and to protect citizens from unfounded charges of discriminatory practices. The Iowa City Human Rights Commission has an obligation to investigate and study the existence, character, cause, and extent of discrimination in Iowa City in order to eliminate discrimination by education, conciliation, and/or enforcement. It is also the duty of the Human Rights Commission to draft revisions to the Human Rights Ordinance if necessary to eliminate prejudice, intolerance, bigotry, and discrimination. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Human Rights Commission meets once a month at 7:00 p.m. Applications must be received by 5:00 p.m., Wednesday, November 8, 2006. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Human Rights Commission should be directed to Stefanie Bowers, Human Rights Coordinator at 356-5022. Board or Commission: HitffiiID Rights ATTENDANCE RECORD YEAR 2006 { Meetin Date TERM NAME EXP. 1124 2128 3128 4125 5/23 6127 7/25 8122 9126 10124 11128 12126 Lisa Beckmann 1/1/07 X X X X NMN X X X X Q Paul Relish 1/1107 OlE X X OlE NMN X X X X Q Geoff Wilmlng 111/07 X X X X NMN OlE DIE X OlE Q Sara Baird 1/1/08 X X X X NMN X X X X Q Bev Witwer 1/1/08 X X X X NMN X X X X Q Scott King 1/1108 X X X X NMN OlE X X X Q Martha 1/1/09 X X X X NMN OlE OlE OlE X Lubaroff Q Sehe. Foss 1/1/09 X X X DIE NMN OlE OlE X OlE Q Kate Karacay 1/1/09 X X X OlE NMN X X X OlE Q KEY: x = Present o = Absent OlE = Absent/Excused NM = No meeting -- = Not a Member NMNQ - No meeting, no quorum 3 .>.... Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in-law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 1 Females: 5 Council Announcement Date: September 19,2006 Application Deadline: Wednesday, 5:00 p.m., November 8,2006 Council Appointment Date: November 14, 2006 HUMAN RIGHTS COMMISSION Three Vacancies - Three Year Terms January 1,2007 - January 1,2010 Term expires for Lisa Beckman, Paul Retish, Geoft Wilming Joy Kross llil 131 Friendship llil Denotes applicant completed the Confidential page of the application. '.'---'--'-'~-------------'-'---'-'-'-~'--- 11-07-06 01:40pm From-UI/COllEGE OF NURSING ADMIN. 3193359990 T-405 P.OI/05 F-7Z3 I! 1 ---: -.... FI! [=f)-!.~:, ....... a.a.... - 7 p,: trn80F IOWA CITY CITY OF IOWA CITY \OVISORY BOARD/COMMISSION APPLICATION FORM 2DDG l'[ f 'o..' - '-, ~..- ""\1/ J, i i t_;; .c;.~:t\ Individullls serving on ~oardslCommissions play an impof'lant role in i~Vi!;1(lg)Iie'CligJipj~n maners of interest to our communIty and its futl.ire. Applicants must resIde in lOlli/a City. After a vacancy nas been announced, the Council reviews all applications during the worl<. sessIon. The appointment is made at tne nellt formal Council meeting. Appoimees serve as unpaid volunteers, Tnis form may be filled Out manually (please use a Illaclt inlt pen). typewritten. or electronically IPDFI. Return tile appliclltion to City CierI<., 410 E. Washington St.. lowll City. lOlli/a. THIS APPLlCA liON IS A PU~LIC DOCUMENT AND AS SUCH CAN ~E REPRODUCEO AND DISTRIBuTED FOR THE puBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED .CONRPENTIAL,. THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION JIIAME \.It. -'" ~ 2.:~Ws ('..............,...,0.. ' NAME ~'f ~S~ HOME ADDRESS 1'31 rrie..d~'J ~c.:'::, Is your nome address (listed abovll) within the corporate limits of Iowa City? mYes How long have you llaen II residem of lOlli/a City? 13 '1~ OCCUPATION ~~:l EMPLOYER ,>HONE NuM~ER' HOME '3~"1 ~~-:f<,. ~USINESS TERM O"l-iO ZIP ?2.2A~ DNo f.,l.I. ~"'S ~I'>- EXPE:RIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUAL.IFY YOU FOR THIS POSITION: :r bL-\~""~ ~~-u.a ri~;to ~ ~ ~-tfo.. d,.;~+a c-.-.cl. ~~ r~~ ()~ -tJ;:.i.r \~;tu.~ ~, Qr ~ ~~-.u.s .:r:. pi.Q.:~ /4:>A.<r cAl.(ler-. ~ ~ ..J..D.J- ~ ..........~~-f,.~ ~ ~ ~~ -I'tn>-lf-~ -' ~ ~flU~ ().f<......,.,.sk<t.d ~ .Ul o.c:s~tta.Q... J.- ~rt. IC~C: \s ~\Ilto--L F of ~ .G\L~ ~c:.~ r~ o...a..:ref~Q..a..cl ~ .,J~~ ()..I'-Lv<-tSI'~ 0Df" tu*, ~ ~ ~ ..en.. ~ " ~ ~(1 cAd a..s(~1u:r,,~-/~' ~ ~ 1<:> -I-iJi.....: ::L ~r"-..i.A' ;-...1>>- ~~~ "I.r-~ ck&CCU',..... tp So . 'cff- ~~ ~~3 ~ IY)~ Q. Q,~.~'s ~.:I.<:l\;'f.O.-to~ 0. F' 0 f 'i:N -:u:.~ ' WHAT IS YOUR PRI'SENT KNOWLEDGE OF THIS ADVISORY BOARD? ~ ~-+U~f.~~~ru... ~s~.Q"..t~~W ~~a-e ~...n-<~ M Jho- ~ ~ ~'+o.,t cw-d ~ ~ ~~i\!l....)$'" oboCL ~ O&J-i>y7 eo>>- ~.I~ ~ ~ ~.",{l..k- c;t.:sw......~ ~I- "':..IX':" ~ ~ ~ ~ h4fs Jc5'bc..:.:s {l-yI v~u,' cd ~~~<:4 $S ~~ an $~f~ . -. ,.,.. 0" . .~.... Misrepresentations on this llppliclltion will constitute jl.iSl cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. Human Rights Commission AppliC<llion June 2006 Page 1 of8 -- --------,~._.__._-,~_._-,--_.-..__.._------~-'~---_.,~--- II-OT-OS 01 :40pm From-UI!COLLEGE OF NURSING ADMIN, 3193359990 T-405 P,02!05 F-T23 WHAT CONTRI6uTIONS DO YOU FEEl.. YOU CAN MAKE TO THIS ADVISORY BOARD lOR STATE REASON FOR PPLYING)? :r.:o ~~ to~i~"':'lI fl'"", ~()..f.d ~'dt-\P ~.Q,..-~~-1J.., W1SM'"k o~ ~ C~S<t\C7\V 15/'-! b&i~ ~ #e ~ f).f .J. . -:Us ~ ~'s ~ Ci~ ~c1 0\4 o.m~~~ ~of~. 4:"::"" bw" ~ w(-H... d.A:V'Cr:>i ~ (W)~..s 'LP.".s .fe.r 2P ~ a.,.d ~\On..1<. Y..tro,...t i-ts cn.:~to.1' ~ POTENTIAL CONFLICTS OF INTEREST P1esse identify any potential conflicts between membership on the advisory board and your personal imerests. including financial imerests and your duties to an employer. In particular. if you are applying to De a member of a Doard Dr commission which makes recommendations to the City Council abOut the allocation of City funds. please list any present affiliations yOU have with agencies that apply for funding from the City. "Affiliation" includes being a board memDer or employee of the agency. )ther types of affiliations must De examined on a case by case basis by the City Anorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits. wittl certain important exceptions, a member of a city Board or Commission' from having an imerest in a City contract. A copy of Section 362.5 is attaChed (see page 7). If you are uncertain whether a potential conflict of imerest exists or tlal/e questions abOllt Section 362.5 of the Caae of Iowa, please contact ttle City Anorney's office at 356-5030. ~; -' ~Q ;;r-: :;~ -\1 :--) ---; ,~ I -J .--. ~ ~._< r"- n- -u , ,Tl r-t <J ,,,-,T' :..._/ ---.- ;o>/' .:;;;.. -c,- ~" y '" 0:> IF YOU ARE NOT SELECTED. DO YOU WANT TO at: NOTiFIED? UYES DNO DO YOu CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYES ~NO lit tillS been Council pOlicy not to permit an individual to serve on twO Boards or Commissions at the same t.me.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions. Council may not consider your apPlication. Human Rights Commission Application June 2006 Page 2 of8 11-0T-06 01:40pm From-UI/COLLEGE OF NURSING ADMIN. 3193359990 1-405 P.03/05 F-T23 BOARD. COMMISSION. & COMMITTEES BUSINESS USTING I! Ii t~-g~ ~. ...., .... A.a..- ~ CITY OF IOWA CITY Name of City Board/Commission Name 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. A copy of Section 362.5 is attached (see page 7). Date 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 5tockholdings). Please indicilte if there at. none. BUSINESS NAMIO BUSINESS ADDRESS IJa"l\.c 1:"".'"' c;~ 6- v ..,,- ..~..: _cO:':'!" v -,<:, --p- ---; - . ..J . 0, -~.. 2~\ ~ - ~\-~:i_ ~ .J " ~ "7 ,;,;; --\\ -,--- ~- ',---p' \ \ . -, \,J cf) NOTE: A new form muSt be completed if the above information changes or an ownerShip .nterest is acquired in an additional bLlsiness. Signature czro j',:.. ~ Address_I'2.r ~_ {\ A~ "1"', J-cr....... Cla-. ....L.A &; 7-~ It 5 Misrepresentations on this application will constitute JUSt cause for removal of an appointee. If you fail to answer all the qLlestions, Council may not consider your application. HLlman Rights Commission Application JLlne 2006 Page 3 of 8 11-07-06 01:41pm From-UI/COLLEGE OF NURSING ADUIN. 3113351110 7-405 P.04/05 F-723 HClUSehold 30% Median Income 1i0% Median 60% Median 80% Median Income Med~n Silt! IPoVer1y Levell In(:Offill InclIme Ilow inCClmlll Income 1 $15,250 $25,400 $30,480 $40,650 $50,800 2 17,450 29,000 34,800 46,500 58,QOO 3 19,600 32,650 39,180 52,300 65,300 4 21,800 36,300 43,560 58,100 72.600 5 23,550 39,200 47.040 62,750 78,400 6 25,300 42.100 50,520 67,400 84 ,200 7 27,050 45,000 54.000 72,050 90 .000 8 28,800 47,900 57,480 76,700 95,800 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective Man:h 8, 2006 ATTACHMENT TO APPLICATION FOR THE HUMAN RIGHTS COMMISSION Il ii lht! miision of lhe 10ll\la CilV Human Rigtlls Commission lO prolecl residenls of lhe city~fJom discrimination as defined in ltle Human RighlS Ordinance. In order to fUrltler this .9pal. th~;\I;ity itrilles to ensure that the Human Rights Commission is representative of lhe::.;c~mull~Y. Therefore, - appoinlments shall tal<e into consideration men anCl women of 118i;19~ ral:lral, religious, cultural, soc.al and economic groupS in the c,ty.- lOrd. 94-3647. 11-8-941 /,,/' .:..: "':--, , '-11 .-- ..-- \.-r~\ .~-~.-\ \..J -c :1S OPTIONAL: -q. PLEASE PRO"IDE ADDlllONAllNFORMA liON FOR THE COUNCIL TO CONSIDER ~EN ~ CHOOSING AN APPLICANT. - .- ~~J Age CO:>U.dl~ I Religion ~ IGender 1"-0; . - I Pisability l rv1 n rO" <> ~ -' I Income (see tablel I ~ ~'itb i c:w-" I Sexual Orientation IN ~-o. I Race, color or ethnic group J National origin D Other (Please explain below) l rluman R19hn> Commission Application June 2006 page 4 of 8 CllD NOTICE THE CITY COUNCil OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOllOWING COMMISSION: PARKS AND RECREATION COMMISSION Three Vacancies - Four-Year Terms January 1. 2007 - January 1. 2011 The duties of the members of the Parks and Recreation Commission are to recommend and review policies. rules, regulations. ordinances. and budgets relating to parks, playgrounds. recreation centers. and cultural functions of the City and make such reports to the City Council as the Commission deems in the public interest; to exercise broad responsibility for the development of parks. recreation centers, playgrounds. and cultural facilities to serve the City--including the creation and appointment of advisory groups to make studies. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Parks and Recreation Commission meets the second Wednesday of each month at 5:00 p.m. Applications must be received by 5:00 p.m., Wednesday, November 8, 2006. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are ayailable from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Parks and Recreation Commission should be directed to Terry Trueblood, Parks & Recreation Director at 356-5110. RilOOl and ROOIiitiUoo Commission August 9, 2006 Page 5 of 5 PARKS AND RECREATION COMMISSION ATTENDANCE RECORD YEAR 2006 TERM NAME EXPIRES 1/11 2/8 3/8 4/12 5/10 6/7 7/19 8/9 9/13 10/11 11/8 12/13 Craig Gustaveson 1/1/07 X X X X X OlE OlE X Judith Klink 1/1/07 OlE X X OlE X X X X Margaret Loomer 1/1/08 X X X X X X X OlE Ryan O'Leary 1/1/10 X X X X X X X X Malt Pacha 1/1/09 X X X OlE OlE X X OlE Jerry Raaz 1/1/08 X X X X X X X X Phil Relsetter 1/1/09 OlE X OlE X X X OlE X John 1/1/07 Watson X OlE X X X X X X John Westefeld 1/1/10 X X X X X X OlE OlE KEY: X = Present o = Absent OlE = Absent/Excused NM = No meeting LQ = No meeting due to lack of quorum Not a Member Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in-law, brother, sister, brother. in-law, sister. in-law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 5 Females: 1 Council Announcement Date: September 19, 2006 Application Deadline: Wednesday, 5:00 p.m., November 8, 2006 Council Appointment Date: November 14, 2006 PARKS AND RECREATION COMMISSION Three Vacancies - Four Year Terms January 1, 2007 - January 1, 2011 Term expires for Craig Gustaveson, Judith Klink, John Watson John Watson ~ 1105 Barrington Rd ~ Denotes applicant completed the Confidential page of the application. .--_._._-,------_....~._-------_._._-_.._- CITY OF IOWA CITY ADVISORY BOARD/COMMISSION ~PPLlCATION FORM I ~ I !~~~'t -..;;;::.... "l1li." ......... ....... CITY OF IOWA CITY Individuals serving on Boards/Commissions play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME \llY\>' 1f'12...r..,QJ, (~ TERM: ~ . Youth Advisory Commission, Age on the date of filing:D Age 15 to 17 (or) Signature of parent/guardian if Age 15 to 17: ~e18~21 '>0 -.. j> =_~ c:; ,,) nC: II ~. r' ) \)~...> 't}. W Al'~()~ -< -;".J : i ;---:1 t,--,,' ""ME u -- <..:,:: f',) HOME ADDRESS \.t O~ "G.vY'~i..... "KQ. ifP 6'~~ Is your home address (listed above) within the corporate limits of Iowa City? 'HJ Yes D No How long have you been a resident of Iowa City? ) () ~ OCCUPATION ~ ''h.\.Q EMPLOYER --.. PHONE NUMBER: HOME 1 \ 'l~ ~S'i -I. S~ BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: c; 2A vJl ~ O'M d-' IV- <r..... t..e... :t """ C; ~ ~~ ~ ~~,<. "- ~.'i} ~ - o~ ~'J~ t'1\\I'1C~' (),J( ~ I. ~ w..~ ~~. ~w ~ ~~Qd^~ lA..d,~. 7~x. ,.. ~ V1g,~ ~ e"lw- ll'tc,,-) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 1 of 7 ------_._,--_._---~~------_.,--~----_.- ----_.~----~-----------~---_._--_.._-_..-..._....._._---._--_._._'"----,-~----~.._.._-_._--_.- WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~.,~ ~~~ \J ~ "rIM.. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ~ ~'t\-~ r-v-..~~U- ~ c\ ~'-7 -/) ~~ '0- ~x. ~ Y~.'l,,:,. ~ ~ c.., """" ~CY\, w. "'- ~ ~~~ i o...c\......t 'tltS>c.~ to. ~'\~~ ..: ~~~ ~ \1~~~ POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. ,)articular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. r>-,.:, '-< S" :::--"'-.- ...1>:_-:-, c.:; C~ C~~, '~;'': --.-... -': ._~ ~;, 6 IT -" "I IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFII;D? 1!J Yes ~::; ~J DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSIO~ rnes 'iLl No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the sarRe time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application, General Application June 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I ~ 1 !~~~'t ...:::::...........~ ..... .. CITY OF IOWA CITY Name of City C/ ":) \I . Board/Commission '\. G..-\.."-.. ~ ~CNo<>'V- Date d. t) 0 (. - ) l ~ ~ Name ~ II \.-.1. ~. W-&:llJ."" Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isattached (see page 6). List all businesses in which you or your spouse/domestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Please indicate if there are none. . BUSINESS NAME BUSINESS ADDRESS \ IV'-'\.. A 1 ('\ "' '"'''-. "( . - '"" S!- t=l ~ .->~< c', ) -'. J ----' =;: ~.' ;-,-; n~~, -~~ , -"- ....- ,"', N <:: --p :=;; NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature ~ \. 0., l:> J.:;- Signature of parent/guardian if Age 15 to 17: Address \.\ O~ ~lAVY~'\..""'" ~ ~""'" ~'\.J ~").:l.V(' Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 3 of 7 ~ NOTICE THE CITY COUNCil OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOllOWING COMMITTEE: PUBLIC ART ADVISORY COMMITTEE One Vacancy - Three-Year Term January 1, 2007 - January 1, 2010 Duties of the Public Art Advisory Committee include developing by-laws and procedures for the Iowa City Public Art Program; administering the Public Art Program by determining the placement of public art, the type of art to be used in a specific project, and the artist to be engaged; overseeing the acceptance of gifts of art; overseeing the maintenance and disposition of public art; and overseeing expenditures of the Public Art Program budget. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Public Art Advisory Committee meets the first Thursday of each month at 3:30 p.m. Applications must be received by 5:00 p.m., Wednesday, November 8, 2006. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Public Art Advisory Committee should be directed to Karin Franklin, Planning & Community Development Director at 356-5232. Pilblill Art Advisory Committee Attendance Record 2006 Term Name Exoires 1/05 2/2 3/2 4/6 6/1 7/6 8/3 9/7 10/5 Emily Carter Walsh 01/01/08 DIE X DIE X X DIE X X X Charles Fellin!! 01/01/09 X X X X X X X X X DaLayne Williamson 01/01/09 X X X X X X X X DIE Emilv Martin 01/01/08 X DIE X X DIE X X X X Mark Seabold 01/01/07 X X X X X X X X X Rick Fosse X X DIE X X X X DIE X Terrv Trueblood X X X X X DIE X X DIE Key: X o DIE = Present Absent Absent/Excused Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in-law, sister- in-law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 1 Females: 3 Council Announcement Date: September 19,2006 Application Deadline: Wednesday, 5:00 p.m., November 8, 2006 Council Appointment Date: November 14, 2006 PUBLIC ART ADVISORY COMMITTEE One Vacancy - Three Year Term January 1, 2007 - January 1, 2010 Term expires for Mark Seabold Mark Seabold ~ 307 College St lRlDenotes applicant completed the Confidential page of the application. CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM I ~ 1 --= -~ ;t~~~tt -..;::... ..aa!..~ ..,.. ~ l CITY OF IOWA CITY Individuals serving on Boards/Commissions play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ~~ ~-( ADVISORY BOARD/COMMISSION NAME ~~ WWtt\nr~ TERM: 01-\0 Youth Advisory Commission, Age on the date offiling:D Age 15 to 17 (or) Signature of parent/guardian if Age 15 to 17: ~ge 18,tQ 21 o gg - ~ ;~ c-:> '7"" ':S - 0" < -n IAME~~ ~ HOME ADDRESS ~01 ~~ t:(. I..,,' I :::::j(-) co _,-:'f-~ tTl '''r -0 '.."I -,"'" :3: ,...... \O.NAc ?tM t~ O~n~ ~'~ )> en Is your home address (listed above) within the corporate limits of Iowa City? Yes Dqqo How long have you been a resident of Iowa City? \~ 'l~........ OCCUPATION k-t11rr~-r EMPLOYER ~\\1er-~ PHONE NUMBER: HOME?A'i. ~. ~ \ BUSINESS ~It . ~-+-. ~ EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: VtA~ ~~(!- ~ ~CA~c..... ~ kN~~ tQNI\~ . Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. . . .1 particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.50fthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. 0 ~ <:0 c",----, ~ -) ,.-.., ~- -' =iC; _:-<r-- ii' ~,;,... ~. ;c:::' 11 r- , ,~-rl I co -0 1_') '-.J IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? D Yes 6~ ~ DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSIO . D ~ M.NO (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 2 of7 ._,---~,-------------- BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I ~ 1 ~~~~tt -..;::,.... ~IIIII" ......- CITY OF IOWA CITY Name of City .t1r. Board/Commission'\V\~V be11. wJ~~ Name ~ ~ Date ~\ / ~ ! (){p Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isaltached (see page 6). List all businesses in which you or your spouse/domestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Please indicate ifthere are none. BUSINESS NAME BUSINESS ADDRESS ~~ 1"_1 0 = ~ :'C-'o..) ...,:.- 1>-", C) 'J'< I ' , ::jQ 0:> '-;'1 m -u ('-~: -..--,"\ ~ ~/;;-:.. w ):> U1 NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature !l/fI'ht{ ~ Signature of parenUguardian if Age 15 to 17: Address~ ~~~. ~ t.tt1I\, LaNA 5'2-~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application, General Application June 2006 Page 3 of 7 m NOTICE THE CITY COUNCil OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOllOWING COMMISSION: SENIOR CENTER COMMISSION Two Vacancies - Three-Year Terms January 1, 2007 - December 31, 2009 The duties of members of the Senior Center Commission are to: 1. Serve in an advisory role to the City Council with regard to needs of the Senior Center. 2. Make recommendations with regard to policies and programs at the Senior Center. 3. Join staff and other interested persons in seeking adequate financial resources for operation of the Senior Center. 4. Encourage full participation by senior citizens in the programs of the Senior Center. 5. Ensure that the Senior Center is effectively integrated into the community and cooperates with organizations with common goals in meeting the needs of senior citizens. 6. Serves in an advocacy role with regard to the needs of senior citizens in Iowa City. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Senior Center Commission meets the third Tuesday of each month at 3:00 p.m. Applications must be received by 5:00 p.m., Wednesday, November 8, 2006. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Senior Center Commission should be directed to Linda Kopping, Senior Center Coordinator at 356-5225. FINAUAPPROVED AUGUST 2006 Sllhibt Genter Commission Attendance Record Year 2006 Name Term 1/24 2/21 3/21 4/18 5/23 6/20 8/15 9/19 Exoires Bob Enael 12/31/08 X X X X X OlE OlE OlE David Gould 12/31108 X X X X X X X OlE Jo Hensch 12/31/06 X X X X X X X X Jay Honohan 12/31/07 X X X X X X X X Bettv Kellv 12/31/07 X OlE X X X X OlE OlE Sarah Maier 12/31/06 X X X X X OlE X X Nancy Wombacher 12/31/06 OlE OlE X X X X X X Key: X= 0= O/E= NM= Present Absent Absent/Excused No meeting Not a member 3 Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 3 Females: 2 Council Announcement Date: September 19,2006 Application Deadline: Wednesday, 5:00 p.m., November 8, 2006 Council Appointment Date: November 14, 2006 SENIOR CENTER COMMISSION Two vacancies - Three Year Terms January 1, 2007 - December 31, 2009 Term expires for Josephine Hensch, Nancy Wombacher Nancy Wombacher lEl 3644 Elgin Drive (Currently serving 151 full term) [2S] Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM I! 1 ~~~~'t -...::::... ......, ......&.L CITY OF IOWA CITY Individuals serving on Boards/Commissions play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME Senior Center Commission TERM: 2007thru2009 Youth Advisory Commission, Age on the date offiling:D Age 15 to 17 (or) 0 Age 18 to 21 Signature of parenUguardian if Age 15 to 17: . -lAME Nancy C. Wombacher HOME ADDRESS 3644 Elgin Drive Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? 51 years OCCUPATION Retired Administrator (Univ. of IA) EMPLOYER PHONE NUMBER: HOME 337-7197 BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ZIP 52245-3972 [l] Yes 0 No Please see attached. "-.) () ~ = ~~ .~ (~ ,~ " ) ~;:.; C) , -; i1 <- . =:i ,- N , ~ ", f ::s , "n ;:=.:: -".J t~ ~ ....J .......I.....c.-. :2: /' W ;:;:::: Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? J have served on the Senior Center Commission for 3 years, and have gained valuable knowledge about the daily ~perations of the Senior Center. I believe the Commission serves as a liaison to the City Council and to the County doard of Supervisors, but more importantly, we represent the members of this community as a voice in the planning process for the Senior Center. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STAT!; REASON FOR APPLYING)? In addition to my enthusiastic support for the Senior Center, I thoroughly enjoy working with the staff and volunteers on large projects to enhance the well-being of the seniors in this community. I am a member of a number of the Senior Center's musical groups, and am a willing assistant at the many functions sponsored by the Senior Center. I have been very involved in the annual All-Iowa New Horizons Band Extravaganza (now in it's 7th year), and this past year, spearheaded the inaugural "Generations of Jazz" event at the Senior Center. I would like to assure that both of these events are established as ongoing programs at the Senior Center. This past fall we held our first trail ride (on horseback), which was a delightfully successful outing. I am working toward developing a relationship with "Elderhostel" for a couple projects in the planning. And, I have also worked to improve Jay Honohan's pancake flipping abilities, and feel that I might be able to make an even bigger impact in that regard with 3 more years of effort. POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. .1 particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 ofthe Code oflowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). ,....., If you are uncertain whether a potential conflict of interest exists or have questions @out SJclion 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. 5'; 9 g ~') -< -..-! "i',. N --< :~,. -0 :-Tl :'---~ o~J;;~ -'" ',-_..I <;::/, W IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? [l] Yes d No ~ DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? 0 Yes 0' No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at th same time.) . ~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 2 of 7 ' Attachment to Advisory Board/Commission Application Form Nancy C. Wombacher EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: For the past II years, since retiring I have been an active member of the Senior Center, and have served for the past 3 years on the Senior Center Commission. I have been intimately involved in a significant number of projects, and have plans for several more in the future. This past year, our Ail-Iowa New Horizons Band Extravaganza was bigger and better than ever. Additionally, we hosted the "inaugural" multi-generational "Generations of Jazz" event, which filled the Senior Center Assembly Room. We anticipate this event will host many more youth bands in 2007, and in fact, may need to be held in a larger facility, due to its popularity. As I stated in my previous application 3 years ago, I have 20 years experience in administration, which included human relations, facility coordination as well as fmancial responsibilities. I was involved in establishing and administering policies and procedures for a rather large, very active department in the College of Medicine, University ofIowa. I have experience with governmental, as well as private foundations' guidelines, rules and regulations as they relate to grant and contract funds. I have experience in grant proposal development, primarily in the "business proposal" aspect. I enjoy working with people, and am dedicated to finding ways to improve the lives of seniors. r......-:. 0 c::.~.) t.:~~.' <;; "" "'- G c::' J> C":; ~. -...,' -il C) {'" N -..( .. ~ ,.-- Ii . ,-r-, V ,. r, :u (_._~ '-.- ....', '..J ~ (.J )> J;:- U1 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I ~ I ~~as~'t ""... _IIDI~ ...,.. .. CITY OF IOWA CITY Name of City Board/Commission Senior Center Commission Date Name Nancy C. Wombacher Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isattached (see page 6). List all businesses in which you or your spouse/domestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS None -- ...." ~ <:;.;:..::' 0-. p-'::: ~c' ~l \.~" -. c~) ~. - '...I ,--. ~< ~' . ~ ."" ro:;C I' :% , , ~/" c...~ ~ .z:- rn NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an ad(ditional business~ Applicant Signature ~(~ Signature of parent/guardian if ge 15 to 17: Address 3644 Elgin Drive Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. , General Application June 2006 Page 3 of7 ,~ NOTICE THE CITY COUNCil OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOllOWING COMMISSION: YOUTH ADVISORY COMMISSION Three Vacancies - Two-Year Terms January 1, 2007 - December 31, 2008 Two (2) persons - Age 15 to 17 on the date of filing (11-08-06) One (1) persons - Age 18 to 21 on the date of filing (11-08-06) The mission of the youth Advisory Commission is to promote understanding and awareness of Iowa City among Iowa City youth, allow a select group of youth to help make decisions concerning them and their peers, enable youth members to utilize and expand on their leadership abilities, to serve as a mechanism for communication between youth and adults in Iowa City and create a bridge whereon youth and adults can develop partnerships. All members of the Commission shall be residents of Iowa City and must be the required age on the date of filing. Said age requirements may be waived by the Council due to a lack of applicants. Meeting time and location to be determined by the Commission. Applications must be received by 5:00 p.m., Wednesday, November 8, 2006. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icoov.oro. Questions about the Iowa City Youth Advisory Commission should be directed to Marian Karr, City Clerk at 356-5041. ._.~-----_.__......__._--~._-,...---_... ._,-_._-------~~---._.._- _.,---~_._.~-----_..__.-.,.,~~---_._..,----,..._.._._------_.._~_.- i~~o~ II II II II II ~~~~~ ~ ~ r.II rI} rI} = ;;;i (tI t"D t"D ,.. '" == == == ~rDl::t........ (tI:1tJ:j '" == ~ :;.tJCl '" '" a ., '" s:>- ~ ~ 2:~ 00'-< !!:!~ ~>l"'J 00 00 Noo ~> '" .. ..... ..0"- = = .. .. '" = -", = '" '" .. a 0"'-< 0"0" Ir] ., ., s:>- O"J:I .. .. 2: '" I:l" a ~ ~ co ~ ., I:l" '" .. .. ., co .. 0"= '" = .. .. == I:l" == '" ~ == '" '" '" == a "''-< - ""1 = s:>- I:l" == "' == .. co '" == ., l"'J .. == .. == - - - - - - - l"'J"" N N N N N N N -- -- -- -- -- -- -- ~l"'J l.;.l l.;.l l.;.l l.;.l l.;.l l.;.l l.;.l - - - - - - - ~~ -- -- -- -- -- -- -- 0 0 0 0 0 0 0 a, -J -J a, a, -J -J 0 '" ~ ~ ~ tol ~ ~ ~ N '" ~ '" ~ ~ ~ ~ ~ ~ -- '" = "'" ~ ~ ~ ~ ~ ~ ~ -- ... '" 0 0 "'" ~ ~ ~ ~ ~ -- tol tol N = 0 0 Ul ~ ~ ~ ~ ~ ~ -- tol tol N Ul '" '" ... .. ~ ~ 0 ~ ~ ~ ~ ~ ~ tol ... t:! "'" .. ... '" 0 0 0 -J '-' ~ 0 ~ ~ -- tol tol tol ... = 0 0 00 ~ ~ ~ ~ ~ -- tol tol ... "'" ~ ~ ~ ~ ~ ~ ~ '.c> -- 0\ 0 0 ... ~ ~ ~ ~ ~ = tol tol :a;.: ~ .., l"'J ><2: l"'Jt:! ~~ Nl"'J ~~ ("J o ~ Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in-law, sister- in- law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 1 Females: 3 Council Announcement Date: September 19, 2006 Application Deadline: Wednesday, 5:00 p.m., November 8, 2006 Council Appointment Date: November 14, 2006 (Recommendations to be made by Council liaison) ... Said age requirements may be waived by the Council due to a lack of applicants. YOUTH ADVISORY COMMISSION Three Vacancies - Two Year Terms January 1, 2007 - December 31, 2008 Two (2) persons - Age 15 to 17 on the date of filing (11-08-06) One (1) persons -Age 18 to 21 on the date of filing (11-08-06) (2) ACle 15 to 17 Stephen Grabowski lEl 4960 Sharon Center Road SW (Not in City limits) Un Weeks lEl 5 Gilmore Ct David Segar lEl 100 Oakridge Ave Salil Kalghatgi lEl (Not in City limits) 831 Timber Ct Sarah Yu lEl (Not in City limits) 842 Forest Edge Ln David U lEl 3732 Foxana Dr (1) ACle 18 to 21 Michael Nelson lEl 260 Scott Ct, Apt 3 lEl Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY ADVISORY BOARD/COMMISSION . - PPLlCATION FORM I! j -....= -~ ~~~!:'t ~.. -V'~ ..,.. - CITY OF IOWA CITY Individuals serving on Boards/Commissions play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME Youth Advisory Commission TERM: 2 vears Youth Advisory Commission, Age on the date o!Jfiling:1ll Z217 (or) D Age 18 to 21 Signature of parent/guardian if Age 15 to 17: 1J.J..tJ/xJ f/l ~ .. 'ME Stephen Grabowski HOME ADDRESS 4960 Sharon Center Road SW ZIP 52240 Is your home address (listed above) within the corporate limits of Iowa City? D Yes III No How long have you been a resident of Iowa City? 14 years OCCUPATION Student EMPLOYER PHONE NUMBER: HOME (319) 683-2903 BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: The National Youth Leadership Conference, Washington D.C., October 2006 Rotary Youth Leadership Lector at Church All State Speech Varsity Football and Soccer ~" 0 = .- O~ ~< 0 ~,J. ., J> C:l ~"'ll -< ~~) I -J ___'C T] , '. " :--~ '-, ',-_/ '", .J:""" . ~ N Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 1 of7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? The Youth Advisory Commission is designed to allow the youth of Iowa City to be represented in the policy decisions of the City Council. Although it serves only an advisory role, it is an important tool in facilitating adult-youth 'llmunication on policy issues. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I am interested in this position because of my desire to leam more about the workings of city government and an intrest in developing my leadership skills in a real life situation. I believe that I will bring positive problem solving skills to the Commission. POTENTIAL CONFLICTS OF INTEREST Please Identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. )articular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. . Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 ofthe Code oflowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. 0 ~ <~ 0 :or: i> .- (~ 11 ....-,: '"""' I ~- .... ,.-.-- - , -.J .< T1 - ~ -;:" -, IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? [l] Yes ~J~" DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? D\l1es [l] No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I ~ I ~""':"_ItI... ;t~~~~~ -..;;;:.... ......'- ...,..~ ~ CITY OF IOWA CITY Name of City Board/Commission Youth Advisory Commission Date 11/06/2006 Name Stephen Grabowski Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isattached (see page 6). list all businesses in which you or your spouse/domestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS None None . 0 .",) c::::., en $::-2 .. C"l .~ .11 I :-)>l -.! ~, ;",'-'-: .::<0' c-j ,- ~, .. ~. $A .r- p ~ NOTE: A new form must be complet acquired in an additional business. Applicant Signature J.. Signature of parenUguardian if Age 15 to 17: Address 4960 Sharon Center Road SW if the above information changes or an ownership interestis . f Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 3 of 7 CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM I! I -.... =- -~... ~~~it:'"t. "-~ -V" ..,.. .. CITY OF IOWA CITY Individuals serving on Boards/Commissions play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME J v-~ /(' ....'\ ' "'.-/, "i :-". ~t Jfl c_o TERM: ~:; "-> ~ - D~~~18 ~211l C'r I -- --, (""; co r- ~ .- i-,-'] -~-~" ~'..-c U ;:-,~: t' ::::: ~/'- c-..) Youth Advisory Commission, Age on the date offiling:Gj Age 15 to 17 (or) 7.JL Signature of parent/guardian if Age 15 to 17: '1'1'~r"""./ ,. . \ME L. IJi.eb. j> .t:- Ul HOME ADDRESS 5 bdl'V\oce. (.~"rt Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? Ii':> \II..." I OCCUPATION sh,ck')? EMPLOYER II/It , PHONE NUMBER: HOME (51'1) 3~I.j-Dn BUSINESS NJ/'r .. EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ZIP IZI Yes S'l..2 ~(, DNo C.\Iotf:"\\~ \.qrl V'o tot '$\(\"),,, "GI,~1 Q.lc... UM\ (..6 '^ ~\....r' ('((~rt.e... 1.JJ ~.....I'4l'".u~ "1" I .,JOC!.....l"~ ..... a."~r'" - iof" ,.1"" ,J,J<IU ~\A~~\ h,'pJI\\. ~ AI~ I tN' }'''r-\1. ;" "''''''''\ \ ~"... hf"'*>"" :.""t, ~ ~vLI.CT ..".J ^'~, 'h"J h",J I .> ....\IM~\O" I. . \ L_ \ J (, 1<JiA' 'I ,;u"<<l."".,, ~ro.v.... ,..,,,,I.u ~; "" {. r -M'..f's ''''rg-t'''~. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? lJu. Y"~ft, Ahl'>o'~ /.J""~ h'l, 4 ')1 oF I tA1 r"'rtL};1M. 0" I..",,", ~"'^ '" , J.,,,i fA.. '1'''''1 I "II~I c/o"""" gf 1~4'i. CiA, )I.'n~ ..,; feel. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? 6,,)0<..... fJ...! I "rr<"i '1... c~~.."'h.... d:1"^,J' .f f4. 'u'''~,.. "",,1< k... },,"Y IA IJ"'", "/1 . /^ "",icLf.ul\ I (A~k. ;.. c,),,,,,I.1c. "..j eM "I c.~!^liJ~ (U:,":!). .',\ I;;A ""..., Ut" It,,,,, ~ ocL..1 ti t~ /.Me!.,s hw,l. 'J POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. II 1 particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). ,,' ,..'~ :> o ~ If you are uncertain whether a potential conflict of interest exists or have questions ~ SeDtion 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. ~> ==] ~ -n ,-" ." co 2>1~''''-,,,,,,,,,,JW::!''C:~',,, kt/), 'Tj .. -~ it, -0 '---1 ~-~.-: 3: ' O:::.:~ '...,,J ....-/'", LV ~ IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? [ZI Yes D No U1 DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? 0 Yes G No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) M'I 0,11 r'{..nf.,~{ (J,f7;.1-s of ,^I r<j~ "p"tJ 4< 1""", ",.)N.. -t Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I ~ 1 ~~~~*t -..:;:.... ......~ ...... CITY OF IOWA CITY Name of City Board/Commission Yo.,t~ N\I/;';VL\ (n'^~'HO- Date 11- ", 0(, Name L,,, WL(.l<.~ Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isattached (see page 6). List all businesses in which you or your spouse/domestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS J/A ../ ^ . ~ ~-~ c :;;:, ~ .L':" :.~, c:) -~,,~. ~:l , -..!.J __0 -. -:-<i.:. _;"4~ r-j r- .,.--, -'''' [-~- ,-,,' :::~-! -I.", ~ <;-" - - Ul NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business, Applicant Signature .if .1/~ Signature of parentlgu~rdian if Age 15 to 17: d-1~;l}j~~ Address S {,.,l......... u,..rl . \?,~ ny <;n ~b Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application, General Application June 2006 Page 3 of 7 CITY OF IOWA CITY ^-DVISORY BOARD/COMMISSION APPLICATION FORM I ~ 1 f~~~~*t ~... ~..~~~ ....,... .. CITY OF IOWA CITY Individuals serving on Boards/Commissions play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME &fr'7Jlft? At:i I/(Srrv'( (OfY/IJ/i'';SI{;n---- TERM: Youth Advisory Commission, Age on the date of 'ng:11] Age 15 to 17 (or) D~ 18 ~21 j> --. c> < -n Signature of parenVguardian if Age 15 to 17: c ') -..j c-~ co " , ~ME "S)"VI\) St.,.'!, HOME ADDRESS \~O O~'t-'f.\\)bE C\\I( Is your home address (listed above) within the corporate limits of Iowa City? , How long have you been a resident of Iowa City? \ G " ' f (: fI \> ~ OCCUPATION S"'" ~<S rJ'\ EMPLOYER N (A PHONE NUMBER: HOME"';'t:"',')'I..t !, to'l BUSINESS r.J (A EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: __~. L'_ ,---;,,--;,,: '.-,' -;:-- ~~- /', ~ )> ZIP [Z] Yes " ~. -'- . i I "'-1 \'-.../ S' ~Ljl, DNo ~~ A...J (./'-'1';;'( ,po. '('f /\'y r. , t"" ~r (~ l "-l be ( r (of~"'\l'e)l, \ ~,l\.f ... r ' H "!';.I(,f~ .''- '. i"( r (.-\,1 \J....) .t~" ( \' (l:; ~r. bt "~" (1."''), " tl (t'-.. /"",;. ~PU01\~ "'.,) '; f ~ ". ,\, ,- r. ~- ":. H~ 1...,,) ~ b?~ (;) -t- c \,,'" "\ t::~ 5C"oQl ~. ;..'tt;o 1- L' ,. .::~*. >~- yp.t ,. t ( 1 ~ t. " -t \,.,h, 'l'""H.. ~\.,'" IW r. " L l';, ~i L r 'I . r -(.' t, t, t "; If' ~~. I "",.""( 'So< I A \. ( ..' t"' P : \: ("':.l~! '", p.; r I \j'L~ ~ " (<;, 'D E: ','" 0'- t.' t ~.. ~p,,:. -,. 'M-'~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 1 of? WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? t~\( ~~"rM A\)\I!,;()~-\ LoIV\MI~~lb\' A\tD"~"J '\r\t LiT"1 (l>\.l~e.IL- "\"'0 \-\~A~ II '( u,,':-," Ol'iNION. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ~~l.. l'>\t1't "-'i ?f,'l'i!t\~"'OI" 6tl '(11c i."~I'~ At7"I~."-{ (o,,,,,,,,,,>Slnl" W"\ll<) Allow M( \i) "\-I~t( ""oJ, \t>tflj 'iI'\;. ~~~'J\) < tN9 VI ~t ~ 11 '( .., t ,., . r' h A ~("V'h-\f'-'I.. IV'''L.( ,~t N f'lbt:.e... POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. "I particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attomey's office. You should also know that Section 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. \-\-1"-'.( Ni) ~ ~",<.",.."I< t. ['-''''1' l' \ , ;. ur- l",io<.\< (.c" o ;?:o J> -", !--,) C:::. ~~ ~ D Il "",c. - ---, . , - IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes D~=, :::?~! DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION~ 5fJ ~silJ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions aPihe san'l"e time.) :c- Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application, General Application June 2006 Page 2 of7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I ~ I ~~~~*t ~.. _...~ ......... H CITY OF IOWA CITY Name of City Board/Commission Name \),.,-.1 \'7 '-lO\J"t~ Pc" V\70~-( Sq~ LO("M\lC,[O." Date Na\J t(; loO fo 1 Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isattached (see page 6). List all businesses in which you or your spouse/domestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS r-JOf'J (;0 "" = C-~) $n 0' -;::;;.' -'>:::i , -Tl .,,:;:: ,) ". ~ r-- :..~ '---'; c< [::,: -0 Tl C) :::.~~ -- '-~ '- .. ~ ~- c- Applicant Signature Signature of parenVgu / Ian if Age 15 to 17: Address (\) e (') (I t..-t.-\ ,) r, c -- Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 3 of7 " n [d' I.. l 0 ,; -() in "'l' i I! 1 ~~~~*t -..;::.... ......~ ~.I.ll.- CITY OF IOWA CITY CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM {OD[, i ell --i'\ r- I ~: !' -;..,' li~':' ",' '-" l I ',-)L__"i\ Individuals serving on Boards/Commissions play an impori~~,.j/ol~ih'~dJisl~~e Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the ' application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. 'ADVISORYBOARD/COMMISSION NAME YOU'IHI9 ])VJ;C,oR y TERM: T WD- '11"<', \"" Youth Advisory Commission, Age on the date offiling:[g"Age 15 to 17 (or) 0 Age 18 to 21 Signature of parenVguardian if Age 15 to 17: ,\lAME ~AL-T....L. KAL-G.H ATG-tL HOME ADDRESS <Z s \ T.:r.lY\BcR lOUQT -L-oi2..I'lL-VHL.'"=. ZIP Is your home address (listed above) within the corporate limits of Iowa City? 0 Yes How long have you been a resident of Iowa City? tV'; (I OCCUPATION S-rUbGfVl EMPLOYER PHONE NUMBER: HOME - l.-\ 1- bib BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: LJeST th.-~4 SCHDDL S+u.-de.<\-\ SI;;Vl'YArc= l:=fY1(3t:.R /OI^f(!I''' Ii W c...^'1.~, '. ~ \, 1 \'"fl J C"l;JO':: -tt!T "tAu 0;::' Wi%' f-b:c..>I 'l:{\~EQ Lt\l'ln"t-"t\./ T V<.AI'(lI\r",,>e(' ,-,N, ~ - LJ>?ST l-I:r:c,l-\, Sc..l-loCL.}u...N~DR.. L\o-ss Vke.- Pres\JeY\t LJ,;;,,~ 1-1:;<,,",, Uo\..~ TE{.l(l'\ ~t((\(!,,,Q.. q'~, 10'" ""t:.r.J< LJes-t H.1l'&.4 Sc..\-\OCL S peec...k (YIe.VY\b<L\\O'\'~\:u..J...c W'fos'\ H~L.t-\ Sc...~OOL.\S.r>,A{Y\QV\^\JQ\ 'O-''''~l\''''<~('<'J.li2.. \?''':S(\~S5 """;{l.,li, (J,,",r~< "J, 5224-1 ~No Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? '-1- f~*W T l.D " bQ.. o..-ble.- :te-~ '~ 'a.dJL ('f\e%L R~~ +0 '~ ~'fu Co \.A.C'\L.LQ.. an6L p.Ar-tkc- C\...~J.. \[\ -t-k i (V\ f'rOI..lLlY\e.(\-\ fer ~Du...-\"':':, Q..:J!L-~'6W"-\2,.\'e. 0 '~~ :~C~O ;-- ---, -II -, ~-~, - =-<- I 00 .- ~- c...,.-, . \ -0 -". :1t ....J co; ~ POTENTIAL CONFLICTS OF INTEREST ~;:>" );; ;;- - Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contactthe City Attorney's office at 356-5030. I N/A I IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? GjYes D No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYes EJ'No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. , General Application June 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I! 1 ~~~~*t ""=-.._...,~ ~ &.L CITY OF IOWA CITY Name of City Board/Commission . y" L-l -n-' l0\..L0L;tL. Date 1lI!o1, (06 Name Sa ~'- IGAc'-~ H~Ib, t Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions,.a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isatlached (see page 6). List all businesses in which you or your spouse/domestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Please indicate if there are none. fVo(\Q... BUSINESS NAME BUSINESS ADDRESS . . 0 :i; . ;::-"'.:C:i ..-""_.. :~:::: ..,~: 11 --....1 (:: (Xl . . -'.1 -0 i I [r~ --_0_] ~'-' ',-" <-/...... r- )> r- . NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature .d.tJJJ ~4~/' Signature of parent/guardian if Age 45 to 17: Address '6 'c, / J'J; 171 1$8'2- 10<-<.11., , ~ -~fr5 {o/2f\.i..-u-r:c'-c'-t- Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 3 of7 CITY OF IOWA CITY I\DVISORY BOARD/COMMISSION APPLICATION FORM I ~ 1 -....= -u:,... ~~~~!:'"t. ~.. .....,~ ....... ... iaI CITY OF IOWA CITY Individuals serving on Boards/Commissions play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME ~Ic TERM: Youth Advisory Commission, Age on the date offiling:lZ! Age 15 to 17 (or) 0 Age 18 to 21 Signature of parenVguardian if Age 15 to 17: r -y-. ..ME SR(OJ\ ~ U\". HOME ADDRESS 84-d-. ~.est b-i\W- u,. ZIP '3 '2. 'Z.'H Is your home address (listed above) within the corporate limits of Iowa City? 0 Yes 1Zl No How long have you been a resident of Iowa City? 'K Q...,-<;' clo...i\-\- of (..&-o..lIA \ \-e.- - ~ ) /1... ~GVY OCCUPATION Y1u.c\...uA -t EMPLOYER _r\AJ(\..L PHONE NUMBER: HOME ~V1-')Si -1n7 BUSINESS Y'RlJI'l D J EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I (Jft\ \(\Vbiv~o\ '10 ~ 'S(.Mtl\ - i OM 0- \?~ of LeO.cU..f\ '(? .LW'i),L\...1l.A-~ z.f:L S'\U~, ~ 31u(lLv\-t SCX\~.IIU'Y\.a..(so v0Yt}-\(\V1)Iw..d r;;;tl ~ Wf(\~ i ~ llV\d do {l tl1 v\1-\ ~ JtA.CJv\ C\0 \fi) llA'\~ f"\C}- ()Vt- v \ Il'^ -1YU- ~nG\ 10 MC/)!miM6\ HllUS€. I I i~ in ~ wi'f11\ C\ clf\Jc\'"S {.- l,,'-'Il at' peoPlQ7ll1'1o.. 1MU\d. \i~ ~ cUJ ~(\t1hc.-t CC-n rw1p ~(1ld-' " o g ,- Misrepresentations on this application will constitute just cause for removal of an appointee~1f yo~il to answer all the questions, Council may not consider your application. ~::i c:) co - 'h ..,., .Ti Page 1 of7 :""-,' ..;:.- ~- j> .t:- ~".j General Application June 2006 r c- WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? \ ~(}vV ~ e...- 1fY\ ~ 'V\'S()Yl/\. V-lO ' ,An- W;M(~~'\e.- f\:\Cv\o..r\-e~ t3JJv:JnC\. S.) H \ J ~ Q'(D~~ 1-0 ~\P 1'\'R oomvyU.HW~ cund\- Cj'eC".+e, rp\eJ:JI..S of k~S\~e. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I 1M \\ \J.0 0J0~e.." to ~r€-sem 0- f1reSn r~C~V€...- '\ r fye- Stnt\nq lcU..Cl.S 10 hL\p 6llf' Gtlml'\ft.U'1\1I1 ~ol Irs r~slcCu1rS. U~l0q frnM (\ dJVWt- b~c~ d,1 h^o>1 ~ ~ rclwJ !h D+-Hr 1Ytost ~ ~-wp1~ M.~, . CU/\^- \ f\-\U'e s-\-ed '\ \A h.9J r \ f\ c;r ~ ~<t1'\ H\ ---tv1.A~, oJ'{COv/ CUld ~reSlj\k1 f"\q, ~r ,dieJ 10 1YU. <1.cl s~ )?oCl/f ().. POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests,including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.50fthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. 6 g N DY\.9....; .=0 j;:~.- IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? Yes .. \) DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSIO ? 0 :l?es [)a'NO (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) I Q:) -'~I ~ -u ,T} Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING j ~ I !~~~tt -..;::... _""~ ............. CITY OF IOWA CITY Name of City Board/Commission l (J WQ U ~ Name S () J({J.J..A..., "ll A - Date \ (/~IOU! Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isattached (see page 6). List all businesses in which you or your spouse/domestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Please indicate ifthere are none. BUSINESS NAME BUSINESS ADDRESS N'DY\...9--' r; "'-:1 C'.:) ~n 00, ',' . .' h C~') .- ~ ~. -~ - ..!... -! . - . "- ~:~: .--r) ,.,--, ~.J' ~ 1----1 ,,-:!:::.;,-:' 5> -:-: .:::- NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an a~diti nal bu iness. Appl'"", SI,oa"rn ~ ~ Signature of parentlgu rdian if Age 5 to 17: ~ /" ~ - ) Address '8" 'Td- ~ es-t 9 c1 W- ~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 3 of 7 CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM I ~ 1 ~~~~*t '-.... I!II""~ ~... dI CITY OF IOWA CITY Individuals serving on Boards/Commissions play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Retum the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION Will BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICAllY CONSIDERED FOR ANY VACANCY DURING THAT TIME. .J. . 0 g .. ~ A ~.. r So "" ADVISORY BOARD/COMMISSION NAME~I o v.: \'\, cJ\J \XA'1 I~DIMwt1 551'fE~ 2; /. ~ --:.." Youth Advisory Commission, Age on the date of filing: [3' Age 15 to 17 (or) ~9$18't'6 21;- _ rn :bo rn O-u 3: r-' Signature of parent/guardian if Age 15 to 17: x ~J NAME ~DQ \j\ c) iA HOME ADDRESS '> 1?- 2 :P .::- "rOXO \'\Q 01. ZIP DYes CJ2241: DNO Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? lo l1f.C\ '5 . OCCUPATION Jk.uJ.t-\l\.~ EMPLOYER PHONE NUMBER: HOME C Jll1) '?, 5 q - '3 ') 72- BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: 1- CD -~\At\Ja1. ~ A-s''o-\I1 ~ )C Co~~ pVt.f ctv) 0Jt- Weot M1{f1 ~~l 7- ~~ v"^ ~1 .5U1 CA.k- aJ- Vq}.r w.", M Je.,a1> \.VI~ ~ CvuY/;~' VlQ}-;'vr'l 0\NJ-'4 1- a~ W"'1 ~ &- ~ ki V ephw.J. 1 wr~ ~ Q J+.c) <Jr>ct. Misrepresentations on this application will constitute just cause for removal. of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 1 of7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? -r \::.VIOw ~ ihL 'ioA 80~ aUC)uD Y.o~ ro Pv (WI!- dr- ~ 1/.lJ(<.Jl.. ill\. ~ o-'ih..t ~ ewvltJ,. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? 1 {c-J t.'~ +VvP- 7- a>.VJ be.. pO-rI- of-- ~ ~~ vo,te. ~ Q~ ~r7 ~J.yr:;.k. k Z ~rl2Urff ~ ~I-A- ~~'1.-f.c..L ~~ i '^ v.t~ ~ 1 Q/.I1 f,f) ~ Ie I.Mfl1 t/ ftJ..~ I1vr h:, ~V\l'u, ~"".c.~ ~ kIf d-o/~. 1 +e.ct Ilk. '1 00"'- hcJp f'/'At.e.. ~ l{,~,...;f~.5 0.\-- Z4~ Ct:-n, ~ rlo1on.. q fa.,-;- 0'1- ~ al~ .it CaVl oklVlk ...-auJ. ts. ~Q :; -- ~.i 0 . ""',.' _11 c~__, . , .' :3 S-~;? co r- POTENTIAL CONFLICTS OF INTEREST 9 ~ S; CJ Please identify any potential conflicts between membership on the advisory boailli and ~ur personal interests,including financial interests and your duties to an employer. -t'" In particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency.Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. SOVl1L--<ti~ 2- f.ro..~ WS<lVl.), "'-<Xl<- 01\ w~_T s~s 7 ~ IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? JXl Yes tJ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYes l\IT No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same timeT" Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council rnay not consider your application. General Application June 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I ~ I ~~~...~... !:.~~!:'"t. --=..... "IID.'- ....... A.a.- iidl CITY OF IOWA CITY Name of City '\j A '- Board/Commission ~ 0 LA VI \)O\AO ~ 4Jvtjcy~ r LO ~ MI )sj eN' Date 11!'l(Ob Name Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isattached (see page 6). List all businesses in which you or your spouse/domestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS -- ~. S2 = '" >~ 2': ., D r~.\-.",- .- -.!J c, I --<~-) co r- '. .1 '- ~~_: ~ ~ ;.s:'^' J::- \.....I .P - NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. :/ Applicant Signature Signature of parentlguar Ian if Age 15 to 17: Address '37>2 ~o><.6: 1'1. U. Dr' ~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 3 of7 CITY OF IOWA CITY ADVISORY BOARD/COMMISSION . ,PPLlCATION FORM I ~ I -....= -lit... ~~q!:'"t. -.;;::;.... ....., ..... ~ I CITY OF IOWA CITY Individuals serving on Boards/Commissions play an important role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. _ After a vacancy has been announced, the Council reviews all applications during the work session. The appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). Return the application to City Clerk, 410 E. Washington St., Iowa City, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BECONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARDfCOMMISSION NAME Youth Advisorv Commission Youth Advisory Commission, Age on the date of filing:D Age 15 to 17 (or) TERM: 2007-2008- Signature of parent/guardian if Age 15 to 17: ~ge 18~ 21 --" :;;:: -~ 0 -po-! ...;: -n --< C".J - I H".{___., co II '-'~1 '-.J . 'I.I,ME Michael Lee Nelson :--::...., m :s: 5.:::::< --;,~ <",., .. <-.. ziP" 5224!fs; III Yes D No HOME ADDRESS 260 Scott Ct Apt 3 Iowa City, IA 52245 Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? -3 years OCCUPATION Student / PT Lab Assistant EMPLOYER CMRF - University of Iowa PHONE NUMBER: HOME 563650 6926 BUSINESS 3193358142 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I have served on the commission for its first year. I was on a subcommittee to design a website for Y AC, and participated positively during the meetings. I have also served on Teens for Tomorrow, a youth philanthropy board which gave out grants to non-profits. I served for two years, and helped the group find its purpose and direction. I especially worked to ensure grants were given based on the strength of the application, and not based on other members' personal beliefs or reservations. As the co-president of the new Travel Club at the UI, I have gained an understanding of the challenges a young group must face. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I have served on the Y AC for its first year. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I am re-applying so I can continue to help the group find direction and its identity. It has been exciting so far, watching us come together. However, I feel there is so much more that we could accomplish. One of my goals is to establish a community mini-grant program through our commission. Area youth who would want the financial means to help the community in some way could come to our group for assistance. I believe this would empower Iowa City youth and build meaningful connections between them and the city government. Through the connections I have formed through the commission, I am more optimistic than ever that this can be accomplished. I feel the commission would continue to benefit from my commitment and perspective. I appreciate and understand the importance of small details and how they contribute to the larger direction of the group. Without my membership, I feel the commission might lose this practical edge. POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. particular, if you are applying to be a member of a board or commission which makes recommendations tothe City Council about the allocation of City funds, please list any present affiliations you have with agenciesthat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attomey's office. . You should also know that Section 362.5 ofthe Code of Iowa generally prohibits, with certain importantexceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of theCode of Iowa, please contact the City Attomey's office at 356-5030. None '" C;;;;J = ~ o ~o .J>~ -- =:' --",.. <:.:.J '"C 1/ -. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? III Yes mi>. OJ :- DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSIO~ ID ~s '~NO (It has been Council policy not to permit an individual to serve on two Boards or Commissions ~he sa"1~ time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I! I --= -ilia' ~~w;e:'t ::.... -r" CITY OF IOWA CITY Name of City Board/Commission Youth Advisory Commission Date 11/0812006 Name Michael Lee Nelson Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a memberof a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 isattached (see page 6). List all businesses in which you or your spouse/domestic partner, or parent if applicant is Age 15 to 17, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation'sstockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS None N1A . . n c;:_) = . ~() z ... <:: 11 r, " .. :-lC; OJ . ., ~~! I rr "'" ~;;: - \.....J )> - ~ NOTE: A new form must be completed if the above information changes or an ownership interestis' acquired in an addit:on,)business. i// /} Applicant Signature ' '/I/\;;::l / ~ Signature of parent/guardian if Age 15 to 17: Address 260 Scott Ct Apt 3 Iowa City, IA 52245 Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2006 Page 3 of 7