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Home My WebLink About2006-11-28 Appointment c::J Marian Karr From: Drew Shaffer [dshaffer@citychanneI4.com] Sent: Wednesday, November 15, 20063:53 PM To: Dale Helling Cc: Marian Karr SUbject: Fwd: Regretfully yours, time for telecom coming to end. Dale and Marian, this is the letter I received from John Weatherson regarding his ICTC resignation. Thanks, Drew Begin forwarded message: From: John Weatherson <iweatherson@omail.com> Date: October 23,2006 12:05:10 PM COT To: Drew Shaffer <dshaffenlilcitvchanneI4.cam> Cc: Saul Mekies <smekiestlilvahoo.cam>, Anon Ymous <maI4242@gmail.com>, Gary Hagen <9l!!Y: haoen@uiowa.edu>, Michael Brau <mbrau@citvchanneI4.cam> Subject: Regretfully yours, time for telecom coming to end. Hello all, Unfortunately, my job requires my presence every monday evening (likewise with both the preceding day and the six that follow). I think the only respectable thing to do is resign as a commissioner. Let me know what, if any, steps are necessary to resign. Sincerest apologies, and I wish you all the best in ensuring Iowa City telecommunications rooted strongly in our community. Best of luck with WiFi, I hope to use it soon. Regards, John John Weatherson 310 N Clinton St Apt 6 Iowa City, IA 52245 (319) 325-4350 iweatherson@gmail.com 11/15/2006 /5' a.. 0) . HAYEK, BROWN, MORELAND & HAYEK, L.L.P. ATTORNEYS AT LAW WILL J. HAYEK (1896-1982) JOHN W. HAYEK DAVID E. BROWN JOSEPH T. MORELAND MATTHEW J. HAYEK"' ALISON WERNER SMITH "ALSO LICENSI!D IN IlliNOIS 120 EAST WASHINGTON STREET IOWA CITY, IOWA 52240-3924 TELEPHONE {319} 337-9606 FAX (319) 338-7376 WNW.hl"bmlaw.oom OF COUNSEL: C. PETER HAYEK November 27,2006 Mr. Stephen Long Ms. Tracy Hightshoe Community Development Department City ofIowa City 4] 0 East Washington Street Iowa City, Iowa 52240 Re: HCDC Dear Steve and Tracy: I am writing to tender my resignation, effective immediately, from the Housing and Community Development Commission I have served on the commission since 2002 and need to redirect my time and energy to other pursuits I have very much enjoyed the opportunity to serve on the commission. The experience not only involved me in some very interesting and important challenges facing our community, but in addition introduced me to a number of city officials who worked closely with me and, in the process, became my friends. I will certainly miss working with the two of you and others. I am sure our paths will continue to cross. In the meantime, keep up the great work that you perform for HCDC and the community as a whole. Sincerely, ~~ Matthew 1. Hayek MJH:ms o :S:(-" ~:-~ " ~? <::::1 "" '-n N 0:> -u - --,-- I I! :'.--' '-.J Ul .r 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 offiling (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 [R] 4960 Sharon Center Road SW (Not in City limits) Li n Weeks [R] 5 Gilmore Ct David Segar [R] 100 Oakridge Ave Salil Kalghatgi [R] 831 Timber Ct (Not in City limits) Sarah Yu [R] 842 Forest Edge Ln (Not in City limits) David Li [R] 3732 Foxana Dr (1) ACle 18 to 21 Michael Nelson [R] 260 Scott Ct, Apt 3 [R] Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY ADVISORY BOARD/COMMISSION .- PPLlCATION FORM I ~ I !~~~tt .....-;;:.... ...,- ...... ... 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 Advisorv Commission TERM: 2 years Youth Advisory Commission, Age on the date Ohfiling:1lI M 17 (or) D Age 18 to 21 Signature of parent/guardian if Age 15 to 17: () ~ t1l U .. 'ME Stephen Grabowski HOME ADDRESS 4960 Sharon Center Road SW Is your home address (listed above) within the corporate limits of Iowa City? 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: ZIP 52240 D Yes III No The National Youth Leadership Conference, Washington'D.C., October 2006 Rotary Youth Leadership Lector at Church All State Speech Varsity Football and Soccer ("-...') 0 " = :?: ~ 0 ~".", :1> CJ -< 'T1 t:-) I -J ~< , Tl [~ " r -..'''' :----, ~'-.; '-.J ,-,' ~';:;;: 0<::;: .r:- <- )> 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 of 7 ~---~-,~-,------~~--~--"'-"-"-'~--"""""--"----"---_..~,-'". 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 'Tlmunication 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 govemment 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 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. 0 ~ 1>0 15 ~." -n c-) ,~ ~ -,:,-,~ I -...J v C-Tl -, 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'Ves [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 ~ ! --= -~ !~q~'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:? cr... ~,-) ~' J':;:.--,-, c:) .-""'1. .- '. '-.. . II , I .)( , -.J _,.J;::.;:.' "-' , llf .::s t: ;.-:;;:::: :-~-:' ~. ::2=/....... .r:- .. po ~ NOTE: A new fonm must be completed if the above infonmation changes or an ownership interestis acquired in an additional business. Applicant Signature J '\ Signature of parent/guardian if Age 15 to 17: Address 4960 Sharon Center Road SW 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 -#'"-= -10... ;t~W!:'"t. ~... .111.'- ...... .. 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 ...... /-: (i -,'';;1/\ _.) :1/'- ~., sf J ^ ".~ TEFIM: ~~; "'> r--. - DA9~~8 fu!z11l ~_ j I-~ ~c-) co r- "'.--- ,-~~. ' Youth Advisory Commission, Age on the date offiling:G] Age 15 to 17 (or) ZJL Signature of parent/guardian if Age 15 to 17: ""/~r--./ . /' ...." ::'".:: 'Ti \ME L." lied." ;::~=L: ..-/-.. ;; ~.) .r.- Ul HOME ADDRESS 5 &dfnoce. L~"rt Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? f& IiI...." I OCCUPATION sh"J"J EMPLOYER ';/11 , PHONE NUMBER: HOME (31'1) 3S~'Dq BUSINESS tlUt- . EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ZIP [Z] Yes S'l.I..~0 DNo CAf"\\'1 w)rk. 1',"" " ~lfl"JA' ~LI,I/I Q.lc.. Q^A <<'':1 "tJ "",I....).. o~ '~N'\. ~ \A .,~ \ hl~pJI\\ . ~ r ., '" ':iI:,.1. ~r ((t{.r~t.. I tJJ ~",/VI/V'IU~ i2."~r",. loJ" ,.1",. "J.'J,tU AI.,:>, I /Nj""r"\1. '1\ ,..~ sw.k Ct<. ~vLu:."" ~ ^,,~.'h"J I,,,,~, .> ~'^.... t'fl<N'\r\(.A. \'-.,IM:,o" ,I. .\ . \ ' . ". r J '\ ~~~'1 ';;'l."V\t().V\, (. f,\ Qr'v.,v N .N''''l.U.. ~;f<M. 1<1r r"M(J.f's ''''rgct~~. 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? llu.. y_~ft, Aci 11"0''1 /".., .\ h,.s ~ L.-i?, oF I &~ r'"'ftJ,1M. 0,,, 1"W'~ OfIV,^ '" , J.,,,f fA". opI""', 1"1'''/ C},I;)'", pf 1;1.."x uf; )t.-nil. ~ feci. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? 6:,).<K fl..! I "I"""" Ij... c"_..t.h"" O;}~"^"Jl'o .f fI.. 'u''',..~ ""..k f.rv. ;'J"jI' i^ /ol;.-#I,.I tJ!1 . /^ ,,,,)JI1011 I [AU,- /.. q),,,,,,I.1c. -J c.- "l cJf'rA';J'" (e.l/.~"1 ~ ",\ '" w'''''1 ~"I[" ft'"" rAMi ud<.1 fj {iCo,;1 ~sJ. '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. '" 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. Acopy of Section 362.5 is attached (see page 6). ,...., ~, o ~ If you are uncertain whether a potential conflict of interest exists or have questions ~ Se~on 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. )> -:-] ~ -n M'1 o~11 (.tcn/"~( lJ"f!,.f$ of ,./ r<.i~ "J'I,,{j '" f./I"'" /vo) 'I" ....t "-" .... co Q~~'",~ 'WVf'....Jc:LjJti~lfN ~, -T-j ~ .....h--; -0 '--I --~~, ~ ' I r'}-':; - ;...../ ?;< w ~:: ~:. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? [1J Yes 0 No U'I 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.) 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 .:;:;~-_IO.... ~~W!:'"t. -..;;:.... "l1li.'- ...,.. .. ia!!II CITY OF IOWA CITY Name of City Board/Commission Yo.,t~ MW.'>or,,\ (M^ ~",o~ Date \I - "?, 0<. Name L,,, W t...k.s 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 .IIA ../ ^ ~ ;-"~ ". .~rl ~ ~ .1_" =--., c::i -i -- "-" . , -'J _":J r-'~, :-<r':":-' ; '";-~r '-"-1 O~-J -- ,--- _i;~ , ~ <:? .. c.n NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature .-:t:!/~ Signature of parent/guardian if Age 15 to 17: <J.-,~~~~ Address 5 {,.,["",,, c-..r\ . l,"~ (. ~y ~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 I\DVISORY BOARD/COMMISSION APPLICATION FORM I ~ I ~~=-..alfla.. ~~~W~'"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 v!(jilff~' Ad i/(sr/V"r (O/11I7.1'';SIt/l......- TERM: Youth Advisory Commission, Age on the date of 'ng:Qg Age 15 to 17 (or) D~ 18 ~21 :~~ =:j S:;: Il Signature of parent/guardian if Age 15 to 17: -~ c~, OJ . , C\\)( ;:.7.::; '-' ~.;- ./', > )> ZIP [E] Ves ~ : Ii .._, ',.J '-ME "S)"V\y Stl,~1t. HOME ADDRESS \ ~ C) w O~~~\\)fte. <)Q l.jl, DNo Is your home address (listed above) within the corporate limits of Iowa City? \ How long have you been a resident of Iowa City? I G " 'f I: f>" :', OCCUPATION 5"''' t;:>E; IV'I EMPLOYER tV ( A PHONE NUMBER: HOME -')ll'i"',')'I_' (, ~"'t. BUSINESS lit {A EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ~(\A A,,-J l.""""C 'c'.rC.fl AT r' ~ t':c.;.... I" ( bn (" (~~, ''-. l"t<) 'l P tv' l" tf f. r--\, I,!., of,.!' ~;{ t t-.,~ A~', \..J..j\."'c'-' '. . ,~~ l, t, hA\tr. ?'" I".. !),"'J~, 'rt: ",t-' r tt....} '> h,~,~',;. .c.,P.cet,-4 I f 't',\,,~ t':-\; ~.f\\.J ~ :.;. ~. ,...^, 'i Ci~ {.)~t \ ",." . \J ~ 5c'\oc~ ~':> t""V\;J nU .",;.( 'S~' >'. \.l\ L~ "0-\~ ,SOC../A,l (1:)('"'' r<:t"",i (',,:,'1~,P.1 .~~. \' t t." 'D'" "l'". 0' f"" ,?fA;t nt I '" f.' ( .\,.,1-., 'f"'-\{. C~Y t/'o(, r f- I ( ,-.) (, ~ ",; t::~ I q ~"C:t<) tHJ r, f" 1, t r... tp6~ 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. General Application June 2006 Page 1 of7 . ._----~-------------_.__..._-_._------------_._..__._-----.---- WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? -N-t iO"T1-I A-?V"'O~-I LolV\""IC,~IIJ\' H~J\~ ^ '-t""". 01'11'-'101-). Alto")) nit LI'rl (OI.)~C.I'- '\"'<> WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? f,(o(oL. 1">-\l\'t "'1 ? A't, It-I \>P'O~ 1,.1 flit to...t1\ At7"l~el'i (Q"'''''\~SI"ru 1rJ"llt0 A\\OvJ M( to c,l>"t( "^'" \\16'~~ 'l"e ~~~\JI~ ( (N' uT ~{.\'I1(;"'\""" ,,"'Co, C\ ~rU""\1-\fI.>L IV' A Vc T~( f-l i';"bt~ 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 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. \.H"".( Nil ~ ~'\'"'..'\ IA I- (<>"'''I-L \l' S ~f, IN\o<..\t-C~)'\ Q ::~O )>~ ,..., ----= <;;;.::;1 0-- o II ","'':: ~-, IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? IZl Yes rri€ ~~! DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSIONj 5(J ~s 'ill No (It has been Council policy not to permit an individual to serve on two Boards or Commissions aHhe san'l"e 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 ",--.. "'IIII'~ ...... .. CITY OF IOWA CITY Name of City Board/Commission Name \)"VIV i 00-r~ 1-+ \> W, 0 ~-f Sq,~ LOf""MI10[0"'1 Date N~\J t(; 'tOO 10 I 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 ,voiV0 . ~, .-- =, ~r. 0" ..> , --::~~ - -Tl -/--L .,,'::..: / ,2.. ,!", f'" -" --.- n ~'. ,"c' ,"",. c)::1) .' \._-1 ~.::: .. .- .r:- 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? CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM q! I ,:___ ]-'1 I ~ 1 ~~~~~'t ~... "'IIII'~ ....,...1.11..- CITY OF IOWA CITY 'j'1U; U;,)l.:r- ,,' n i -() F'i'l 4: liD C- .'" '1: y i,_,,!,_':,-;,,~ Individuals serving on Boards/Commissions play an imporiQii'Ji6Ilih'JdJislhlftt,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 <Ipplications during the work session. The <Ippointment 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 YnU,H 19 bV1;:<:'of? 't TERM: T W D- 'Iea.r- Youth Advisory Commission, Age on the date offiling:IT1'Age 15 to 17 (or) 0 Age 18 to 21 Signature of parenVguardian if Age 15 to 17: '-lAME SAL-T..L. KAL.("H AT~L HOME ADDRESS <6 s 1 T.:x:.m B"E.R lOU,<l.T -L-Or2.i::JLVrL_....r.: 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? rv'j f~ OCCUPATION SJUb~fVl EMPLOYER PHONE NUMBER: HOME - Y \- bIb BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: LJeST \-h-c.,\-t SCHDDL S+u..c.te.<\-\ SGPJA.L:: E;(Y1(SE..R lo~"!II/'1, GA^,~~. . " \'" J lCra,IJo,:: ~ HI:;Ab O~ WCS"T 1-1:><'>-1 tJ""nn. c:...\-li'In'L'~1 1 V~r","e\"" \ 6..... e.. - W':::ST l--1:r.L,l-\. SC-l4oDL- J~N~RQ.., C-.~o..::'s. V'c.e.. Pres\deY\t w,;",... \-\:;c,l.l ~'-~ IEA(YI {YItm<J.",'L q ,10" ,I c..,"J-e. LJes-t HJrc..f-l SC.i-\DOL S peec...~ y'Y\e.W\b<2..dOl\-..~\:",-~ We::" \.h:c...!-I s.c...~OOL.. ,IS. \>, A {V1Q V\A bQ\ '0 ~...'O l I-''\, h..1Q.. Q,,,:sMSS , "",.",J.,. {)f\'<?r:, u.-1.. 522..'-1-1 [g] No Misrepresentations on this application will constitute just cause for remov<ll 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? /;:O~~:%l ~~~ ~n(fnnL+. ~L~. ~UO-fI'OYL Jry };k ~ *~~ WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? .l i ~~ W T W' bQ. Ct.-ble.. k J~=~- - ~ .~ [Y\~ R~~ -to ~ ~fu Co \A.. ('\ c..:~ ClJ, CL f I.,\.r -t k r- ~ ~ J.. \ {\ -\-ro.. i {Y\ f('O V L(Y\e. ~ -\ fer ~DU.\~<;' Q.Q!.L(:'6w\-'l2..('e- 0 1ffi. .~:;:n "'-'..c,. ":--'~_ ;;;-~ _.~, -n ...- "~- -, I C;) 4J -0" ~. .--r\ ' \ '-"', . I ~~ ~ n .r:- POTENTIAL CONFLICTS OF INTEREST -7 ~- :P' ;;:- - 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 Attomey'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 exi.sts or have questions about Section 362.5 of theCode of Iowa, please contact the City Attomey's office at 356-5030. I \'VIA IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? G1'Yes 0 No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? 0 Yes ~o (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 -...= -~ ~~W~'t ~... ......,~ ....,......... CITY OF IOWA CITY Name of City Board/Commission . yO') Gl T\-\ CDLLl'L."tL Name S{)t;:Z;:l- IGAc:...r;" HfJ.',o,L Date :1lIJ 0 '1? r 0 6 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 . lVo{\Q.... BUSINESS NAME BUSINESS ADDRESS . . 0 ;,~ :;>(;; -.;- -'-" P~'" , ....,:::: Il ,-, -....... .jG co - -'cr' -v I ,.-.] S-2 ~~ 'J .r: .)> ~ .> . NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. t; I Applicant Signature Signature of parent/guardian if Age 15 to 17: Address f J- t11 ($;= 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 I\DVISORY BOARD/COMMISSION APPLICATION FORM I ~ 1 ::::::~~_at... ;t~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 BOARD/COMMISSION NAME ~I< TERM: Youth Advisory Commission, Age on the date Offiling:lZ! Age 15 to 17 (or) D Age 18 to 21 Signature of parenVguardian if Age 15 to 17: r >- .. \ME S'OSO...h. ~ l/\... HOME ADDRESS 84'd- MJy-fl5t Ww- ~. ZIP '37...21 \ Is your home address (listed above) within the corporate limits of Iowa City? DYes lZJ No How long have you been a resident of Iowa City? 'K 12..,<;\ d....ru\;- of (.-&'O"II.A \ \e.., - ~ ) 11.. ~M OCCUPATION 9\U.~ -t EMPLOYER (\,U(\.,L PHONE NUMBER: HOME ~Vi-')51-1n7 BUSINESS Y'R'lY' a J EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: 10Jm \(\VDived '1(\ ~ 'Sc...ltu:l\:l\ - i 6i'Y\. 0... pLVA-o-f LeO.cl...u"', '6' .Lw~,~ 1tA-:\15V' if:[ sru.cU.Kf1) J tlN'\o.. 3tu.Cl.LIfl-{ smo.A"t-.. i ~ oJso veNlt \ (W~ l v-e..d rr'\. tI yY1A.^-1\ i ~ ct.v\o.. do Ll c...1"I t,{f"\ ~ 3LA..<:.N\C\0 VI \ UI\~ f"\q..- etu+- l!l ~~~nCl.'d"MC()onOV\G\H6Use..1 li~ 11) ~ Vv111r\ o...clf\Jex-s~ JJ/tli (}f' peoPlQ7tV\cllM:U\d \i~ ~ M ~(\cr 1\ttO!t CClY1 ~1 P ~(t11t. ~~ o 2 ..> "..:...;. Misrepresentations on this application will constitute just cause for removal of an appoi1ltee~ff youTfail to answer all the questions, Council may not consider your application. .=.: CC>- . ,T' Page 1 of? ~' -- $ >..: ~C- )> ,~,.~j General Application June 2006 ...':"" .j::- WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? \ ~OJJ ~ e....- 1fY\~ ~ 'V\'3<SYV\.l:?O" , An- ~MC{XJ.f1J.Q..\'e... Mcl.AlA+e~ f3.JfvJ"-a... S-) H \.S (A ~'(O~~ ~ ~\P ~ 0Jml'VlAJV'(~ CI-J/Id\- CfeCA-te.. ry\eLfLS Dt: le.~S\O-9\"lJ;'re. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I VVi \\ \')-e." OJOk./ tr> ?res-urt 0-- freSn pe..ny-e.-Ct;tV€--i r fye- Stnr\ nq 1 cl1as 10 hL\ P 6u..(' (A) m yyLNY1 '1v\ ~ cl \~ rE:-Sl cO...rrrS. ~(1q1'rmv1Q dJVWl.- b(\c~d,l MoJ1 ~~ idwJ !h D++er 1h0Jt ~ ~1~ oUJ,~ \. . ctNV'- \ ,,~es1-td '\ '" ~\r\ (\ % ~ ~c\VI H\ -tM.Js. ()J{'""COv, CU'\d ~ resU\-\1 f\q, ~ r- ,ci.iDS tc 1VU. <^-cl \A s~ pocvrGl 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 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. 0:::::; = N ovu....- ;:':0 J;.~ ';::.) -< I CD "Tl ,-, ',,-, / ~-'-"" " --:-1 , , IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? Yes ~:- i.,) DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSIO ?' 0 fes oa'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 ~~~~*t -..:::....-=., ..w'Ia- CITY OF IOWA CITY Name of City Board/Commission l CJ LUO-... G ~ Name SruV7,U^-'l'{lA , Date J l!~1 OLe 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 D Y\.SL--' ;=~ f'<...;! <::;:) <r> 0"\ -- -.... C:.:l -,..... ...".~- - '0. J --' -; '- ~', r;: ,.-, 02? ~". i'"'---! -:",. ~ -:--:- ~ NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an a~diti nal bu iness. AppU~'" S;gMlurn ~~ ~ Signature of parentlgu rdian if Age 5 to 17: ~ /' ~ - ; Address ~'td-. ~es-t 9ti~ llII. 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 ^ DVISORY BOARD/COMMISSION APPLICATION FORM I ~ I ~~~-~.... ~~W!:'"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. is ~ 1 1\, :;;:r: c...... ADVISORY BOARD/COMMISSION NAME ' 'J I}' /' ri' i . -> ; 'I "A' VV' j'I%~! is ,.__, _< ~c~_ ~ Youth Advisory Commission, Age on the date offiling:I};]:Age 15 to 17 (or) Signature of parent/guardian if Age 15 to 17: D7i.ge 1816 21-., -_fJ.;' ~ t I J ,.-~, _"00) :::J: ;---; ~ ;"'';; ,-. "'~_.J )> I i .l,ME jU ..... (j\, HOME ADDRESS 'l0r) j :;"L ..., t- f) ~< (J V\ i} (:t ZIP DYes Is your home address (listed above) within the corporate limits of Iowa City? ! r, ltF(.J ^ How long have you been a resident of Iowa City? ' ~ , . OCCUPATION :di.Ack '" + EMPLOYER PHONE NUMBER: HOME ,<)! ({) S q - ~ c; 72- BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: DNo '1- CD -~\Ah.Jal ~ A-s.'Q.\Ij d<J:, )C Co~-e.. pVtf du.}; o.A- ~ rt/{}1 .sv~\. 7- <i.t1Nl v'v\ ~1 XHlCA.~ aJ- vqjr H.", ~ rk-al:> Wl~ ~ CvUf/;'J,iV\Qft'vn 0\NJ-'4 1- a~ W"'1 ~ Ix.- ~ N V r>huJ.J. z (Mf;V1&r ~ Q 4. C) 7Jr> CA. 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 \-:.\^()w ~ ~ 'U>~~ aoe;nA.- aMc:>v.D ~~ to Dv rCV)r- ,y ~ \flJ'c.fl- i IA ~ o-~ ~ ~lA.,~ I. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? 1 {~ V~ ~ L- ():>.Vl be. pO-rf. of- r:lft- ~~ VO~CL.:( Q~ .[uir7 VM.OJ.~ k Z ~V"~ ~ ~'P- ~ifp'Vq.~ ~~ i I!\ ~~ ~, 1 Cl ~ 1/1) cu:dve- Ie lM!I1 t/ ttJ.~ 1IAi{' 10 ~V'k'u, ~r~....u-- VI(,u,1J kl f cAJi~. 1 .(.e.d It'~ 7. 001'\. I0.p ~~ ~ l{;~..J4ts at- ZCJ~ c,;~ ~ Wlon.,. q fa.r!- 0'1- fhL al~ l Ca.VI ~V~ ,..-a.u,l 13. ~Q ~; .~.' ~,c 2J co :-~"........ ~--; '-55-' "- C.- ?wo i,' 1 POTENTIAL CONFLICTS OF INTEREST ~-) =;... ...;;;: i-! ""-........." --" Please identify any potential conflicts between membership on the advisory bOa)lJ and jpur personal interests,including financial interests and your duties to an employer. .::- m 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. So~<ti~ 2- \M)Cl<.- Ch\ W~ _ -rhw- s~ s 7 ~ ".ra.1\v WSo"\')' IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? JXl Yes D No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYes l'Vr 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 may not consider your application. General Application June 2006 Page 2 of 7 ._._._~,________.~__~_~._.__'__~__'_._'_~_______ __._~_.__.___.__~,_.._,..___.~.__'__~'_'u~" BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I! j -....= -ilia'... ;t~w!:'"t. -..:::..... _III'''' ..... 11M ...., CITY OF IOWA CITY Name of City ",J (I) l.J ,\ VI II.. iJI vi" CY.1 Board/Commission ( ,- { COve,,,, C'(I (\.\ rv,.: ",..-) , Date \1/::;' (OC, Name :~ t, \)0,0 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 -, ,~,-~ ~) , <:::::::::, c., ,-' , t' >~ ,-.'< ""~. i'l c.: I "il _, co ,-- ~< r- . ;",'-;' , ::;". ~ -..,. $/' .r:-- .~ - . ..P - NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. ., Applicant Signature "'V.J /' ?f/i Signature of parenvguar~n if Age 15 to 17: ~ ~ Address') 7> 2 ~ OK6 vt c; Drl'" tJ 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 of7 CITY OF IOWA CITY ADVISORY BOARD/COMMISSION . ~PPLlCATION FORM I ~ j -....= -lit.., t~ciii!:"t. -..;;:... ......, ...". .. r 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 Youth Advisory Commission, Age on the date offiling:D Age 15 to 17 (or) TERM: 2007-2008- Signature of parenVguardian if Age 15 to 17: ~ge 18:m21 ~_ 0 ~~) J>- - -"1 ~ -'j ......-: i ::;".-::.~' I 0:> :~, i fli ~ ;:0::; ::j ~,~ <:>;;,: - ..... ziP" 5224~ III Yes . D No , II . ''\ME Michael lee Nelson "-'. '-.../ 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 PHONE NUMBER: HOME 5636506926 EMPLOYER CMRF - University of Iowa 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-proms. 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? 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 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. None "-' ~ = "" o ::?~ y; :_~ -- .' ~ (--- .~ i1 -: , IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? [l] Yes rnp.' 0:> ,- DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION;Q 3D ~s ~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions ~he sa~~ 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 ~~~-~... i:~W~~ '-.. T" ...,...- CITY OF IOWA CITY Name of City Board/Commission Youth Advisory Commission Date 11/08/2006 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 (se-e 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 N/A n = = ~() Z r-, -.;"-~ -.;;::: 11 ~(; CD r - " ~II n--: :<>- ~7t - '0 - ):> -- - ...... NOTE: A new fonm must be completed if the above information changes or an ownership interestis- acquired in an addi~on~~business. ~ Applicant Signature ' //1/\.. ~ Signature of parenUguardian 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