The URL can be used to link to this page

Home My WebLink About2007-12-11 Appointment u: 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, December 5, 2007. 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 Michael Tharp, Airport Operations Specialist at 356-5045. 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; November 14, 2006; December 12, 2006; January 9, 2007; February 20, 2007; March 20, 2007; May 1, 2007; June 5, 2007; July 24, 2007; September 18, 2007; November5,2007 Application Deadline: Wednesday, 5:00p.m., December 5,2007 Council Appointment Date: December 11, 2007 AIRPORT ZONING BOARD OF ADJUSTMENT One Vacancy - Unexpired + 5-yr Term Ending December 31, 2011 Carl Williams resigned No applications as of Wednesday, 5:00p.m., December 5,2007 I2S] Denotes applicant completed the Confidential page of the application. r::;: 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, December 5, 2007. 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 Michael Tharp, Airport Operations Specialist at 356-5045. 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; November 14, 2006; December 12, 2006; January 9, 2007; February 20, 2007; March 20, 2007; May 1, 2007; June 5, 2007; July 24, 2007; September 18, 2007; November 5, 2007 Application Deadline: Wednesday, 5:00p.m., December 5,2007 Council Appointment Date: December 11, 2007 AIRPORT ZONING COMMISSION One Vacancy - Six-year Term January 1, 2006 - December 31, 2011 Term expires for Mark Anderson No applications as of Wednesday, 5:00p.m., December 5,2007 [8] Denotes applicant completed the Confidential page of the application. ~ NOTICE THE CITY COUNCil OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOllOWING BOARD: BOARD OF ADJUSTMENT One vacancy - Five-Year Term January 1, 2008 - January 1, 2013 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, December 5, 2007. 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 Sarah Walz, Associate Planner at 356-5239. 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: 1 Council Announcement Date: October 16,2007 Application Deadline: Wednesday, 5:00 p.m., December 5,2007 Council Appointment Date: December 11, 2007 BOARD OF ADJUSTMENT One vacancy - Five Year Term January 1, 2008 - January 1, 2013 Term expires for Carol Alexander No applications as of Wednesday, 5:00p.m., December 5,2007 [8] Denotes applicant completed the Confidential page of the application. l'<:-l1-UI I 15d NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF APPEALS One Vacancy - Five-Year Term January 1, 2008 - December 31,2012 One (1) Licensed Plumber 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, December 5, 2007. 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. Board of Ipp~ll~ Attendance Record 2006 NAME TERM EXPIRES Jan-07 Feb-07 Mar-07 Apr-07 Gary Haman 12/31/2007 x x x NM Steve Buckman 12/31/2011 x x x Doug DuCharme 12/31/2009 x x OlE Tim Fehr 12/31/2008 x x OlE John Roffman 12/31/2007 x x x Chad Campion 12/31/2008 0 0 x AI Gerard 12/31/2010 x x x KEY X = present o = absent OlE = absent/excused NM = No meeting _ = not a member May-07 Jun-07 NM x x o x x x x Board of Appeals Attendance Record 2006 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 x x x x x 0 OlE x x x x x x x 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: 0 Council Announcement Date: September 18, 2007; November 5, 2007 Application Deadline: Wednesday, 5:00 p.m., December 5,2007 Council Appointment Date: December 11, 2007 BOARD OF APPEALS One vacancy - Five Year Term January 1, 2008 - December 31, 2012 Licensed Plumber Term expires for Gary Haman Licensed Plumber Andrea French [El 531 S. 151 Avenue Richard Bachelder [El 1374 Santa Fe Dr [El Denotes applicant completed the Confidential page of the application. City of Iowa City Advisory Board/Commission/Committee Appli,cation Form I ~ 1 --= -~ ~~a;:~'t~ ~~ ~~.~ ~ ..IL. 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. 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/Committee Nameh'oCl {' j of A,ppea Js I Youth Advisory Commission, Age on the date offiling:D Age 15 to 17 (or) Term ':) file. ~ 5 Wge 18.t9 21 o g oe- --.J ~"""r'\ _--- \" J "-, ~ c___j -< --n ,,) I"\,) ----J c :~. <=> ;-- .-<. 1-- -,} r'i ~ I, W;!s~~i~ 'Is your home address (listed above) within the corporate limits of Iowa City? [K] Yes [fNo How long have you been a resident of Iowa City? J;c, a~cl CArec.... -J;r;)5 'jears OCCUPATION rL UI/1Bl?~ EMPLOYER '&;;A VA'! .fLUPL8Ges I IJJC-. PHONE NUMBER: HOME 3tJJ - / S/ '3 BUSINESS 364, 28)'-/ : /;3/ -1/5"2- / EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: Signature of parent/guardian if Age 15 to 17: lAME AMDI?EA FREAle H HOME ADDRESS 53/ S 1-::;1- A '.1- ...- II [; , .:1':- ,:1M dt.. //dl1u-.l ff)c,~ f'it-~6~y, ~VMti} ktle' 6~(.... wcr /c..;J 4-. --fi..-L p/~.h'~JJ --fr~!o/~ '! L~ .~6vV~~ a.~? !o~ CJ~~~ 22 .1~~v.s . ::r ~vt -fr~yVVl'J.aV'd~l-l1f7uL~J}\. L".. I}Uh\.~>.-cniA flf') tl tl5 tl. t"~. J1Jrc-1 ,'J'rv-C~s I t,1 ~ IV d. /{ ~1/.J / . . 'OJ C ~ ( ., \") , I .! ~. Q.U n J -h:t/h.""\. I ( c./L to I t.j-t.:-.. di1 ?J~4-'O'/ 3 0/ C~1h-uL/7~ ' ' 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 December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~ lb,"/vp ~ fJypeaLs Ha~.s ,/htuttVL/J /~c~:/uvt"'~ Ii /)- > ') l..-- ? / ,\ - I. dockt-- {J~ !lU/flee._ aYl.c./' /ratrh<...(/J Ul:-' J-'rr~1~ (-t. , (! cJ'>1sfrk. c/l-i WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? --- - / 'l _ h q /r't:, &.12::~1 2Ji ~ e- e: 1<re r / e'j-1 U'-~ ~ 1 f/ /tt ~ .10 6'>-'} C;;'<.. h vi Lno&/ruolIOn In ::[;;MJ,J. /hy h~'~~Jr 2? 6lJl~n!,J!:lUHtb,'d ~~dZf..S i!a... O:SS-fr;j- Zn /:JO~ ~&U5-1'dM. -f7Y1C,k ''f - .1-- "'no tJ), It {r. j, h 1/ iUh -h tlVI'laf ~t!n ~~? /1->/( g-,'~-<J 6:t ?1:/h 1 [f.1)J-#vh'~'< ~~/};cj -k t~ bj~ ~ 6<?~,j) ~ '.P Ct;'~ (J~'" bc~~ VI e<<J.L9 ~d' s~lc2 ~t~I~~, Jzr,~~~ 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. .n 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 about Section 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. !"-) o ~C) ..... ---I ,J C) -< = .-J CJ -n -.;q;-::: , --:1 IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes EJ~o s:: :,_.) DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSI~?' G1 Yes ~ 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 December 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING. I! 1 -,..= -~.... :t~W!:'"'- ~~ ~~~ ~ ...I.L. CITY OF IOWA CITY Name of City Bo ard/Commission/Committee ANDk'7L-P ---;) ~ DLJR;Rj) 0(::: 4PPQC\LS Date 11/7/2 c.JO 7 / Name h2 ~NC!~ If 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 AI (; AI ~ r1 = <::::> ;'2: CJ :::=; ~~ ....:~ 11 ~-=.{c 0 ,. ---..... ,........1 1_: r'-, :!:n . r-1;< \....J ~ I.D ); 0 ~ NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional buSin~>v~/ ApphcantSlgnature /~0 v, ,L Signature of parent/guardian if Age 15 to 17:' Address:::;3; S, / U:-Ave. 7?t-..JA-C:f-7 :>~~t/J- 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 December 2006 Page 3 of 7 City of Iowa City Advisory Board/Commission/Committee Appli,cation Form 1 ~ 1 -,....= -~ ~~w~'t ~~"'IIII!.~ -......... "'Q 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. 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/Committee Name ,g{'}C.t. II) (\ f A p (J~') Youth Advisory Commission, Age on the date offiling:D Age 15 to 17 (or) Term O~ - 'Z.(1yr0 D Age 18 to 21 Signature of parenUguardian if Age 15 to 17: "AME ~~~~('!~lt ~QC.\,,-~\J.-QV lR\cK) HOME ADDRESS --.llli __SGX.Y\\'O.... r e. ~('.. ZIP rn Yes 522..4b DNa Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident jlOWa City? 17 y~~ OCCUPATION mOl.,t'\,~ 'tV', fJl()..y(]b-e,; EMPLOYER ~A( ~ C~, .~\-L PHONE NUMBER: HOME ~~lq-s.~4 -loll, BUSINESS ~3l1 ~~1~3 J - 9b YI EXPERIENCE ANDIOR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: cl~yi> ~ ~ th {J~ I~ ,<-;l..C. ~(J' he~ JU~~ (}->'\. 4~ Ei~ ,J6(~ - .' . 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 December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? [C, JL)bvv~ teek ~{u~, WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? J~ .~ rL-d~Au.w.J) l~~ . t/WU L-uru'l C_'__ . ~ A'Vvf) j>>-i. J A.kJu-L-Q r CM-. ~~~ I ~~ 'ctf- · 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. , 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 SElc~tion 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. - I IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? [XJ Yes [] No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYes [K] 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 December 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING 1 ~ 1 !~W~'t ~~"lIII~~ .....,-1.1.... CITY OF IOWA CITY Name of City ~ ~. Board/Commis~ion/Committee" (l)GLit& ()\ . f-'P ~L ~ Name ~\c..\r~t9. ~. ~~L~.a.U-er Date IJ-/)~b1 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 spouseldomestic 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 NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an a~business. [) J Applicant Signature '..... (CL9 ~O~~ Signature of parent/guardian if ~e 15 to 17: Address /371 .sa~\ll'\ (}... ~l-Lib 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 December 2006 Page 3 of 7 a:r NOTICE THE CITY COUNCil OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOllOWING COMMISSION: HUMAN RIGHTS COMMISSION Three Vacancies - Three-Year Terms January 1, 2008 - January 1, 2011 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, andlor 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, December 5, 2007. 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: Human :g;4gJ:t-t:.i$ ATTENDANCE RECORD YEAR 2007 TERM NAME EXP. 1123 2/27 3127 4/24 5/22 6/26 7/24 8/21 9/25 10/23 11127 12/25 Bev Witwer 1/1/08 X O/r: X NM X X X X X X Sara Baird 1/1/08 X X X NM X X X X X OlE Scott King 1/1108 OlE X X NM X OlE X X X OlE Martha 111/09 X OlE X NM X X X X X OlE Lubaroff Kate Karacay 1/1/09 X X X NM OlE OlE X X OlE X Florence 111/09 -- -- --- --- -- X X X OlE X Ejiwale Joy Kross 1/1/10 X X X NM X X OlE X OlE X Newman 1/1/10 -.. -- n_ --- --- --- --- OlE X X Abuissa Eric Kusiak 1/1/10 _0- ..- -- --- --- --- --- --- X X (Meeting Date) KEY: x = Present o = Absent OlE = AbsentlExcused NM = No meeting --- = Not a Member NMNQ - No meeting, no quorum 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: 4 Council Announcement Date: October 16, 2007 Application Deadline: Wednesday, 5:00 p.m., December 5,2007 Council Appointment Date: December 11, 2007 HUMAN RIGHTS COMMISSION Three Vacancies - Three-year Terms January 1, 2008 - January 1, 2011 Term expires for Scott King, Sara Baird, Beverly Witwer) Corey Stoglin [8] 400-1/2 Kirkwood Ave, Apt #4 Andy Willard [8] 431 South Summit St Dell Briggs [R] 27 Durham Court Ronald Willet Kinum [R] PO Box 10099 Yolanda Spears [8] 1009 Dover St Marian Lashley Coleman [8] 2161 Banbury Circle Pat Schnack [8] 2324 Mayfield Road Jennifer Sherer [8] 3019 Pinecrest Rd Nathan Decker [8] 737 Michael St, Apt 52 [8] Denotes applicant completed the Confidential page of the application. City of Iowa City Advisory Board/Commission/Committee Application Form l ~ 1 ~~::......~... ~~~!:~ '" "_I~ ......~ CITY OF IOWA CITY Individuals serving on BoardslCommissionslCommittees 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory BoardlCommissionlCommittee Name HLt'fl\uY\ "1545 (O'}"V\'M,. \ 55 IC'.)'\. Term J(~.V\ 1)'2008- J'c...v...ly..oi( NAME CO re..y ~ toS U~ HOME ADDRESS \f 00 L(1.. K I r/(wood. A \l~ kpt H. L/ Is your home address (listed above) within the corporate limits of Iowa City? I VI Yes <1 yr- ZIP S").-1- "-{ ()' DNo How long have you been a resident of Iowa City? OCCUPATION /""'055 piJ't:-v~t0'" ,..,HONE NUMBER: HOME '3 I q - L/60 ~ f) I l))f EMPLOYER I Q.. f"svt L.ut"f BUSINESS J J~ - "3lj(- CJ I 5'Oe.-it1-oLj EXPERIENCE ANDIOR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: '1- Sdv"J 0 '^- +- '" -G- lA^", \V e.fSl, +1" 0 F- -r. 0 WADI \1 (". si*y GOM'M l-tiL~ Go- S c:. 5i- \.....6 C-V\.-\- l:- S<.-('vv L-S fA- e..Cb\)...(.L ()H\>..N-l(,~cty o..-J.-0'IC,olf'" ror th..G- ......&~(v'^o.~ 5U-(i.1"d. ~ )-\' r-o ~ S <) G l- \ GC l lv vr $ 'bc-.&\<. 5 Y'" ""~ 7. 6.."'" r r G. ~\ d ~t (J F +~ 1A> Lv 1\ c-'( +y c "'-~ f't-~ r C> ~ t ~ Iv. 1\. Pt. G. ~~ c~ =.3 c' ,") ....-j II WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~ I"-v-. <- W 1- ~ II- {. t ~c.y ~d P o.-J..j r ,..,c, 5 ~ l,.. "M. t:..v\ /"' i 'J h."\ ') CuY' eel'.... <, ~<;- ( ....'; ~:'..'. ~>< --~ \.() -- )> c..:> i-----, <...J 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 December 2006 Page 1 of 8 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR "PPL YING)? 1: Wc..",o\- -t'c:> <-,^S\>.ifv +,^v-\ "3(f:YLVC<. C~*V c..",Y'J..{~c....t..."J +0 'Vv--DUl/... P-OV'u..otJ '\ "V'\.+~ ~ G.- r v/)-' oF- h. ~"'" C. \"- 'r- 'i S ~ $ . 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 +I,at apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. ther 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 ,392.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. C~ ~ -~ .... <. + -n LJ o :--_:"7 T1 ..----, <_J - .. '- . /' ." \,.0 .-- ).; (,.) IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? [}jYES DNO DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYES 02J NO (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) I Misrepresentations on this application will constitute just cause for removal of an appointee. I If you fail to answer all the questions, Council may not consider your application. Human Rights Commission Application December 2006 Page 2 of 8 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING ,~ ! ,::;:.:::.....~... !~~~'"t. ~..~~~ CITY OF IOWA CITY Name of City , Board/Commission/Committee \-..t \A.."", c.. \r-. \f' \ C& 't-,.'t ( C crt"^"'" IS) 1 CJ '^' Name C () f' e-- y <;t D 7 Ll V\. 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 l 0 j->;Ct Ie:. 7 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 'V\. 0 "" , ,; '" Q c.-~ --- ~ --.J " ;: -,' .: . n ":..' C0 -,,- " ,'- ~ ~._- : I """" '" - i -, , -.-,. '. j , ->:- ~ -~ .. ...'--. )~ 0) - NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature ~~ ~ ~ 0 v \.( ~ tel (' r--wooJ PrVe,- ~~+ tt '-1 . 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. Human Rights Commission Application December 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 HUMAN RIGHTS COMMISSION It is the mission of the Iowa City Human Rights Commission to protect residents of the city from discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city strives to ensure that the Human Rights Commission is representative of the community. Therefore, "appointments shall take into consideration men and women of various racial, religious, cultural, social and economic groups in the city." lOrd. 94-3647, 11-8-94) OPTIONAL: PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN CHOOSING AN APPLICANT. [lIJ Age NIt. Religion !V\..c;..lr, I Gender N/~ Disability ~~OJ~<t)o I Income (see table) , I Race, color AFv-\c...",,,,, ~ r.....u-\c-v"\ or ethnic group S}r~t s~"t- I Sexual Orientation National origin ;-'-) D Other IPlease explain below) -,-~ ~." .... -'... c:) -.:~;.I c_~ I , I I C) -'--"-1 Human Rights Commission Application December 2006 1,_:") Page 4 of 8 C) City of Iowa City Advisory Board/Commission/Committee Application Form I ~ 1 -~= -Ii).... ~~ai!:"t. ~_aa.~ ~-.I.L. 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. 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Human Rights Commission NAME Andy Willard HOME ADDRESS 431 South Summit Street, Iowa City, IA Term Three Years Is your home address (listed above) within the corporate limits of Iowa City? [{] Yes How long have you been a resident of Iowa City? Two years, Three Months ZIP 52240 DNo OCCUPATION Experiential Learning Coordinator & Faculty o EMPLOYER University o~~ )....~ ~__c ,...,~ c::.> = --.I ...,.. 23 BUSINESS (319) 335-83~J.:-~ -< 11 ~--i C ) .&- .:-< r---- rT! ",.. EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITIOtt) ~ ::: ,<-. . . My approach to teaching and studying international, national, and local efforts to achieve human rigOl& is desigRed to highlight the people who are involved in particular disputes. In teaching, I encourage students to engage in fieldwork tcS=Relp them make connections between their reading and the worldly conflicts to which the reading refers. With respect to my research, I have , published articles on human rights in a variety of publications. Though my human rights work has an international focus, the emphasis is on the relationship between international prescriptions and their impact on the lives of everyday citizens. I believe my knowledge of the worldwide human rights program and the ways in which it is expressed and applied in local contexts are important qualifications in my application. PHONE NUMBER: HOME (319) 248-0348 !-n CJ For over thirty years, I have been involved in varying degree with people associated with the human rights program. However, I have not yet served on a local human rights commission. To serve the Iowa City community in this capacity would be a great opportun ity. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? My introduction to the Commission's work was provided by Stefanie Bowers when she met with the students in the human rights course I taught during the 2006-2007 academic year. Beyond her description, the information on the web site is very informative in terms of specifying the Commission's purposes and procedures. 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 December 2006 Page 1 of 8 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? See my response above in the first box question on page 1. Also, I am confident my positions at the University, which include serving on the Executive Board of the University's Center for Human Rights, teaching in International Programs, working with Honors students, and serving on the University's Experiential Learning Council, have the potential to playa significant role in shaping my contribution to the Commission's work. Though my professional activities beyond the University may be less pertinent, I serve as President of the Policy Sciences Center, Inc. (a non-profit organization) and on the editorial board of the journal, "Policy Sciences." Finally, I hope my experience in grappling with complex transnational human rights disputes will be an asset for the Commission. Thank you for your consideration. 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. Jther 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. 0 ~ ~::: () -'-~ =-: ~"'_. CJ < 11 C) -<" ; "'---. ___I \_ ) -:-<r I'! C.,) :c~ ;2: /', )> )> :1~ - ... , :Tl ---, \.J co IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? [Z]YES DNO DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYES W 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. Human Rights Commission Application December 2006 Page 2 of 8 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING 1 ~ 1 ~~~~'t ~~ ....~~'- ........... --..... CITY OF IOWA CITY Name of City Board/Commission/Committee Human Rights Commission Name Andy Willard Date 11/12/2007 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). 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 "-> 0 25 :'o~ !' --.l ......~.... / ~- 1_>- ;:::~ C}-.: -~-;:::: I - -=~;:-, .c- "'- -~ -- : :em. ; I 0;; -- -"" "':> ' co ..~ ~ C> NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature tf:::ft /A); ~c.A J? Address 431 South S mit Street. Iowa City, IA 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. Human Rights Commission Application December 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 HUMAN RIGHTS COMMISSION It is the mission of the Iowa City Human Rights Commission to protect residents of the city from discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city strives to ensure that the Human Rights Commission is representative of the community. Therefore, "appointments shall take i~to consideration men and women of various racial, religious, cultural, social and economic groups in the city." (Ord. 94-3647, 11-8-94) OPTIONAL: PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN CHOOSING AN APPLICANT. DAge Religion I Gender Disability I Income (see table) Race, color or ethnic group I Sexual Orientation National origin D Other (Please explain below) o ...-- <:--=- (~ )>=j r-..:J = C::> --' o il Human Rights Commission Application December 2006 , ';'= _~""'~ i r~'; ~'i -~. ~y ,r'~'"" t: --,..--' ,.-"-, :<: :> > -'41'"' - ...... -~ I co Page 4 of 8 C> City of Iowa City Advisory Board/Commission/Committee \pplication Form _-L 1 _! J.~-_Itl... ;i~q~"'I. ~~ ..aa.~ ........,.-.M-. 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. 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 (PO F). 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. Advisory Board/Commission/Committee Name .u U VV\. 2. V\, ~" q h.\-"'::> C~, 'fV\ Yt'\. Term 3 Lt '(" "- NAME --:[)L \ \ ~ ~\ '1 q "5 HOME ADDRESS ~') 1 ~u,,'" ~Vv\. Q-\: . Tow.? Q"'~l ,Tc, Is your home address (listed above) within the corporate limits of Iowa City? ~ How long have you been a resident of Iowa City? .z ~ 4. a...~ OCCUPATION t_c;~~_ \'-\-u"f-' EMPLOYER C\, \ J oJ 'i. \ , r~ '!;) rl ~ 'I iC ""HONE NUMBER: HOME ~~\ - ~toq.t; BUSINESS ~S 1- ~3':)"'Y- / q3~-1i~'l ZIP ~ .Q c? {.() DNa EXPERIENCE ANDIOR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ~ L ',~,- ot c\'\.c\',,,,--,\ U-) c:~ .. u '" S '. 8 :2:0 )>,~ r-.:> ,,-::.,-:) c:::> -... (.::J ..c II C) -J -_.~...... o. ::: ~-..,. on :-, \_...1 (:J -< }; o WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I 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 December 2006 Page 1 of 8 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING) ? .d. \ m 'L 'tV\.. b "I- \- \.'t Lw;.. Q' -~ I C-,.,,-\ V)\l.1. vy. -\- '\ r~:~...,. ~ f'n~K:,J~) awYl~'~ ~~<~vqrc\ 2 V\ ~ W '- \,,\~.. <...I Y-J ~ \..cA\ J '. ~ -\::-" . \-\... '.. .) c.1 , -'\0\ VV\. "- ""- ' , -\', h.o~'t l,~ \ \'\ a l.,.\-- VV\.u'f <'\ v\. <', ..."~ , --0 ts"<.~"\. \ 6\~ (, "\Or Zio ~~:-J' i b~ c;, V'\ € <':;';, '1. ::> J\l ~ ~ J """ I'\... ,~-\ ,v,s '"'--\- ~) <L ~ ..- <_d..... '" ~ (- ~G'-- w'.\ \ '-\ ~~, 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. t\ 0 'l\ "- r--..;> ;d :~C? = -.J _.. 0-'- CJ ~.:;:: =-n C) -'- =;r-, --< r:- r-" S25~i ~~ ~ -1~'"''' ! , I "-/ \___J en :::- 6 )> IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? DYES ~O DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYES I23NO (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. Human Rights Commission Application December 2006 Page 2 of 8 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING I ~ ! =~'5._iIt... ~q4tl~ ~ --., _...IIoL "l CITY OF IOWA CITY ~~~~ ~ \ Board/Commission/Committee .-\llt'fY\..a. ~ L~ "l n..+~ C o~ w,.- Date / / -.9 -6 1 Name ~ 'L \ \ ~1S ,~~.t\ C.\ q ~ 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). 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 ~o v'\ 'L ~ 0 = --' < ,""" j.:; \- '., CJ - l ....~~ , ) - - ~ C)\ ..:-.'...., \ I i 1 i" ::"; -1 S:~ 7:: j 0 :<-.. ::c> - NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature ,..--U~ Address ,;2 1 '04 ,,'n ~ n\ Q -\ . ,~lD;;~ Q '--- .\" , , T.d-.. 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 December 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 $50,800 2 17,450 29,000 34,800 46,500 58,000 3 19,600 32,650 39,180 52,300 65,300 4 21,800 36,300 43,560 58,100 72,600 5 23,550 39,200 47,040 62,750 78,400 6 25,300 42,100 50,520 67,400 84,200 7 27,050 45,000 54,000 72,050 90,000 8 28,800 47,900 57,480 76,700 95,800 ATTACHMENT TO APPLICATION FOR THE HUMAN RIGHTS COMMISSION It is the mission of the Iowa City Human Rights Commission to protect residents of the city from discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city strives to ensure that the Human Rights Commission is representative of the community. Therefore, "appointments shall take into consideration men and women of various racial, religious, cultural, social and economic groups in the city. II (Ord. 94-3647, 11-8-94) OPTIONAL: PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN CHOOSING AN APPLICANT. I j I I Age I Ga p+,~ -\- Religion Md\~ I Gender Disability I ~- ~ I DO () I Income (see table) . 0$-4 I Race, color or ethnic group I National origin ~ L eLL I.\\'L t<<..r05'i'j. u <.\1 Sexual Orientation D Other (Please explain below) Iman Rights Commission Application December 2006 Page 4 of 8 r,,, o g _- --.J ~~~ ~ .~ -'---. i -Tl ~~ f~ 0 ',~~J }; City of Iowa City Advisory Board/Commission/Committee Application Form Individuals serving on BoardslCommissionslCommittees 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name f..{UMC\N RU~HTS tiJMlA1 S51D^t{rm -2008 -fo 20'11 NAME 1<ofra/cL W,1/~~ l<int/J11 .', HOME ADDRESS POSf-O.{tiCll- 110)( 10099' Iol,V/l (''if 52240 b~-.S"2240 Is your home address (listed above) within the corporate limits of Iowa City? IRI Yes :0 No .) -n , r,) How long have you been a resident of Iowa City? +W tJ 'f-l? ~ Ys OCCUPATION N tl'~ J EMPLOYER , MCI Jewt COtP1~(:fr/)~ ol'lllY PHONE NUMBER: HOME (~19) '3?4 - '3754 . ~ BUSINESS !.owaClf~ Ron @W'2uJ.com EXPERIENCE ANDIOR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: CO) ! 'j ; '-./ C~) ~ l tJt.Q.~~}{)r G~c~ P~Y!d- oj #1.e UI1Jffd 5taIe5~ Iowa. Gv-eet1 PZf.jr~ (J~d \fo~t\SOI\ COVJ1W G lI1'elJ pii(V~ cud -a chile IVI pub"~Ir~J CIVil V '1hf~ ~dV7)ca.ct "a (fllAt1flr" ~l1d tit+ Gt! GtMl/1 puhlrc co'mMelJrr WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? .r'\~' re(t I Vt,{om1~ft~11 0.)/:11 ("~,."f'q-1i1 ro~f" et.1fJ CD vn ci1 wte-erfil1fl s +hzJ- J J/a~.d bW,/(f zf-feI1J/ t\{~"Dl)f/t, J l)!,J} be (bfY5J'i'~"1.fllf pNS.f'fJ+- ~1" a (eM'" I S5J0l1 "1l'~ &,y- 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 December 2006 Page 1 of 8 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPL YING)? r h ~V-e 6- 51vol1ff Ih -leN' sf ~t.1J a.. ~ elf 'cA!ed C oM A1lf~r) -I- fo de&-~1~(~d pe6(J1e~ Crill I a.t1d h~1l1~s,\ r-'1IA1S' b'J 5p-e~k/~ ovr ~tJil.ll/>r .'rJV'Ulrr~ f3'lJ dl~o'If11'/IltlfrO" ~ -a'ld I S1V6f\i4f aJvocak .fvve TJe"Y)o(~a('t. ~-ev~ '2n--e a OU41ber Q[ ;S5~S re!~ydt~# ho+A hOlVltwt ~J1d GJ)517J-u+~VJ,?l1 c,'vi1 V1J~.fs-/ Wh.eVfII1 -fI1-e pcJbk:c (s he,~.1 '> ub) VI ~ -/ed +0 c.. V, c+I'11 <;+2. fr;.. 0:1 CoM /f1 eil ,,;.) p 6 vJY' V' ~ *' ~ wea/!/l of (011 fD~fe C:OI)So(1IUIl1S~o!k/1 (n.+evnah'orrc.J oV' ww I r} f\ 271lH1 a./ --. \)IJtJl (4 111 [e cr s +h € 50 c ,.a/ s--tr tJ cftJre &f 0 uY' 5oc/e"o/-'s eve'(j d;;t~ l,:(e II) ~QraftiH w-J.(jS. 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 bea 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. (- ' r\ ) -' ,j ( ) IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? OOYES DNO - DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYES ~ 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. Human Rights Commission Application December 2006 Page 2 of 8 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Name 1<on "l-JJ WUM/tN RiGHTS COMMJs5JDN W,:lj e ~ f<j' J1 V WI Date lVov€m.ber 28;,2a07 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). 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 -~on.e- / / ~--. "'; / , .," / .. / , -/ .: / .. .." --' / .' .. , ' '1 / ~ / / / 7 I , / NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature -I2tJi1M ~U1h Address POS 5'2.240 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 December 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 $50,800 2 17,450 29,000 34,800 46,500 58,000 3 19,600 32,650 39,180 52,300 65,300 4 21,800 36,300 43,560 58,100 72,600 5 23,550 39,200 47,040 62,750 78,400 6 25,300 42,100 50,520 67,400 84,200 7 27,050 45,000 54,000 72,050 90,000 8 28,800 47;900 57,480 76,700 95,800 ATTACHMENT TO APPLICATION FOR THE HUMAN RIGHTS COMMISSION It is the mission of the Iowa City Human Rights Commission to protect residents of the dt'y from~ discrimination as defined in the Human Rights Ordinance. In order to further this goal, .the city: strives to ensure that the Human Rights Commission is representative of the corrtmunity,' Therefore, "appointments shall take into consideration men and women of variouS::,:racial, religious, cultural, social and economic groups in the city." (Ord. 94-3647, 11-8-~4) OPTIONAL: PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN CHOOSING AN APPLICANT. I5"B I Age I tJoYl-+he iSf' t'e II dIm d oE?J n ~f '" V)1cdtf\ \'beNe/. 1J1 96d I ~~(~ond {> 'J"~ Of" fM~Wt do p'd. rf{-a.1 0" V A pel1J~isabilitY LM ale I Gender r f'oVEP.'t- I Income (see table) . ~ 1O/9oo'!!! I "'.Riera st'xvalJ Sexual Orientation UsA I Race, color or ethnic group .1 National origin eft vC'~ S" la rt ~ Other (Please explain below) :L hAVoIt wrift.eJt ecJ1d tlj'A\I'e ~11 POS-#J. Joy.- lIew$ Wled/-a.. C''1td O-llt-R()..r U . a ~ Li' rls f=','d..()(/s ! 7c: Is ~ . 1400/<, "Llfse (. '61) ~11 /IS 110-1- 2'.,: (otYI/fl~rc la fl'~ W1~ b () r is N'f/' rJ1,./Vl h.'~ rr -I . ~~ L T'2 ~ Human Rights Commission Application ;' J'<rn c- 'J t-l<kt I d? V (T ""-ll Z~ December 2006 Page 4 of 8 f~r.J{.)"1aJ Dr-q?f1;Z2l'fr'O), c,vi-tl, .tA-€ C/2tf< COUYl'W- RQcovder. City of Iowa City Advisory Board/Commission/Committee Application Form 1 ~ 1 _r-= -~ ~~~~'t:t ~, J!lMl~~~ ~...I.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. 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Human Rights Commission NAME Yolanda D. Spears HOME ADDRESS 1009 Dover Street Is your home address (listed above) within the corporate limits of Iowa City? [{] Yes How long have you been a resident of Iowa City? approximately 19 years Term Current Vacancy ZIP 52240 DNo EMPLOYER ICCSD BUSINESS (319) 688-1140 OCCUPATION Family Resource Center Director ,>HONE NUMBER: HOME (319) 337-9595 EXPERIENCE ANDIOR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: The experience and/or activities that qualify me for this position is that I am currently the F,R.C. Director at Lucas Elementary, Master in Social Work student at the University of Iowa and the recipient of the I.C, Chamber of Commerce Education Committee 2006 Parent Volunteer Award. I have experience working with individuals from a variety of backgrounds and I am committed to helping marginalized individuals in the community, f"-~__, c "_:-"J -_.~ . ......-., --J r,,) t.D -....., i I WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? - ~ /"~ "_ '__J I believe that the H,R. Commission enforce and educate the community about our local anti-discrimir:lation laws/human rights ~~~, - - ,'J -,-.J 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 December 2006 Page 1 of 8 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPL YING)? I am applying to this advisory board because I believe that my experience of working within the community can be an asset to the commission, I believe that advocating for one individual can create a positive impact on the community, I am willing to reach out to educate the community about cultural competence issues and the importance of diversity, My academic knowledge and personal experiences will create a positive impact on this advisory board, 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. lther 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. (--' C'~ - r... ) , '-, - '--1 j IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? WYES DNO :.,; DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? D YES em 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. Human Rights Commission Application December 2006 Page 2 of 8 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING ,! 1 ~~~~8t ~~"rl~ _........ l CITY OF IOWA CITY Name of City Board/Commission/Committee Human Rights Commission Name Yolanda D, Spears 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 11/28/2007 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 None - .-- ,"':; ( e ~' '- -'-'''- , ,. .. " - i ['-.) , '" .. - , .. . ..' .. :. ' ....... ~ C) l ./ NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature ~ Address 1009 Do er tr 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. Human Rights Commission Application December 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 HUMAN RIGHTS COMMISSION It is the mission of the Iowa City Human Rights Commission to protect residents of the city from discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city strives to ensure that the Human Rights Commission is representative of the community. Therefore, "appointments shall take into consideration men and women of various racial, religious, cultural, social and economic groups in the city." lOrd. 94-3647, 11-8-94) OPTIONAL: PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN CHOOSING AN APPLICANT. ,-I ReligiQn GAge n I Disahility Femalel Gender ; 50%1 Income (see table) IAfrican American . '_I RaceJ_ color . or ethnic group I National origin I Sexual Orientation D Other (Please explain below) Human Rights Commission Application December 2006 Page 4 of 8 City of Iowa City Advisory Board/Commission/Committee Application Form l! 1 --= -~... ~~W!:~ ~~...-.~ ~...I.L. - CITY OF IOWA CITY Individuals serving on BoardslCommissionslCommittees 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Ju/'JtlJ,VJ. K0/t,f$ (!t)M~SSilY1 Term NAME " i-aJ: Cc; -e a ~~ ~.' HOME ADDRESS OL {1;r ~1~5 ;L-;;lY6 orporate limits of Iowa City? IXI Yes ,DNa: -;'1 /J ! How long have you been a resident of Iowa City? ~ "1' 9 j.eLLrs ,'" .. Ul t " OCCUPATIONJ:d j 1 (i cJ-z,....,.- EMPLOYER .:r:-~ C&fb ~~.~h- t'HONE NUMBER: HOME 3/ q - .3 .<:;j - 1.~O X' BUSINESS 3 I ..- 3tl-i - C --J EXPERIENCE ANDIOR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: JLr~ ~ ~,-,'1J a fU,v,f-,ClAJ ~Hu.- J~ ~ ~OILt/~~ Su~ :U:sWf.d: ,~"JA,:;j;;- ?''!IJ,d~i1;V~:Iy~ ~ t:t.RJ. CA~ ~I '~81Js eo.lvyr~ ~M(~ t:ktJ/s ~'IL -flu- ~~ l:L1tJ1VU2--t~ I'vS~I~ ~ . :EtM/t{, 6'.L..- 5 ektJ (5: ,JI/f(/V1.;-+iJY:<t.d. SM..e ~ r~ ~r(ll/~. '~lId::J tlo iJ~ ~ k-v- . eJt ~/~ WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? If- I\S rnvl U;~l- 5..J(/};L' M +/t-d +he /11/5J/1(] ~:f- The ..r:()W~ C//-ej HU-IYIMI f{j(jhJ~ CO~~; ~,~ . j stJ r:ofea:t re s/de4s ~ ~ a;') fr7P'-<- LUr 1k11 Liu/w ~ - /1A.- n. v I VL a,. 'r- ~ e UI 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 December 2006 Page 1 of 8 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR '\PPL YING)? A~ tL ~ ~ W,l 'V m e-m e-/Yl- 6..v-L.-J ffi Ar:u;~ &>a.n{ .1 W: ~(<-t tL qr ear d.e ~ I ex F:7'WLU- ~ u.xwf:-. 'j i S ~ u e s ( ..J d.u: -t Ht-fAUt/AA. T2ifJ U · 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. Jther 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. ., ,- ' There. IS Ylo LOlLI/,'d; '-- j .-.../ IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? IZlYES DNO DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYES ~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. Human Rights Commission Application December 2006 Page 2 of 8 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING I! 1 ~~:'...a~'" ~~W~'"? ~~ ~~.~ ........-1&.. CITY OF IOWA CITY Name of City Board/Commission/Committee Jltl/YJan. Name Ml1fj{i.tJil (dlelJ?tl.rl R. ~ hfr.; UI11I11"~f /~ ;1 Date /2-1 ~7 . 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). List all businesses in which you or your spouseldomestic 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 -7hPA"'~ 11 r.e NoN f; , - ,.. .-'- ." ..' ~. _.'~ _'c_'_ i -, , -, \..-, .. -. '_ J A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. {!iJ ML ~ k.J;J;;'fO NOTE: 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 December 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 HUMAN RIGHTS COMMISSION It is the mission of the Iowa City Human Rights Commission to protect residents of the city from discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city strives to ensure that the Human Rights Commission is representative of the community. Therefore, "appointments shall take into consideration men and women of various racial, religious, cultural, social and economic groups in the city." (Ord. 94-3647, 11-8-94) OPTIONAL: PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN CHOOSING AN APPLICANT. I femaJ-t I Gender I Bo-~/sr I NON G' Religion [Ii] Age Disability I Income (see table) I Race, color or ethnic group I Sexual Orientation If3Lk(!)c I National origin D Other (Please explain below) Human Rights Commission Application December 2006 Page 4 of 8 December 3,2007 To: The Honorable Judge Fr: Marian Coleman, Equity Director Iowa City Community School District Re: Irene McKinney: Mrs. Irene McKinney asked me to write a character reference letter in her interest. She informed me that the letter was to be shared in a formal Court setting, I take great pleasure in writing this letter for her. I met Mrs. McKinney three years ago at a school activity. Her child was participating in a diversity program. Mrs. McKinney became a strong supporter of school sponsored events. She supported her child and the children of others. Many of the other students that Mrs. McKinney supported were from the homes of single mothers. She spent her personal time and money making sure that the needs of the students were met. She helped to provide opportunities for numerous students. Mrs. McKinney is a caring well-liked member of the Iowa City Community. She models positive behavior for her children and the children of others. She is a Christian woman who believes that God provides for her every need. Irene has excellent rapport with all age groups. In 2006, I worked with her daughter and her daughter's friend on a presentation at the school that they attended. Mrs. McKinney was trustworthy and responsible and encouraged the students to do their best. Mrs. McKinney has many positive personal attributes. In the years that I have know her, I have been impressed with her dedication to any endeavors with which she has been involved. I feel her attributes demonstrates someone with exceptional character. Please consider her good ~s as you review the matter at hand. S. I WrN4. mcere y, (Mrs.) Marian Coleman Former Equity Director Iowa City Community Schools -. . ~ City of Iowa City Advisory Board/Commission/Committee Application Form (--., f ,..- ...., 1.'_/ 'I .,. \ !,., \ Individuals serving on BoardslCommissionslCommittees 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 51., 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. HOME ADDRESS It::. ()~/) f Is your home address {listed above) within the corporate limits of Iowa City? ~ Yes D No ~~:~Th~ r?1fJ ~<2 BUSINESS Advisory Boardl NAME (YJ./fVFI t= LV ZIP OCCUPATION PHONE NUMBER: HOME EXPERIENCE ANDIOR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: YJ1,u (}JLJJ/lj~ ftu-1A'~ ~ ~ ~ f ;!!i~ffi =-~. ~ tJJJ dU<L€,~. '17tLU tJ.AJ-- ~ I' ~ / -J 1 LAR-, ~ [L~ ~~~~~. ~,71LZ ~~~" ~-;G~ J m }\l.1Aj, CA-n ~ LJLU 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 December 2006 Page 1 of 8 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPL YINGj? ~) t~ '/YA c/~ a )) ,'-f) ~G ~ (~!Y'~~ ~~. ., .'~~ (J~ 01 J:J-()/~_ ~ l~ -n,v ~ ~~~~ ~~d~" . ~~ O--~. ~VVL ~_M-i ~ L~ w-J:h: jVJ -.1 ~ c./-..d Vr. !tJlj.) ~ 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' dt'the Code of Iowa, please contact the City Attorney's office at 356-5030. - .. "1 ., " IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~YES DNO DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? D YES ~ 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. Human Rights Commission Application December 2006 Page 2 of 8 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING 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). Name of City Board/Commission/Committee Name 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 YI ^- /\ /) 7f vu v , - , .-, . .,c. ., -- NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Address 6- C)d Sf;- Signature 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 December 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 HUMAN RIGHTS COMMISSION It is the mission of the Iowa City Human Rights Commission to protect residents of the city from discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city strives to ensure that the Human Rights Commission is representative of the community. Therefore, "appointments shall take i,nto consideration men and women of variouS' racial, religious, cultural, social and economic groups in the city." lOrd. 94-3647, 11-8-~4) OPTIONAL: PLEASE PROVIDE ADDITIONALINFORMA TION FOR THE COUNCIL TO CONSIDER WHEN CHOOSING AN APPLICANT. ~Age I()NMo ~ I Religion I ~.. I Disability l-f!t ~ I Gender I ~ Income (see table) I /I 'I Race, color L~~ or ethniC group I~) ~NatiOnal origin l./Jp ~ ~14~1 Sexual Orientation D Other {Please explain below} Human Rights Commission Application December 2006 Page 4 of 8 City of Iowa City Advisory Board/Commission/Committee ..\pplication Form & ~ 1 -~ = -~... ~~ai~'"t. "",... ...aat~ ..,.~ 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. 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 BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory BoardlCommissionlCommittee Name Human Rights Commission NAME Jennifer Sherer HOME ADDRESS 3019 Pinecrest Rd, Iowa City IA 52245 Is your home address (listed above) within the corporate limits of Iowa City? [{] Yes How long have you been a resident of Iowa City? 10 years Term 2008-2011 ZIP 5221~, ;D- .-, ~., ,Na:.:~ - i OCCUPATION Labor Educator ",ONE NUMBER: HOME 337-9986 EMPLOYER University of Iowa LaborCOenter 1 , BUSINESS 335-4891 ,j (_""_1 EXPERIENCE ANDIOR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ( J As a labor educator for the last five years, I've designed and taught classes for Iowa union members on a range of topics, including rights in the workplace under labor and employment law. Through my job I've researched and designed educational materials for workers on issues including sexual harassment, workplace bullying, privacy in the workplace. the Family and Medical Leave Act, and the Americans with Disabilities Act. I also worked for two years through the Labor Center with the UI Center for Human Rights on the Child Labor Public Education Project, designing and leading numerous public forums on global child labor and international workers' rights. I was a member and advisor of UI Students Against Sweatshops for six years, helping UI students campaign to incorporate human rights standards into university purchasing and licensing policies. While a graduate student, I served as President and Vice-President of UE 896-COGS (Campaign to Organize Graduate Students), representing UI graduate employees and working with departments across the university to ensure fair treatment & compliance with the collective bargaining agreement. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? My understanding is that the commission works toward the elimination of discrimination in Iowa City through enforcement of the Human Rights Ordinance, public education and recognition programs, and review of and recommendations on city policy. ~ Misrepresentations on this application will constitute just cause for removal of an appointee. Ilf you fail to answer all the questions, Council may not consider your application. Human Rights Commission Application December 2006 Page 1 of 8 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I would bring to the commission a commitment to non-discrimination, to ensuring all local citizens know and understand their rights, and to ensuring the Human Rights Ordinance is fairly enforced. In particular, I would be excited about applying my experience as an educator to the task of informing the public about Iowa City's Human Rights Ordinance and other pressing local issues (several that come to mind are sexual harassment, immigration, and racial profiling). I would be interested especially in helping the commission work with local community, labor, and student organizations to reach a broad cross-section of Iowa City citizens with its educational programs. The presence of the university, the hospital, and other large employers means that Iowa City will always be home to a large number of new and diverse residents, making ongoing education a greater challenge but also a higher priority. I also have a wealth of skills in organizing and planning events that I believe would be useful in carrying out the mission of 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. 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 +I,at apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. ,her 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? WYES DNO : DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYES ,. ) (..:) WNO (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. Human Rights Commission Application December 2006 Page 2 of 8 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING l! 1 ,;:::;,:'~...a~'" !~W~""!. ~ "'IIII'~ ~ . --:..l'! ....... -AL. CITY OF IOWA CITY Name of City Board/Commission/Committee Human Rights Commission Name Jennifer Sherer Date 12/04/2008 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). 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 \.J() ",0 .. ." , , - .' ". ) , . NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signatur~2!,~{ 2~ I () Address 3019 Pinecrest Rd, 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. Human Rights Commission Application December 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 HUMAN RIGHTS COMMISSION It is the mission of the Iowa City Human Rights Commission to protect residents of the city from discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city strives to ensure that the Human Rights Commission is representative of the community. Therefore, "appointments shall take into consideration men and women of various racial, religious, cultural, social and economic groups in the city." lOrd. 94-3647, 11-8-94) OPTIONAL: PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN CHOOSING AN APPLICANT. DAge I Religion I Gender I Disability I I I Income (see table) I Race, color or ethnic group I National origin I Sexual Orientation D Other (Please explain below) Human Rights Commission Application December 2006 Page 4 of 8 City of Iowa City Advisory Board/Commission/Committee Application Form l ~ 1 ~~:......;~... ~~W;t:~ "'-..~ ~GIIt~ ...... .-...U..... 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. 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 fonna! Council meeting. Appointees serve as unpaid volunteers. This fonn 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 AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Iowa City Human Rights Commission NAME Nathan Decker HOME ADDRESS 737 Michael Street, Apartment 52 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? May 2007 Tenn Jan. 2008-2011 ZIP 52246 DNo OCCUPATION Law Student :fONE NUMBER: HOME (989) 928-4494 EMPLOYER N/A BUSINESS ~j EXPERIENCE ANDIOR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: (T') ...- I am very committed to the concept of equal protection under the law, and am pursuing this interest in my legal studies. I also gained an insight into the numerous way in which discrimination can occur, both in policy and practice, while obtaining a concentration in publiC policy during my undergraduate studies. I am currently in a student government position with the Iowa Student Bar Association and have several years of previous civic experience on the Community Foundation in my hometown. Moreover, my hometown (City of Saginaw, MI) was highly diverse, with a 47-42-12 Caucasian-Black-Hispanic percentile ratio and 29% poverty rate (Source: 2000 U.S. Census). This meant that many of the decisions made in my role with the Foundation had to take into account the equality services across demographic categories, including race and economic class. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I understand the monthly meeting format on Tuesdays and the number of annual events, including the breakfast, job fair, and youth award dinner. I also realize this is a multi-year position which ends the first day of 2011. I am a first year law student, so I should be present during this entire time period. 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 December 2006 Page 1 of 8 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? Drawing from my previous experience, I feel that I am a qualified candidate to represent both the graduate and undergraduate student communities. Ideally my legal education will also assist in statutory review of ordinances and in making legislative recommendations. On a personal level, I was brought up in an environment were civic duty was emphasized. especially to under- or inappropriately served constituencies. That sense of duty remains, and this would be a good way for me to give back to the community, both to represent the law school and on my own behalf. 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. "'AffiliationW includes being a board member or employee of the agency. !her 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. None IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? 0YES DNO DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYES 0 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. Human Rights Commission Application December 2006 Page 2 of8 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING 1 ~ 1 -,..= -~.. ~~~;!:'"y. ~.. ..aa.~ -........ CITY OF IOWA (ITY Name of City Board/Commission/Committee Iowa City Human Rights Commission Name Nathan Decker Date 12/01/2007 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). 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 None , , , -' Signature A new form must be completed if the above information changes or an ownerShip interest is acquired in an additional business. -----:?--':::;z..-..... ~ ....-- ~-z_ - //"'-?~- NOTE: Address 737 Michael Street, Apartment 52 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 December 2006 Page3of8 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 Levell 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 HUMAN RIGHTS COMMISSION It is the mission of the Iowa City Human Rights Commission to protect residents of the city from discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city strives to ensure that the Human Rights Commission is representative of the community. Therefore, "'appointments shall take into consideration men and women of various racial, religious, cultural, social and economic groups in the city." (Ord. 94-3647, 11-8-94) OPTIONAL: PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN CHOOSING AN APPLICANT. o Age Iprotestant (Presbyterian) I Religion Malel Gender INane I Disability <$15,0001 Income (see table) Icaucasian Heterosexuall Sexual Orientation fmerican I Race, color or ethmc group I National origin D Other (Please explain below) Human Rights Commission Application December 2006 Page 4 of 8 ~ NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: PARKS AND RECREATION COMMISSION Two Vacancies - Four-Year Terms January 1, 2008 - January 1, 2012 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, December 5, 2007. 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 Parks and Recreation Commission should be directed to Terry Trueblood, Parks & Recreation Director at 356-5110. PAjRKS AND RECREATION COMMISSION : ATTENDANCE RECORD YEAR 2007 , NAME I TERM , 0 i ..., =: :::l - '" =: .... ..., N EXPIRES - t:: - ~ - ~ - :5 - - a -- -- N ;;:; ~ 10 -- -- QO -- - -- \C .... a.. - - - ~ David OlE Boun~eois 111/11 X OlE X X OlE X OlE X X X Craig I Gustaveson Ill/II X OlE PIE OlE X X X X X X X Margaret Loomer 111/08 X X DIE OlE X X X X X OlE X Ryan O'Leary 111110 X X :X X X X X X X X X Matt , Pacha 111/09 X X ix X X X X X X X X Jerry Ix Raaz ]/]/08 X X X OlE X X X X OlE OlE Phil Reisetter 1/1/09 OlE X iX X X X X OlE OlE X X John Watson 1 I1I1I X OlE b/E X X OlE X X X X X John Westefeld 11]/10 X X X OlE X X X X X X X KEY: x= 0= OlE = NM= LQ= Pres~nt Abse~t Abse~t/Excused No rrjeeting No meeting due to lack of quorum Not ~ 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: 7 Females: 0 Council Announcement Date: October 16, 2007 Application Deadline: Wednesday, 5:00 p.m., December 5,2007 Council Appointment Date: December 11, 2007 PARKS AND RECREATION COMMISSION Two Vacancies - Four Year Terms January 1, 2008 - January 1, 2012 Term expires for Margaret Loomer, Jerry Raaz Judith Pfohl [8] 2229 Abbey Lane Margaret Loomer 1248 Jensen St [8] (Currently serving 1 sl - 4 yr term) Jerry Raaz [8] 48 Green Mountain Dr (Currently serving unexpired term) [8] Denotes applicant completed the Confidential page of the application. City of Iowa City Advisory Board/Commission/Committe~ Application Form rlnp" t.0ul t l - l ~~::.""""~... !:~w!:~ ~... ~II!!'~ ~......... r',', Iii 3: 3J:ITY or IOWA CITY r ", , ' t.. ! T 29 ,.. i I I, Individuals serving on Boards/Commissions/Committees plaYI@r!t;qP?;t~Qrrole. i~ advising the Council on matters of interest to our community and its future, Applicants must reside in 'Iowa' City I-\fter a vacancy has been announced. the Council reviews all applications during the work appointment is made at the next formal Council meeting, Appointees serve as unpaid volunteers This forni may be filled out manually (please LIse a black ink pen), typewritten, or electronically (POF) 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 FelF; TliE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS ,t\,PF)iIC/-\T!F)f\i WILL BE:C~ONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOI;Z I\N'y V/\Ci\t'JCY DURING THAT TIME, .Advisory Board/Col'l1mission/Committee Name Park and Recreation Commission Term ..1..Years _______, Youth Advisory Commission, Age on the date of filing: Age 15 to 17 (or) Age 18 to 21 Signature of parent/guardian if Age 15 to 17: , {"M E~_~~~~_~_f~~I____.________ HOME ADDRESS .2229 Abbey Lane Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? since 1974 ZIP 52246 ^'---,----,,~,-,-'.'._'" [l] Yes D No EMPLOYER ICCSD BUSINESS none OCCUPATION Substitute Teacher PHONE NUMBER: HOME _351-1684 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ,.-- l i I I I , i i ! ! ! I have been active in the community since moving here, including Ty'n Cae neighborhood President since establishment in 1992. I wolunteered six years at the Free Medical clinic lab, seven years as Campfire leader, appointed Iowa City Riverfront and Natural Areas Commision 199204, Strategic Planning Teach (Communication) ! memberr ICCSD 1993, and Action Teacm Memberr ICCSD Strategic planning Financial Resoures 1990. I I organized a multi-neighborhood pin grant for the trail connectrion through West High. I organized the city, I University, and volunteers to weed Mormon Trek median. I am an appointed assistant comissioner for the County I Soil and Water Conservation District. My son participated in Iowa City soccer and summer camps. I , w_____"._,~~__._,.~_.._~_-.w__,__._w,..~ rv1isrepresentations on this application will constitute just cause for removal of an appointee It you fail to answer all the questions, Council may not consider your application. General Application December 2006 Page 1 of 7 IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? The duties ae to recommend and review policies and budgets of cultural functions of the City. The l1mision reports to the City Council. I am aware of the need to represent a diversity of recreation for the City and open space or the equivalent is required from developers. vVHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD REASON FOR APPL YINO)? ~; a strong-;;atu;'li;t background. I would like to use my knowledge from Soil and Water S;;;;rd:.and~;-,;cien-;;;; 1 teaching connections, to help improve the parts. I have been intimately involved establishing and maintaining Kiwanis park since inception. I believe good recreational options are integral to Quality of Life. I was envolved in establishing and maintaining a 4 acre priaire, 520 WHIP windbreak trees, and general landscaping of my church. I \ am interested in the master plan and open space fund use. I know from experiene that ideas like Family Fun Nights I I' have been successful to help promote neighborhoods. I have worked with many city employees on various projects I and think my reputation for getting jobs done will be an asset. ~- I - _J (:::1 I --I ;" N ill i._~_~~_._---- "~I'l .-:-nt:..__ __, '"'D ,_'--, I - -- ~ ..~."..l ~: -,~ ~', ---~-? ------:..,"'--- POTENTIAL CONFLICTS OF INTEREST C.,) 0) 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 agencyOther 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. tv ~'..~ ~ G f/ 1r h ,,'-' d e (1": ; d r'__ t ou. d y: t ) ~ ,r t. t c:: ((N J ~ , IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? [Z] Yes No 00 YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? 0 Yes [Z]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 I to answer all the questions, Council may not consider your application, C;eneral Application December 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING l! 1 =.~::'uii~" t~~!:~ ,,-- -=.~ - ~-~.l1l! ......... ...... CITY or IOWA CITY Narne of City Board/Cornrnisslon/Committee Park and Recreation Commission Date 10/25/2007 ~___'__N'_~_~""~_"'_ Narne Pfohl Section 3625 of the Code of Iowa generally prohibits, with certain important exceptions. a memberof a Board or Commission from having an interest in a city contract. A copy of Section 362,5 lsattached 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 moreof corporation'sstockholdings). Please indicate if there are none. ~ BUSINESS NAME BUSINESS ADDRESS ~frY\.1.. -- r--.:> ~ -- 0 = --' , ------ -~~3~j -- :<: ' . ;Tl ' .'- - --",' : -~ -....... '......-1 r - - /', ---" .. .-' ..,:-- .;.- ~#- ~ -.I -- -, NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature ~ W Signature of parent/guar~n if Age 15 r617: A,dd ress__~~~9 Ab~Y..b:~~__ ~ ",__~~,~_,,~____~_"__~"~M_"_""___ _~>____... ,_.,,~.~-- .~.. .. .____..A~~~___~____~_.,,_.._._~..._'__....... Misrepresentations on this application will constitute just cause for removal of an appointee If you fall to answer all the questions, Council may not consider your application, General f\pplication December 2006 Page 3 of 7 City of Iowa City Advisory Board/Commission/Committee Application Form 1 ~ 1 -~= -~~ t~w~~ ~... "'IID.~ -..~ 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. 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/Committee Name _PCl.I/"'\~ a.-.d. Re.c.. BoW\. ~ Term 3 ,-\eev.. 5> Youth Advisory Commission, Age on the date offiling:D Age 15 to 17 (or) D Age 18 to 21 Signature of parent/guardian if Age 15 to 17: '" HOMEADDRESS ld...,,/P, ~..-Jse..., 5~. Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? 4 -3 ~ e4V\.S OCCUPATION Re/~,..p ~ EMPLOYER PHONE NUMBER: HOME "15'1 - <;)....4-~ 0 BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: o :20 ......" --; C?, ~.'""") -- II ~~2~P :<r" ! II IZ] yesoSDlio cj </" - ):; N -..J '---' = -...I t..JAME P1 cih.Qr~-\- ::t:. Loc> .....,e,....r ,) ~ sv.<Ju if ~ i () ie.OA.- ,~~~ C) \' 0'" fJa...<.k C-..t~ /?ec. 8oGz.L~ p,O\~ G~Ec 1\/ - S~"',"'<;- as' -Pla-..:f-.s~ C1't.u.v..~c.~ C. 3 1"-- 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. General Application December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? .r: QyV\ CLw '-Vu..-. 0 +- ~ i .s 5 ~ a't- p re':d...::,rl,) : -11 --f-k j 1'\ ~e J' 'i' 4-y 6+ .:Lo-.JJa. C. ~ P Cu\ (< >- WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I~ ~ 1< VI C uJ \ €. ~ '\ e... ( 0..-5 0: 't - ~ '-Q..l,.-tJ /h.1-e ,-' C.,Q..(... ') 0 f. ~ --\ ~ ; s s Wl~ ~. C. \' ...... l' 0 v.-.... c, ~ _ w I J ,/h "-~. .'~ <.1 ;'Y! C~ e f~e c (), u..e. /r;(> W1'~ r-~ '-:~"? -- ':3 Q -;"'. ~~ g, c~ o -~~ ':P -::,.~~ S.;' \ ~ ~.:- r" \ :::: --' -- '., -- Q ~/--, -.-: .....:..;;>> ~- )? -r\ -.- .---- ',,"n \----1. ',-..J r..,) -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. 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). 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. I IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? G Yes D No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? D Yes ~ 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 December 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING l ~ 1 -~= -~ ~~~!:'r ""... ...IID.' ~~ CITY OF IOWA CITY Name of City Board/Commission/Committee P CV\. k.. cw..d. {{ e c B "o."-~ Date j/- j?- -0'7- Name MCv\~* L l-06.'\1e.r 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 N cJ i/'\P ;:=; = c::::> ~C) ....:;-:..... I'" ~ 11 .' -, \-,---;- \ -'-J_C-) \.D _-<. I :I"" j I 111 ,-4 Qs;:: - \...J - ~ .. N -...I NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature ~~j ~ Signature of parent/guardian if Age 15 to 17: Address i ':J..'fA :jo."se.... 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. General Application December 2006 Page 3 of 7 City of Iowa City Advisory Board/Commission/Committee ~ pplication Form 1 ~ 1 -~= -~ t~(ei!:'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. 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 vo . form . k en or electronicall F). Return the application to City Clerk, 410 E. Washington St., Iowa City, lowa.~ THIS APPLlCATIO IBUTED 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/Committee Name 'P&.k0 ~ 'Racr~ f J5YA\fhI71V\ Term ~O ,...~-) Youth Advisory Commission, Age on the date of filing:D Age 15 to 17 (or) U~ge 18:!9 21 ""-'- ,,---, - Signature of parent/guardian if Age 15 to 17: p -- <4,;: =-n l.) N . -c, \) /'I ~ - :~ -n NAME~'{'f~ \~-z..- C); -0 '~J .0MEADDRESS~~ ~ ~V\ DrNe....:r:::c. z~ ~f.5 Is your home address (listed above) within the corporate limits oflowa City? ~ Yes 0 No How long have you been a re~den~ of Iowa City? '3:7 at .&..k:3 5 ~ ~ (. \r :--.. OCCUPATION\j.? ~,tr\ie$ ~~ EMPLOYER~~ u:i-'7) PHONE NUMBER: HOME ~ \ 9 . 3 3~ .5 hWJ BUSINESS ..3.J'7~ 3? 9- ~'fi3 EXPERIENCE ANDIOR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: i-\tMK...w.....1< <L ~ J k- t. ~;J~.~~~~~~~ ~.~ ~ tW-~ ~tJ...;J#~~. 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 December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~~r6 ~ ~~~~ ~~ WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ~1 ~~!~. t:'>tU'\O.A~ tJY '~/~ ' ' '" r-~_ ~ '/0 fu ~ 1J fu ~ ''''~~~ ~ 'f4 rM~ ~ p~ ~. ~ ~.~ ~ <to ~ Gb1<<Uu.~ - ~ \.flJ.. J~ 01'Hu~~' 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 t:y 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 of the 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 @ut S~on 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. ::':',-: ,.. --. (~~. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~Yes O:NO c;. DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? D Yes ~ No (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) -'::1 '~n '-'-, ',-.J f'0 -..J 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 December 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING ,~ 1 -~= -~ ~~W!:'t ~... "'IID.~ ~-- CITY OF IOWA CITY Name of City 0 I//" 1J Board/Commission/Committee r ttKltV? ().M(1- Name ~,_~-Z- ~ecv~~ ~\~btl Date I(U~D7 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 t \li'vJ) r-) r_'_' r, {:::.=,} \...< --' - ... - - 1\ c-.~\ - f'oJ F_'_'_ - - ...>, " -r\ -"" ... '1 -' -' _:-~.. \".,J ?~ ~', f"" P - -J NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature T\:/\ A~ Signature Of~P'f'ntlgua~ t~ -'7: ~-_ Address ~ ~-e-evt ~ ~ ~ r.A-- 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 December 2006 Page 3 of 7 ~ ~ NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOllOWING COMMITTEE: PUBLIC ART ADVISORY COMMITTEE Two Vacancies - Three-Year Terms One (1) Art or Design Professional One (1) Ex Officio January 1, 2008 - January 1, 2011 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, December 5, 2007. 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 Marcia Klingaman, Neighborhood Services Planner at 356-5237. Iowa City Public Art Advisory Committee Minutes November 1, 2007 Page 5 Publi~ .Art Advisory Committee Attendance Record 2007 Term Name Expires 2/1 4/5 5/3 6/28 8/2 9/6 11/1 Emllv Carter waTsll Ol/OI/O~ -X- UTE T X - r- --om- 'A _._-- - - ' ,- -- f- DaLayne Williamson 01/01/09 X X OlE X X X X Emily Martin 01/01108 OlE X X X X X OlE Mark Seabold 01/01/10 X OlE X X X X X Patrick Carney 01/01/09 -- -- -- -- X X X X X Rick Fosse OlE X OlE X O\E X X Terry Trueblood X X X OIE* X X X Key: X Present o Absent OlE Absent/Excused * Mike Moran represented Terry Trueblood 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: October 16, 2007 Application Deadline: Wednesday, 5:00 p.m., December 5,2007 Council Appointment Date: December 11, 2007 PUBLIC ART ADVISORY COMMITTEE Two Vacancies - Three Year Terms (1) Art or Design Professional and (1) Ex Officio January 1, 2008 - January 1, 2011 Term expires for Emily Carter Walsh, Emily Martin (1) Art or DesiQn Professional (Also qualify for Ex-Officio vacancy) Annadora Khan [8] 923 Dearborn St Jan Finlayson [8] 2365 Cae Drive Thomas Aprile [8] 50 Lakeview Place NE Alden Lowell Doud [8] 221 E College St #1001 Viktor Tichy [8] 1203 Sheridan Ave (1) Ex Officio Emily Carter-Walsh [8] 1209 Seymour Ave (Currently serving 2nd three-yr term) Barbara Nicknish [8] 832 Kirkwood Ave [8]Denotes applicant completed the Confidential page of the application. City of Iowa City Advisory Board/Commission/Committee II ~pplication Form ,~ 1 -,...= -1iII'l ~~ai!:tt ~~~~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. 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/Committee Name Public Art Advisory t-..) - T errrt:S C) ~ r?'J Ag:'.' e 1:ito ifl L2I ~-- -", 1"0 -~- ,-0 '...\ \ \ ~"; 1 : ,_ .J Youth Advisory Commission, Age on the date of filing:D Age 15 to 17 (or) Signature of parent/guardian if Age 15 to 17: 1''' - -, /.>' c-:) \ME Annadora Khan C1 HOME ADDRESS 923 Dearborn St Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? 33 years ZIP 52240 lZl Yes D No OCCUPATION Library Assistant 111 EMPLOYER University of Iowa Libraries PHONE NUMBER: HOME 319-354-8413 BUSINESS 310-335-5447 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I hold an MFA in Art from the University of Iowa. I'm involved with the Longfellow Association and have been treasury for the last 4 years. I'm interested in enlarging the scope of my involvment with Iowa City commissions I think that this particular opening is of interest to me because of my art background which continues in my job as supervisor of a Multimedia computer lab where people deal with images continually. I also have a gallery in NY and have another solo show planned for May 2009. 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 December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I have no present knowlegdge of the advisory committee. I do recognise at least one name from the committee and ~m familiar with this persons personal art work. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? As I stated previously I'm applying because I feel that my background and work experience make me qualified to sit on this committee. I think my knowlegde of art the committe may find helpful in their future projects. I also feel that where ever organization I am a part of I try to contribute as much as I can. ,- ". , , r.) ,'1 ) r',,) ./.? ~J (.'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. 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. 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? DYes [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 December 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING ,~ 1 --= -~... ~~W~'"l. ~~~=I~ CITY OF IOWA CITY Name of City Board/Commission/Committee Public Art Advisory Date 11/28/2007 Name Annadora Khan 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 1""-""- c- '- .~:', ., : '" .",', --,- \'......:-1 - ---......---" ~.'-~ , ~ 1 ..' d) .' - r"--) .- " ,,s-=') - ( ,-1 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 parent/gu~rdian if Age 15 to 17: Address 923 Dearborn 8t 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 December 2006 Page 3 of 7 City of Iowa City Advisory Board/Commission/Committee ~pplication Form ,! 1 -~= -4.., ~~~!:.... ~~..~~~ ........ u- 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, 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/Committee Name erm ~ tJr'. D Age 18 to) 21 l-~''''"} C~ ==3 -<:~: ,,-"" ... .. I Youth Advisory Commission, Age on the date offiling:D Age 15 to 17 (or) Signature of parenVguardian if Age 15 to 17: _' :--J' ._~.. . NAME JiJlY\ n (\1tt~0Y\ )MEADDRESS 1-1JfI C~~ Drl~ I G') - , Tl Z~ g1~4-a~ -g'yes> D~ Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? W '((20 OCCUPATION ' ' EMPLOYER -=n:ff:" MA~'D'J PHONE NUMBER: HOME 00:r. ~ ~? BUSINESS 0~0 I /)000 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: \ rn~e" p~pr \0 ~etl,rt; ~rv~\~l mpenbltL-- ~ tlfY1 imeV1DY d{~I~~Y"' ~ malYl~0peV1t HI \0\NZl tH"j' \ raV'C-- ~ ~ In Ar1/t?t'o/~n-&m U tR lit \ ~r~ -fflY ~ lmtk?f q ~urr-? m ~ ltJM Ar~ ~<9ti~L- ~r2f. I ~y \f'(,4 on ~ r<\e'fY\~rzs, CoAnd\ ttt ~ IAIMA ~M ~ fjOrb th~h ~Ird,,?em- ft1l~01m. I 0ftV\'-bj 0Y1'0\([A\ ttv>\YVt'r~ t+S F~rt t?f ~ ~t7r6Y1 vtM W/ n I e .(\ tY\v arltl\ titr{" &Scene. 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. "",eneral Application December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? \ Vlm OlWt1re '~pieu0 t lJt. n I I t:1 If} \?a?t AvU fMy 1t??Af1b~1 I ~m A:Crqul1i'r1fed wlfh fV1~rJc 6~oU r ~Vld r~t.ot Y't/ ~\\\\I1~Y\ h -k~0Y1A1 A-42I"/ifhwf7. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? .\ fev\ llIvrr I uqn 'NOr~ VeYl:J (ffCc1iVd~ 'l't\th -ftli0 tomrnl rv \V\ omer -to mv1~ Jev\~O(b, ~kNvlt fVlbliv tltrt. \ m~ ~Ul \f~ ~V t/ \ n +h~ c/GYY)m\AYlI-hj C/tYlol ~ \tt- ?7t cArv~ 'fv0N\u\Pj& of it - \ fhin\?- mt\ ~muvvi~ ~pcw1't' nUt? wmbiNd wiitl iY\~ tilY't bP1~rTJWN;l. Id'ld 1~lf F~ -to -fl1iG tomml1tet-. \ VlG\vt- tJl~ d~~Jt Wl~ YJ'lt:f~ ~ ~C;, In ~ ~Y1J r??l.\\~ not an Vlrt od D~I~ij:::;> ~\e-- - I .f~ I . I ~. ~ \ -t~ . 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 y 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 of the 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 a~t--$ec~~ 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. :: . - -ll I Nc uNfLivT~ '~:.- ;l J I IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes D No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? D Yes @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 December 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING ,~ 1 ~~~!:tt ~~"IDI~ ....,.. ---- CITY OF IOWA CITY Name of City Board/Commission/Committee Name \?' -r~'70Y\ Date l.l...;l. o-:=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 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. ? ........... ,-' ,< ' '...! / ~ '., .' r,:,,_,-1 --.--1 / ~ -- -.'--:C, , ---." --; ~ ~ '. .. C) ~ ~ :::~.- () -' ~ ~, NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature ~Mat~ Signature of parent/gua ia if Age 15 to 17: 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. General Application December 2006 Page 3 of7 City of Iowa City Advisory Board/Commission/Committee r\pplication Form 1 ~ 1 --= -~... f~W!:'"t. ~. ~~I~ ~ ILL. 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. 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. WashingtonSt., 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/Committee Name .\ llc- Qj Term J.-OV 8- - 2-0 ( I Youth Advisory Commission, Age on the date of filing: D Age 15 to 17 (or) . Age 18;1921 '.-=:-J ---' Signature of parent/guardian if Age 15 to 17: , i ~ME~Q 1\fV\-i\ <; R, A ~ r i. \ 'f' J:vwA ~ HOME ADDRESS 5D Li\. ~-v' I t. ~ f t t.t,C.~ Aj B ~o \A.lk Z~P Is your home address (listed above) within the corporate limits of Iowa City? ~Yes How long have you been a resident of Iowa City? ,,7- \ -e a (' S OCCUPATION <; c.\A \ () \-\'\ re (\> (l) ~~ S ~ ~ (2.. EMPLOYER ~~''', J \ ., f. PHONE NUMBER: HOME s)1, ~ fa l-t ~ BUSINESS 3 "&J- - / 7 7 J EXPERIENCE ANDIOR ACTIVITIES WH~CH YOU FEEL QUALIFY YOU FOR THIS POSITION: C') J .j )~D ("'-, DNo ...... J...: Ow "- I1vt ~'h1 \{ -e Ov1 <;" C{ .s a \'1 f n5 5 ~ ; l)11 cJ .- ,4r CL f ns ~.e S ~ l" ~& <; (' A~ k- (~ t\f evJ \f \J~-k ev-h. T-h I r-l-V " file IJ cr-r;, 1"1 c ~ ~ ro ~ I ~"-H o-f 1-.-,11- k € lL 1 ~ ....-,--t-vy f-vv'w ~ '1. d) ~n ~ IA l"; . (~ L04..1 /V}^.t{ 111 i.f fe. {( (> W s /'\'11" C{ v~ {. vt. d 1tA..f: k~ I~ (~ 0,>>\ e v ~ C-4 Fe.-tL_~l,V s ':-f-'. tJ ,:: "'M tU . ~ r I """"*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 December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I ({ "1 cl r r f-tt~ H---J hr ~ ~ Vl f-'1~ b ~J cl..ot;,s.e f: ~A~ tJUf J iJa( ~~t hv10 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? Bet~ C) ~ SC~h.v~ 'f-~ ~ ~ ~~ b~, " . ~, ~"'/ y. :t'vL~ L~ e \I~L...Jti"f ) 4"L:IIq-tt01 ,~ 'Ji qeJ~e~, ~J.-p ~VI ec~~ ~ t-u-;..t h {lR ~ {'e rve /l~ , I POTENTIAL CONFLICTS OF INTEREST ---....) Please identify any potential conflicts between membership on the advisory board and :ypur 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. I IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? [1 Yes D No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYes l2J 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 December 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING 1! 1 --= -~ ~~ai~tr "~~~J~ ~,""""" CITY OF IOWA CITY Name of City Board/Commission/Committee ~ Name ( ~tVV'-li ( a-1;t ~. J V7 J en; g A- f(t If' ~~J2 Date i Z -u;:5~ -f!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 - I ., " ~- r -- ~, J I ~ / / , l' / If) j I ~ , / l/ / / I '-, , J r ; \... u - ,- Lt NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in ~ess. ~ Applicant Signature . r7A.. ~ /~ Signature of parent/guardian if Age 15 to 17: Address (;3 L-~e v - e IV' P L- N:-{ f 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 December 2006 Page 3 of 7 City of Iowa City Advisory Board/Commission/Committee I-\pplication Form I ~ 1 !~~~tt ~~_a.~ ..... aa-. 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. 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/Committee Name P4.h lie.. A rt AJv'':so~~tr)~tfeeTerm~ r--_1 Youth Advisory Commission, Age on the date offiling:D Age 15 to 17 (or) D ~ge 18 tQ"~1 Signature of parent/guardian if Age 15 to 17: ~ 'I I , '. ~':'ME t! {den. L~w~1I Mud 1 ...j HOME ADDRESS .2.:21 0", C&llU~SI-.tiJ loot} LW4C;+jJ fA Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? S~ nc.~ r",,~ I'i'tf'% OCCUPATION R..+: t"e d EMPLOYER - PHONE NUMBER: HOME 33 q- 4S17 BUSINESS - EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: Zlp,<s".2/~ [1-ves D No A.JJ~... ",e-:1-~...ef\'\..en+,) :1'ec:(rne...d <I; d~ lema.. ~VL ~r\Ar'" k~~~orj <lLl-r-t"tcwlu.Hot. 't-..J -tr...e C.~r+a.u.ld:r",..5i:.L.:1e. "f a,,,f, fe.....,JoVl)f..lle.w-e>d -t\) tcfl.tr,"H..e-~.5efH..<<5~ ~.{. h'h... ..8 6....d g ~...C!~td e. Ce ",t-....... J..r d~4 /J t'4-J.~ 'I~ a.,,'h si eo..d 5) ~ us Yfl...k (Jqqi- I q q fs) (file beC=tl a CD Ile",+op 01 prl't'l+>. p<<l"'-J.\I'l-~.s a'fl.d Q. ~cf't.UA(u..lr-\.\(,~~o-.'" /'1'1.tt'jje4-rs} Ql\d a cl"'I.s.L:)",,~ r~.c:L~'1r <sf crrl.{f i.'.sf.r,; (#t'>~ tl"/JouY'"""-4.k..J..~tk pre"~ ro-+-- 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 December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? .fl"dM. 1he ["fe'rne+/Web.s:fe and ~bJec:,+~pI4'ed '?rttt'~pa.'b 0" i~ f~J#5t'l"':-lln M~ll WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? - I - h <lye (&. ~<!> r.1\ fr>e le.Vl-oS I 'Ie. 0J n., ~\5 k t") ~ /cdj ~ elf mosf of ~ I "" p~ri. .,..:1- tLr+ M-().V-e m-e,.l'..As --tr6rt'l- ~h.. 14, e ifh. <!.en,.{UJrle$ Cl nt: 1 1'7&\"u-. It. ot.ve. .s ......".~ , k n &->-v Ie dJ ~ o..(? c.....: ~e,.. \\ It. .[<9r ml.(.,~-e-u. ~ c ~ tle..t,. + "::] ~ r: J ptt"i.rf: ct rf (:" (...Iu.-J: ~ G'lIlllt r-tl"-v-e.....si ~ (!IS ) J.r-. t'lL- 'f .... eQ.J~ nJ 4. YI J "G-,,-"!lf'H'i\.~ Co -{ r & 1 l'\.1 Q' 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 knowthatSection 362.5 of the 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. T J 0 k.oJ b ~ (: t1'fe -tl:~ If. r"/'I. & It. ""+$ +0 1fL.!l.. n+l~c...t, j, /..L.o-t I 0. ty\. a t'H'I elYLb e r" f. tl.. 'Me. "'^' b.e..Y''s' C t.lA.W\. c:..: {a.. oJ. IJ IIVlA I. "d d ~ov ~J- ,tlI~~ (c.nd ~.. J" C;:j) +0- U I M A IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? Q Yes D No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYes GNo (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 December 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING I ~ 1 -~= -~... ~~W~~ ~~...aa.~ -.......... - CITY OF IOWA CITY Name of City 'iJ A Ii , Board/Commission/Committee 1" 4., 1/, (,. A N c:\ II ~5 4:J Name A fcJe n LQ ~ t t :J) t,l,d Co~m."~ Date J ~/b- J 0 -7 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. ~ f'vJ ~ n..e- BUSINESS NAME BUSINESS ADDRESS " ' ,- . .. 1 NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. Applicant Signature ~{~L Signature of parent/guardian if Age 15 to 17: Add ress ;i , k {!.-I , t::" 51 ~ ti "(){ T', tJJ. () 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 December 2006 Page 3 of 7 City of Iowa City Advisory Board/Commission/Committee r\pplication Form j ~ 1 --= -~ f~W!:'t ~ ..ggl~ ~ . - ~,l.~ -" lLlL 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. 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/Committee Name ~6t1" An A-l>Y/J~'1 tOI1I1/ Tee Term j.ycH2.. rr~11 Youth Advisory Commission, Age on the date offiling:D Age 15 to 17 (or) 0 Age 'fito 21 Signature of parent/guardian if Age 15 to 17: I (-~-~j ,\ME V:JLnJLlI~y HOME ADDRESS IttJ!> tHC/2./P;fiJ At,: , , -j Iphllf- 0T'J ZIP Jtz 10 [ZI Yes D No Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? 4rfA~f, OCCUPATION ,/UftlreCr- "by~tJelL EMPLOYER t:;/1'1 ~HEl~f1~~ PHONE NUMBER: HOME '!JJ9-'5q- t..11.r BUSINESS ~9-J50.t/15.r EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: / Wp~1) IH If llb'/6/Ji-'7l-ItLtH/TEcT IIJ !J!I/-61{c, ClEO( R-tC/, 1410,,-/974 I ItV J//t>MJIt-/ ,Ausi72IA- IN If74 I /tJ PtlstprJ /971- /171' I ,A-M) A-s1t-/!.CIfITCcr - ])Ei/l'ZPf7E/2- /tJ /7I11U'l~j) I' IOt.!-+-. ft'f<f7 -1001. ' I J7lttJ/~f) l1/ltf/lrecTJ/IlE )tJ j/&I1./E- #,j) f;OJWN/ ~/;;> I fI#e # PEfilL?? /,.J"ftLT Ifl /JElL f'1!pH n;tHhlISI1/ t4AJIIC--rl.firy ~r /7/fr/frk~l"1nvr ( I?q Y , I 7/t'j( Ii-t r RRT /ftVv f'OCi;ey l1r 1J1e r/f!qleta C/l/t./f'77.17V' J~I?"l. (/9?'(- 1OoZ) jHVt> I #th'e- WP{ll FLfU-$ I/f!!- j7H6Llt'.1-TIOiV!('"!:C'tJITj /,.J /1~ JlI./tJIJ ItJrJ fl?"E-7JZ; C(JM'l!5f3 ;V,fflI7,.viillvt 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 December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? {/tJi.,! /11/1111 1!47lV tJjJ 1?(~ Wi.p~ /'ic frl> /,-/ "lIte- jl/E<.J$ 1/f1'C'~ #-11(!{ {- ~p~. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? i fikV6- ,A- ..feN 61l17!: !jV Aff /!7'P /1I!.tJllrEcTI1/Z-c ~~ Etf~/c (clectl I!HH~ttL I ./hf.Ja!-IA- I pi) Jf'+;rJ) 711..47 t11'tf 10 ftJ /JI/)i?tt jtfcs. 111/7Jt1.c P-/C,f-fWR5IvaE ;1-l'- MffllTtfcr:5> I~/'-~"~S Its rAIL II-j I /<fJtJtY, ~D 117 !'7077tetL hJ.A-i /J/JII1<.h"v1- A12.r mJ17#,7P~~ 7t7 1'1 tJt1I;Ij..~L tPr CZEeK eAfILe5 :ri-J W{-tL.ri'1 EXfUfTl~? /1If7J'1 IJr {ltC .s~CttL-?rhlZ'tl. fl..-'7'lfl/ZS 1IC7l..ft'lr, j LOtlt' fi~ f'rNJ) vt'1I6'N /hiP Mtu.!iDl'~'+77tJ;v5 tplL /3l#1177hfL- {.::.JJYi;eo;vl"1t..?VT It p,A!c tJ/-z. WE- /11/'1,,1 ~(M(J/'I'..! I i!t)vc-f) TO I tiwfr c/ry, I klff.-iZ,!- /r I/A-f }/p; Sc j)l~/t</1$Lf- To IUK_t lowl<- CfT't ,If- 111~';fflfU Euul'~> ell!{ I P LIK.~ 70 VfIAljL I nry 8E ,A7JLc 70 ()~?e- StJ/7c.c-zJrfA7 UJVlaHt..& ft:eipt!CT/P'C- IrJ 1'J1,,'L ~fr pr rk6t..,t.- .A7<-:T tf7V[) /(l2..b/hJ l)~6J; 11'1 ~47tLt'Ct:' /1/flo/L.. 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. III 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. ," III.-tVc j.ltJ CPI./rt../L-,S of- IIVTL~'4~r t',e.. ,.HJp~/,lrTi()~..s / ~i:JA- I /</P'UV/>,L-IJC-.L4 ~ pl!.P~()~\ IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? 0 Yes 0 No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYes ~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 December 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING 1 ~ 1 --= -~ !~Wi!:'t ~ _au.~ ~ . r ~n.1I! ~ &.a..- CITY OF IOWA CITY Name of City /&7(,/(1- C 177 , Board/Commission/Committee thIJLlc- ;rei JfPllj~e'l (J,/1l1f7ec- Name !:ILTPI-.. &11 '! Date /2 -.J - tJ 7 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 tJeJt/lttJ It-! !)lttPf$.J. J ! vc , 1217:> S /{~lU f),4tJ /h' ~ (trtt.-t.'! TJtvt'lolr1t~ PI'" ltuf14t-.l porit-17l11...) I t!?J A- tl17 / /11- -rVl4o 11 tl('-1 7Jev6~olt'1t.;vr " <foJ IV ' f1A7JU III / ~r ItJlE!l:Tft!f I A-t-L o.J fit-/~ht!tO/ /11. ) r/tItLf'1I-~ f /If .rl~.J' , - - c .. - , - - . .... NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. -#J.v Applicant Signature Signature of parent/guardian if Age 15 to 17: Address i1.p'5 J/lftll).W Arc f /"tJlt 0rtt / , /A J22fo 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 December 2006 Page 3 of 7 City of Iowa City Advisory Board/Commission/Committee ,~ pplication Form ,~ ,1 f~iU~1t ~... ~.., -- 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. 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/Committee Name~(2,UC ~T 1C\1)\7IS6K..~(p~1Il.""rT7U:::- Term I/I/D'S - VI/II Youth Advisory Commission, Age on the date offiling:D Age 15 to 17 (or) O{\ge 18:Jp 21 .' -----, ,- ~_. . . ,.-....... ,.........-, --J Signature of parent/guardian if Age 15 to 17: : i NAME Fvv\l L ~ Cfti'.-Tt:.'L" - l01i ~ H- HOME ADDRESS Is your home address (listed ab ve) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? ~~ 'jP r.[ So OCCUPATION?ttvr(l{-~ J/ PH tlZ 'EMPLOYER 'SELF PHONE NUMBER: HOME l~ I q) b?5;;)-'17~'-i BUSINESS (3)11) ~z,/ -ldfI(cY EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ,-j " ,,'~ (....:l ~p oZ?r '-10 ~ Yes UNo As 11 Lo~<o-rIW\.t' e.Ec;lDt::~~ -:[ Hr/vc; lA)iTNtS~----O if(C O!\JcCt;U6 ({.(ftAj6t... )10 iT-IE U1S0,AC LAJ\,.)Ds'CAP-i:::.- 6FIoL.J'-i ~/'J . -ttAv, l--.)b7H4Tf3AttGRoc)0D, I 'Aw..- 'Y2t=-srE'CTt0L 6 t= -THE 'f)(AL-OC)v't 6CTW~ LWD ~K.~ NEW D[Vtz.o(lIA.t: t+lSTcl2( c.. tS lJ iLDI ~":,S ,4-/00 'P0t;Uc.. L..,y")i"----t=S o,c 4/CT'. 0\:OC 71-/c rN;,t ")(/'< 'It:;: AfL-S l:r H 4vt: 64 i^-i EO Sf'e..u Fi C Kt0Dc.JLf:-1)(,t:" D:'0 ittE S\;'Lt:C nDr-.:J P f-t.4SF u t=- ~LJe:,LI C hZ-I n~c.E:->, ALe 'HE Wf:-( THl2.c'\...)bH \OTH\::: ::J::.iV-.S''''rrrU,ltllu ~ e 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. General Application December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? -1 lY\\,I'c Se\Z\JED IL>~O ',tJ(.J\ltS, .~ ltIf:P~)BUc. ,4l2-T AD\J\Sti''-\ ~D. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? .r C!\N Cul'.::ni~.16UTt "'-0 lIfE: L:>2Cr;iL"~ Y\"\f-tlLi~C:> \?e~E<;'S 'f.':S~~~ 1\A.'1 K~)C;\\...,2)L00GE of (\./\ffT'2lZ-,1 ftL_> AN'D CuNST\2\,)(T10J()) ftt:STt\~t c Cl2-11IQDt:. I.4;ND PDse; (Bet 'Sf\F~ ~ ~::cr:=E~S~c..JRc... C~u::-e.~s.~ 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 L,~y 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 S~ction 362.5 of theCode of Iowa, please contact the City Attorney's office at 356-5030. ' I ( , IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? 0 Yes G No ,-- DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYes 0 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 December 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING ,~ .1 ;t~a;'it ~... ...., -- - CITY OF IOWA CITY Name of City '\7 . . Board/Commission/Committee t i::t A C- Date \ I.-/,.3 ( 01 Name -.:.0 vYt I L-_I (' Al2.Tt:L \.A. 14 L-':::. H { 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 V" ~ r..Il'S\'~.<-" '?rrnTl:IhlZAPt\y /7_0c{ <:!"E"'\..\MC0.e.. -=rt)(D.4- (J 1'TUl :II-t 5>z 1..;, ~ I -. , .. '. .c,c:. --._..~ i I c' , -'. . , .' . ~ _~_r c.) : .. -" ,0 .r'--~\ --.- 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 parent/guardian if Age 15 to 17: 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. General Application December 2006 Page 3 of 7 City of Iowa City Advisory Board/Commission/Committee Appli,cation Form I! 1 --= -Itl ~~w~'t ~ -~.~ ~ . --:!.n.'! ~,....I.a.- 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. 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 DOCUMl=NTAND 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. (!O/'YJ/J?1/ 1Te-e- Advisory Board/Commission/Committee Name 'd(/ I 5 tJ fZ b. Term Youth Advisory Commission, Age on the date of filing:D Age 15to 17 (or) D Age 18 to 21 Signature of parent/guardian if Age 15 to 17: \JAME BI1 f( b n f IJ K. If /c K vi; S h HOMEADDRESS 3'3'7, ~fCR.w6 oA Il uJ2--- --...- C S::2.-2-'10 D~ ~o "'; .Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? 1f1; ~~ OCCUPATION JlfrnV2- MPLOYER:] ~j PHONE NUMBER: HOME2.J ~ 33;<;;2. / b 1 BUSINESS -- EXPERIENCE ANDIOR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: f tN () R KIi?- &-- 0 N (he ,1- t:) u-- /V d-.4 l/fJl..J P' 0 R- T h tEL. II t2- T s r 0 P.... +1-.-8 Sf A +e- or:: f" GJ ;<i I a,S a. Ui11 ~ tV-rCl-eR.. ..J- u.J A ,5., PR eS' d.. Q. 0 ~ I D n teL) 0 1 e- ~ A- t;; . I h ,$ () f?- ct, /l /J t ~ /l !:.. /0 N$ f2--fJ I; e. cR-. fYY1 () IV E Y r 12 {)!fU !r2f ,/ A f-e ,8"i 5/ ,11/ €-5 s, I ') t (51<-1 t1 fJ '5' A '1-1 D "f l<J No I ~ tVfR./IC- a-C~ 't-! J e '(2. +- rt, 1 . t.' ::r::. Lv' f' 5 D N \,,~ ~ ~ I €.. N J.:.s De. u -e.. I () P frY' N ~ 00- /IJ ~ ZIP [2 Yes 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 December 2006 Page 1 of 7 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ife-. CtJ /'15 /d e J2/i ../j.-, ON C/IYJ05 IN r II ~-J- foR- 6 f e- l'J fJ;vd- 0- U t e-E IN dL.L+-ctooP- Sf'f1~~S; WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? r 79ftn ~ec,1 S IV e e>-rvt:t. .-1-' f1 () e.- b., ('1:V +0 0 ~ () () 5 E 11 (.L +- f.,,(/ h I e-fJ CL ) \ - -I . . ' F T Iv .;::L / IV +e re- e 5 {- J I tV ~ ) IAf / I / ~ C; ~ o-N ref/tIe rl!- oJ.,LIJC! P- 3rt 7fCi' s. A~'. I c::.. ~..- -i .1 i 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 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. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? lliJ Yes D No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYes L:il 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 December 2006 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING 1 ~ 1 ~~~~'r ~~ ~Jmt~ .......,............ CITY OF IOWA CITY Name of City Boa rd/Com mission/Committee Name R/7p hA L Ii LA. C 1"'-1 P ~ b I I <- A p--.f- II d V I 5 ~&f- k. Mil ~rJlsh Jje-c- t2P/)7 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 L ~/cIN~ ~ NOTE: A new form must be completed if the above information changes or an ownership interestis acquired in an additional business. &;' ,,/ PJ" /1 T J I Applicant Signature, cutlf-ci/~L/ (L / ~~.~ Signature of parent/guardian if Age 15 to 17: 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. General Application December 2006 Page 3 of7 12-11-07 15h NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: SENIOR CENTER COMMISSION One Vacancy - Three-Year Term January 1, 2008 - December 31, 2010 The duties of members of the Senior Center Commission are to: Serve in an advisory role to the City Council with regard to needs of the Senior Center. Make recommendations with regard to policies and programs at the Senior Center. Join staff and other interested persons in seeking adequate financial resources for operation of the Senior Center. Encourage full participation by senior citizens in the programs of the Senior Center. 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. 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, December 5, 2007. 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. 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: 2 Council Announcement Date: September 18, 2007; November 5, 2007 Application Deadline: Wednesday, 5:00 p.m., December 5,2007 Council Appointment Date: December 11, 2007 SENIOR CENTER COMMISSION One vacancy - Three Year Term January 1, 2008 - December 31,2010 Term expires for Betty Kelly No applications as of Wednesday, 5:00p.m., December 5,2007 [8] Denotes applicant completed the Confidential page of the application. C1[: NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: YOUTH ADVISORY COMMISSION One Vacancy - Two-Year Term January 1,2008 - December 31,2009 One (1) person - Age 18 to 21 on the date of filing 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, December 5, 2007. 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.icqov.orq. Questions about the Iowa City Youth Advisory Commission should be directed to Marian Karr, City Clerk at 356-5041 . 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 18, 2007; November 5, 2007 Application Deadline: Wednesday, 5:00 p.m., December 5,2007 Council Appointment Date: December 11, 2007 (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 One Vacancy - Two Year Term January 1,2008 - December 31,2009 One (1) person - Age 18 to 21 on the date of filing (10-31-07) Term expires for Maison Bleam No applications as of Wednesday, 5:00p.m., December 5, 2007 [R] Denotes applicant completed the Confidential page of the application. c;:: NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: YOUTH ADVISORY COMMISSION One Vacancy - Unexpired + Two-Year Term Ending December 31,2009 One (1) person - Age 18 to 21 on the date of filing 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, December 5, 2007. 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.icqov.orq. Questions about the Iowa City Youth Advisory Commission should be directed to Marian Karr, City Clerk at 356-5041 . 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 4, 2007; October 16, 2007 Application Deadline: Wednesday, 5:00 p.m., December 5,2007 Council Appointment Date: December 11, 2007 (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 One Vacancy - Unexpired + Two-Year Term Ending December 31,2009 One (1) person - Age 18 to 21 on the date of filing (10-10-07) (Jacqueline Stubbers resigned) No applications as of Wednesday, 5:00p.m., December 5, 2007 [R] Denotes applicant completed the Confidential page of the application.