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"` ;"''���°'�'- �` A visory oardlCo issionlCo ittee
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C�T�oF� lowa C:i�rY �P�licat�c�n Fc��°
UfVESCC�CI1"Y QF lfl'ERATURE
Tl�ic a�y��lication i� a public doeument and as suct' caa� be re�raduc�d and distributed f°ar the
pnkrlic. This applicatiou �rill be considered for twelve �anths only a�r�d sutomalisaily
cansidered far�ny vacancy duri�Yb tliat ti►ne.
e�dvisory Bc�ari�JC'aty�ylzission,`C c��nz�aiktee Name �(.L� � ",� � �� � � , t`�._G'��,fi� � �s'` '�
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Date of Application E r � Z`' //t,�
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Name �� i � � ' - ,
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Home Addxess _(�- 4 ��,, 1-�"v � ,/`
Contact�phone number�l�'��',�"�,-_,j c>�_...�_.___. Finail A�dress �,r� -b'?(,i� �` Uir� tt - �'c���
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Your home address must be within the corporate limits of Iowa Gity?
How lon have ou lived in Iowa Cit � �
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Gender: Male � Female
Experiences and/ar activities�vhich you feel qualify yc�u�'or this posit�on: � -
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W'hat is your �resent knorvled�e of this ad��isory bqarc�?
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Please contac# th� city attorney �t 319-35fi-iO3Q to �iiscei5s c�ay��trons or� conce��ns re�;ard��g a
pc�teutial conf�ict�f�x�terest.
Patential Canfiict of I.uteY•est
I'he Hausing and Community i)evelopment Comrnission makes recommendations to the City
Council regarding the distribution of federal CBllG/F�OME funds. The general rule is that no
persans who eYercise or have eYercised any functions or responsibilities with respect to lederally
funded aetivities, or who are in a position to participate in the decision—making process or gain
inside iilforr�ation with regard to such activities, may obtain a financial interest or benefit from a
federally-assisted activity, or have a firrancial interest in any contract, subcantract, agreement wit1�
respect to the proceeds of the federally--assisted activity, either for themselves or thase with whom
they l�ave business or irnmediate family ties,during their tenure or for one year thereafter.
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Section 362.5 of the Code of Iowa generally prohibits, with certain importanC exceptions, a
n�ern��r vf u ciry�oard or�Comr�zission frorn having an intere�t ii1 a city contrac�t. Section 3fi2.5
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City Council Reso[ution #15-300 established a policy that the followin.g persons shal] not be
eligible ior appaintments to Boards and Commissions.
A council member's spouse, domestic partn�r or partner in cohabitation, children, step children,
children for wham the Council Member assumes parental responsibility, mother, father, son-in-law,
daughter-in-law, sister-in-law, grandparent.s, and grandchilciren, aunt, uncle, niece, nephew, fir5t
cousin, fi�ster parent,poster chilci, persons who are parents of the same chilc�, and persons�vhom the
employee is in an intirnate relationship.
Res. #15-300 states that each application for reappaintment to a City Baard or Commission will be
considered without regard to incumbency. If reappointed, an individual waulc� be limited to one
reappointment to a full term in order to increase the oppartunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards ar Commissions at the same
time. You will be asked to resign fi-om one if appointed to another.
Do you currently have a conflict of interest?YES NO�` ,,
Do you currently serve on another lowa City board or comnussion?YES NO Y
If so which one do you prefer?
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"I�lae C;ity C;�uncil values all typ�s of divcrsity on its l�aards and c�rnmissions. �'our respanses on
this pagc provide valuable infoi�tnation to the Council in�chieving t}�at goal.
I17 order to ensure that tlie board and co�7�missit>« �is representative of t�le cornmtinity and the�
grot�il�s(s)which it serves,please prt�vic���your int�ornlation for the following:
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C'ountty of`(�rigin (�' .� �=�'
_ __ _. _
Sexual Orie�itation ��p� i;_S r�.V �.,�__.
f��,�>„ii,�: �C'.s>o.° �:,1_.�
Do yc�u have a disability�?YES NO ���
Race,Color or Ethnic("rroup L�"�4,�`f=
_ __.
*i�ote.
Tl�e H�xm«�n Itights Cou,m�ssion str#ves to e��sure fhe Cr�rumission is re}�re�entat���e of the
ca�rimunity. Therefore appoiatment shall take i�to can�iderarion persons of various racial,
reli�ious,eultural,sc�iial and econamic �roups in the citv.(Orciinance)
The I�I(3llSlri� xnd Community I)�v�lopn�ent Commissian strives to satisfy �ts purpcose ac�d
inte�rt, �r�l�.�e�n possible to �ave at least �rrc pers�n w�tl� ��pertise in cor�stractian, at Ie�st a�e
persom wikl�expca-tise fivance and one�erson who receives rental assistance. ([�esol�tic�n)
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Si�;nature of Appl�cant* �_ <<° �~'z�T._....�.�����
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Misrepresentations an this applicarion �vill constitu#e just cause far removal o� �n appointee.
If you fail to ans`�•er ati tlae quest�ansg CounciM va�ill ncrt consit3er y�oar applicatian.
_ . _____ _ _ ...
You are enrr�uraged to cantact inciividut�l C`o��ncil M�n�t.�ers ta cxpress ��our ii�terest iu
servinh. C'oniact infcfrra�a�tit'n is �tf�rl�ed.
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