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Home My WebLink AboutPacket (3) , � , r � �� !�:�:m��,�,►�� „� """°°`�� Adviso�y Board/Commission/Committee CITY QF IOWA CITY APPlication k'orm UNESC4 CITY OF I.ITERATURE This application is a pu�lic docizment and as such can be repraduced and distrihuted for the public, This application will be considered for twelve months only and automatically considered for any vacancy during that iime. Advisory BoardlCommission/Committee Narne j�� j,.;�� (��,��._��,.. ��,�m�� /�1'� Date of Application ��=�,�Y,��-� �� }� - �- _ ---. _.. __ _____ ___._._ Name ��%i'�.....�.1/�1�.,-1 ��.L��'✓�.1�'�_'�._____ ,_., Home AddressF��4-�f�� 1 , � t�f�_-�-��------ ___-----_____--- ___- - Contact phone number I�1�; � " l;mail Address ` � �� __ � ,�L�_:�.:--- r�!�`�,i h� –L c�r�m�u� L � � �,c�.1�� Your home address must be within the corporate limits of Iowa City? '�� How long have you lived in Iowa City? �� -{�, �j C�;�� t� , t� ,�. Occu.patiG�: _ "Yy�L�i�G'�" i m�-;-��j��l!� L�•�t- 5l:'L•lLL� ��>+''��:-�-��.`li"'J� 1�.�' ``��f u�/ Ux�'�-j–; Gender: Male Female �( Experiences and/or activities which you feel qualify you foz-this position: � ��.,�� «� �r'� r � � ' �` �� .�n t��n�n��'�.:��c.�,r,i.i�' �� !��t�n I��h'w� r� �i-z 2�°-i n��L>i,►��i I -�ra�m �.u i � _ ��,i�. C 3 �� :e r�� %��1�:.l, ��,�v�� rn Z. � �� _1— t.t;��f�, c�. ��'�-��'t'�2,�:e.�.. �-� �.,,,-�'�,�-w�.r i►.�i''iJ►�,n.,��1 �.��-e.�t-I-t�.er C.��'N��' ' �"� (��EZ �1`'.�"��, �f� `�'�Z', .J�'�1h5��°"i C�'% s �5� ��—i� c��7 ��iPl�'�� '�`�� T,. ��M ki�'.Y–�� t�. �'t'U..� ��.rr C,�r�n f'rn;tf�.. ;.�-1`'ft1��t'1-�'�.f�'' � What is yaur present knowledge of this advisary board? �� 4��,ii C��x--z�-z� �'t��:�i�e;.�i�c�. �. ��-�- i+5 ��a.l_5 �t,"G� ��."�-2�''�t�-1,t- s -�,._ �� 5�'-afW�� b'r�T�-� �.t�Yrm� � �c� J �� i`� �t,�cl '��%t"j✓�'1`� • ' '� +� ��J �� C�.�c3 {� ��'z��-- �,1�.��-� i,��j ta,a,��e.�� ,�I�� ',4�.r-�}-�rn� . . , ,� a � , �,-.� . .., Please cantact the city attarney at 319-356-�d30 to discuss questions or concerns regarding a potential conflict af interest. Poteatiat Conflict of Interest The Housing and Community Development Commission makes recomineiidations to the City Council regarding the distribution of federal CBDGBOME funds. The general rule is that no persons who exercise or have exereised any functions or responsibilities with respect to federally funded actit�ities, or who are in a position to participate in thz decision—making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally-assisted activity, or have a financial interest in any contract, subc�ntract, agreement with respect to the proceeds of the federally—assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter, __ Seetion 362.5 of the Code of Iowa generally prohibits, witl� certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. Section 362.5 City Council Resolution #15-300 established a policy that the following persons shall not be eligible for appointments to Boards and Commissions. A council member's spouse, damestic partner or partner in cohabitation, children, step children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-la�v, daughter-in-law, sister-in-law, grandparents, and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent,poster child, persons who are parents of the same child, and persons wham the employee is in an intimate relationship. Ites. #15-300 states that each application for reappoirltmetit to a City Board or Commission wi1! be considered without regard to incurnbency. If reappointed, an individual wauld 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 or Commissions at the-same time. You will be asked to resign from one if appointed to another. Do you currently have a conflict of interest?YES NO.� List potential canflicts of interest{5ee last page for inf'ormation regarding conflict of interest) Please..indicate if there are none. BUSiNESS N�411�E i ______.__--------- BU�I�iE�� 4DC�RE�� _---____-- __ -___ _.__. -----�� Do you currently serve on another Iowa City board or commission?Y1:S NC� If so which one do you prefer? e The City Council valt�es all types of diversity an its boards and commissious. Your 1•esponses on this page providc vatuable information to thc Council in achieving that goaJ. In order to ensure that the bc�ard and coinmission is representative of the coinmunity and the groups(s)which it seives,please provide your infortnati�n for the f'ollowrng: ��e -��--- Country of Origin �i, � , r ��..___ Sex�alOrientation __��-��.��,��,,� ____._._____ Reli�it�rz .,��,�,��,j� ___._ . Do you have a disability?YES NO�C Race, Colar or Ethnic Graup _��,U�,��`� XNote: The Human Rights Commission strives to ensure the Commission is representative of the cammunity. Therefore appointment shall take into consideration persons of various racial, religiaus, cultural, sociat and economic groups in the city.{prdinance) The ��ousing and C�mmunit�� TDevelopme�t Commission strives t� satnsf,y its pu�-g�ose a�d intent, when possible to have at least one person with expec•tise in constructian, at least one person with expertise finance and one persan who receives rental assistance.{Resolution) Signa�ture of Applicant* - -�-' " _... �^vw�-t.t,rJ.�1 :_.�Jt�'Z��I±I.�.�y _ .:. '�- _______ __ .-- _.__ __.. Nlisrepresentations an this application will constitute just causc for removal of an appointee. If you fail to answer all the questions,Council will not cousider your application. ___ _ _ : .__ __. You are encouraged to contact individual Council Members to express yonr interest in serving. Contact information is attached.