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Home My WebLink AboutPacket � r � �� n�,��,"�� "` "'r'�'��' Advisory Board/Commission/Committee -n...._ CITY OF IOWA CITY Application Form UNESCO CITY OF LITERATURE This application is a public document and as such can be reproduced and distributed for the public. This application will be considered for twelve months only and automatically considered for any vacancy during that time. Advisory Board/Commission/Committee Name �,��n,c.� ��,�� m ��o �.f�" Date of Application � =3 _- �".� � _ � ��, Name � �-r( � � �'1(�52..c`,� �_ c:. Home Address 1 �� L �-.r, � � t�� 1�� -,��1��,^.s� �-��`1 �� S �2.��i Contact phone number ��``�`��'� ��r_�Email Address �'I 1.�,� � �,, � �,,� �,� ,,, —� � �� t't'i u,i�� ;�'1 Your home address must be within the corporate limits of Iowa City? How long have you lived in Iowa City? �;r�c.,_;� `�.�; .� � Occupation: �� i`Yl '�� -k� �� /'T � c��,.�-�� Gender: Male� Female Experiences and/or activities which you feel qualify you for this position: � � What is your present knowledge of this advisory board? � � ��-� ��-,� A �� Ui Y11�� f 1 �\.� V�t�S ` ,� ��t tz-�,'l2� t� � _ S ?� . , �.'�t�'1 lrl 1 S � � ��< � y �. c�i�4isT1 �l,�l l') ��-^-� �-�'� 1. `t \ -/ L5 c9 ��)�"'� •''1�l' t� � r LL.�' � � � � h \./�� , � _ '�n� c� �,�; ►-� c� ``2.�.> i, . � � v��,� �� -� ��,�t� Z � �t � � � � � C'� �Y.'r'L� � �Q �� Q �� (�l� ��1'(`..��'L �" �r �� ca�1 v" "-j1 � �2 rv��"� 1''� �.^"1 1 �1.� 1��..� �j i`r'� c1 ►1.(' S.-p �� y" i �c� ►,. y� �� s ; ��,�. , e' ,� � � �, � -Z �, a � �, � . �- ��.�.� � Please contact the city attorney at 319-356-5030 to discuss questions or concerns regarding a potential conflict of interest. Potential Conflict of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision—making process ar 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, subcontract, agreement with respect to the proceeds of the federally—assisted activity, either for themselves ar those with whom they have business or immediate family ties, during their tenure or for one year thereafter. 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. 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, domestic partner or partner in cohabitation, children, step children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, 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 whom the employee is in an intimate relationship. Res. #15-300 states that each application for reappointment to a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment to a full tenn in order to increase the opportunities 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 conflicts of interest(See last page for information regarding conflict of interest) Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS Do you currently serve on another Iowa City board or commission?YES NO� If so which one do you prefer? The City Council values all types of diversity on its boards and commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the board and commission is representative of the community and the groups(s)which it serves,please provide your information for the following: Age� �( .�,l,,.�, Country of Origin � t,; �q� Sexual Orientation Religion ` �, �r.� y1+� Do you have a disability?YES NO� Race, Color or Ethnic Group � �� *Note: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore appointment shall take into consideration persons of various racial, religious,cultural,social and economic groups in the city.(Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise finance and one person who receives rental assistance. (Resolution) ..-----'��._--. ....--- Signature of Applicant* Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. You are encouraged to contact individual Council Memibers to express your interest in serving. Contact information is attached. � r , �.�,:.��t,�" �' ��III�� '• 3� "''r' '�� Advisory Board/Commission/Committee -n..s� CITY OF IOWA C1TY Application Form UNESCO CITY OF LITERATURE This application is a public document and as such can be reproduced and distributed'.,for the public. This application will be considered for twelve months only and autom'atically : considered for any vacancy during that time. _ .�� " Advisory Board/Commission/Committee Name g C' �� •��j'� Date of Application �� °� ; � � ``� �„�' [� � � , Name ,� --� �;--, �_�.__� Home Address � � �� - j ' _�� Contact phone number � � ��v��mail Address � � � � � �" " � C (��(J'1�1�1�' �� Your home address must be within the corporate limits of Iowa City? How long have you lived in Iowa City? `��}'�G'�! ►�.� �� `' ��n�- �, Occupation: �i� � �,,�1�� - /� L�� C� �� Gender: Male Female �l./ �� ' �E� �' � G� '�� 1'� �. Experiences and/or activities which you feel qualify you for this position: (�� (�,- � i fi I� ��:-� �rc�, �Qc-ac�� '��.�:�� o �� '�� -��s��.-��- ��-r��e�-- C i�.�� :�tc�� .� a.�►� � �� `' � cr;�c��-- rn c�r� c�� z _ � ��'rf��ZJ�- C��d �s=�u� t ��r�`� �� .� �..5��- �c;c I `� ��-� r;� r�i�. �� c� , � , � � �, ��C�� !}-��:.��;��'c� �� m��1 `�C1�� c�as� � 3 � What is your present knowledge of this advisory board? � o� � C��`� ��4 rr�� . , �G��z�i �� -'��` ��. ��k:��c a�v�s�� y� � � � � L � � �`�- � �� -- t� rn� ��nc��-tz��'� �c�-�- -�� c�c�S �� c��r� � � � �� `� r cl c�:�- �d f�c-� � �. es �G� �r�, r�� ° -�r' ��c�� c .� � � � . � cx�..��I �� a �� c�a�c� C� �� . �c t.��I�e ��. �n� C��c�cl � �c� � �c�� 1 �� :, Please contact the city attorney at 319-356-5030 to discuss questions or concerns regarding a potential conflict of interest. Pote�tial Conflict of Interest � � � The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the 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, subcontract, 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. 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. 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, domestic partner or partner in cohabitation, children, step children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, 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 whom the employee is in an intimate relationship. Res. #15-300 states that each application for reappointment to a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment to a full term in arder to increase the opportunities for new applicants to serve. Council policy is not to permit an individual to serve on two Boar s 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 conflicts of interest(See last page for information regarding conflict of interest) Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS Do you currently serve on another Iowa City board or commission?YES NO If so which one do you prefer? The City Council values all types of diversity on its boards and commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the board and commission is representative of the community and the groups(s) which it serves,please provide your information for the following: Age� Country of Origin �.;��1�� `��5 ., SexualOrientation ��;�-- ° c �:.�_� Religion ��i �('}, ' � � �� '. � ; :'i Do you have a disability?YES NO Race, Color or Ethnic Group ��(��(�.� *Note: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise finance and one person who receives rental assistance. (Resolution) , � Signature of Applicant* �� Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions,Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Contact information is attached. t � a .�...:�.��, � �a�r �� "` ;"''��°'�'- �` A visory oardlCo issionlCo ittee � 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'` '� � �C _�,\_ �.� � __ _ Date of Application E r � Z`' //t,� __. __. __ _ — m_-____ � ___ Name �� i � � ' - , __� �_ _.� ✓�— ��`__� �.�.._ ____ _..._. _ _ _ Home Addxess _(�- 4 ��,, 1-�"v � ,/` Contact�phone number�l�'��',�"�,-_,j c>�_...�_.___. Finail A�dress �,r� -b'?(,i� �` Uir� tt - �'c�� ____..._ Your home address must be within the corporate limits of Iowa Gity? How lon have ou lived in Iowa Cit � � g Y y• � �' 1 �_. t)s�Cta��€it�:�: �`k'"�-�-,�,.�"C_( ��!`tf�tPf54y_ / ��l �� Gender: Male � Female Experiences and/ar activities�vhich you feel qualify yc�u�'or this posit�on: � - _�_ �� ,z 1 P.-✓��6`, / �. �� r '�"�� =�� i�t!� (e�-.< <�3•r ,s l�,� _ �� l r ��,�-� �' e�r� G��ti-c-�� 3 �V a � J �C,.i�. u.. t � / �` P 3` , ;`�r ��-' ��r G �� 4` f �t,r,� <G2i�T`� r � (r`l�� 4 �s _ �.._ << �i:, �Y• � � � — � �� ` �C�.r Y �ut,,r i f' Gz-".�' Sc��-c �� t �1 � ��r�� t� / ��( �.;,.� c C` �. ��(P.� r�,.�.,,.� �<.-../ C'Gt r ��''e� w- � ( /t � W'hat is your �resent knorvled�e of this ad��isory bqarc�? / (e �.(c�-� �--r= �...f� �. � C;�� \F(.G�i �`� C� ��, �( v16�u� ``�`r �. / �/�. � -�-��. C��C `.�`C' �ic,r%x C`�'� �,i�'t '�-C�� •�z% C c>>�r 1 w",� � L-y" ( `�'- 1 �� i .:� �a'� ps.�� :�� g_ s � �;_� 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. _. _ _ _ _.... ......._ _ _ _ _ __ _ _ . _..__ 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 _ _ _ _ .. __ _ _....._ 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? ,s � � � :� :;-3� _ _ 'i .�':_.� �c. ds..�� u � z �.: _ . � > -_ "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: , r�� _�-_ 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) ,. � ,� � Si�;nature of Appl�cant* �_ <<° �~'z�T._....�.�� _ _._. 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. �. � , •;:.� � �, ��,`, a" ��a :1'v:; � �- � . �_ „