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HomeMy WebLinkAbout2017-11-21 Appointment11-21-17 12a Notice The City Council Of Iowa City Is Considering Appointment To The Following Board: Airport Zoning Board Of Adjustment One vacancy to fill an unexpired term Upon appointment - December 31, 2018 • The powers and duties of the Airport Zoning Board of Adjustment are 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. • 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. • 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. The Board meets at the call of the Chairperson. • Iowa City -appointed members of boards and commissions must be at least 18 years of age and live in Iowa City. The City Iowa City encourages diversity in the appointment of citizens to boards and commissions. Applications must be received by 5:00 p.m., Tuesday, November 14, 2017. An application can be completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the Clerk's office. Questions about the Johnson County/Iowa City Airport Zoning Board of Adjustment should be directed to Michael Tharp, Airport Operations Specialist at 356-5045. Board/Commission Application Cover Board/Commission: Airport Zoning Board of Adjustment One vacancy to fill an unexpired term Upon appointment -12/31/2018 It is hereby established, as a formal policy of the City Council of Iowa City, 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 order to increase the opportunities for new applicants to serve. Council Announcement Date: 8/20/2013 Application Deadline: 11/14/2017 Council Appointment Date: 11/21/2017 Date of Non -Gender Appointment: After date above Council may appoint without regard to gender Gender Balance Requirement: None Current Gender Balance: Female: 0 Male:1 Gender Name and Address No Applications Notice The City Council Of Iowa City Is Considering Appointment To The Following Board: Airport Zoning Board Of Adjustment One vacancy to fill an unexpired term Upon appointment - December 31, 2020 • The powers and duties of the Airport Zoning Board of Adjustment are 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. • 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. • 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. The Board meets at the call of the Chairperson. Iowa City -appointed members of boards and commissions must be at least 18 years of age and live in Iowa City. The City Iowa City encourages diversity in the appointment of citizens to boards and commissions. Applications must be received by 5:00 p.m., Tuesday, November 14, 2017. An application can be completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the Clerk's office. Questions about the Johnson County/Iowa City Airport Zoning Board of Adjustment should be directed to Michael Tharp, Airport Operations Specialist at 356-5045. Board/Commission Application Cover Board/Commission: Airport Zoning Board of Adjustment One vacancy to fill on unexpired term Upon appointment -12/31/2020 It is hereby established, as a formal policy of the City Council of Iowa City, 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 order to increase the opportunities for new applicants to serve. Council Announcement Date: 11/10/2015 Application Deadline: 11/14/2017 Council Appointment Date: 11/21/2017 Date of Non -Gender Appointment: After date above Council may appoint without regard to gender Gender Balance Requirement: None Current Gender Balance: Female: 0 Male:1 Gender Name and Address No Applications 11-21-17 12c Notice The City Council Of Iowa City Is Considering Appointment To The Following Board: Airport Zoning Commission One vacancy to fill an unexpired term Upon appointment - December 31, 2021 Duties of the Airport Zoning Commission are: • To recommend amendments to the current Iowa City Airport Zoning regulations, including the repeal thereof. • To recommend the adoption of new Airport Zoning regulations. The Board meets as required. Iowa City -appointed members of boards and commissions must be 18 years of age and live in Iowa City. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions Applications must be received by 5:00 p.m., Tuesday, November 14, 2017. An application can be completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the Clerk's office. Questions about the Iowa City Airport Zoning Commission should be directed to Michael Tharp, Airport Operations Specialist at 356-5045. Board/Commission Application Cover Board/Commission: Airport Zoning Commission One vacancy to fill an unexpired term Upon appointment -12/31/2021 It is hereby established, as a formal policy of the City Council of Iowa City, 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 order to increase the opportunities for new applicants to serve. Council Announcement Date: 3/1/2016 Application Deadline: 11/14/2017 Council Appointment Date: 11/21/2017 Date of Non -Gender Appointment: Gender Balance Requirement: Current Gender Balance: After date above Council may appoint without regard to gender None Female:0 Male:2 Gender Name and Address No Applications 11-21-17 12d Notice The City Council Of Iowa City Is Considering Appointment To The Following Board: Board of Adjustment One Vacancy — Five — year term January 1, 2018 — Ending January 1, 2023 • Duties: The Board of Adjustment is a citizen panel that reviews requests for special exceptions and variances. • The Board also considers appeals when there is a disagreement about an administrative decision made by the City. • Members of the board act like judges, making decisions about individual properties and uses that may have difficulty meeting a specific zoning regulation or to resolve disputes about administrative zoning decisions. • The Board is assisted in its work by planning staff and the City Attorney's office. Decisions made by the Board of Adjustment are binding upon all parties unless overturned upon appeal to District Court. • The Board meets the second Wednesday of each month at 5:15 p.m. Iowa City appointed members of boards and commissions must be 18 years of age and live in Iowa City. The City of Iowa City encourages diversity in the appointment to boards and commissions. Applications must be received by 5:00 p.m., Tuesday, November 14, 2017. An application can be completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the Clerk's office. Questions about the Iowa City Board of Adjustment Commission should be directed to Sarah Walz, Associate Planner at 356-5239. Board/Commission Application Cover Board/Commission: Adjustment, Board of One vacancy to fill a five year term 1/1/2018 -1/1/2023 It is hereby established, as a formal policy of the City Council of Iowa City, 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 order to increase the opportunities for new applicants to serve. Council Announcement Date: 9/19/2017 Application Deadline: 11/14/2017 Council Appointment Date: 11/21/2017 Date of Non -Gender Appointment: 12/18/2017 After date above Council may appoint without regard to gender Gender Balance Requirement: 1 None Current Gender Balance: Female: 2 Male: 2 Gender Name and Address Male Hall, Ryan 200 S Summit St BOARD OF ADJUSTMENT ATTENDANCE RECORD NAME TERM EXP. 12116 1113 2117 319 4113 6115 7113 8110 9114 9121 9130 10112 BAKER, LARRY 1/1/2017 X X O/E X X X X X X X X X GOER, CONNIE 111/2020 X X X X X X X X X X O/E X GRENIS, BROCK 1/1/2016 X -- — — — -- — -- — — — CHRISCHILLES, T. GENE 1/1/2019 X X X X X 0/E X X X X X X SOGLIN, BECKY 1/1/2018 X X X X O/E X X X X X X X WEITZEL, TIM 1/1/2021 — — X X X X X X X X X X KEY: X=Present 0 = Absent 01E = Absent/Excused —= Not a Member Advisory Board/Commission Application Form "To 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 CITY OF IOWA CITY considered for any vacancy during that time. UNESCOCIY OF IREMNRE NOTE: Must be 18 years of age and live vdthin city lirruts of Iowa City to apply Date of Application 11/13/2017 First Name' Ryan Last Name* Flail Home Address* 200 S Summit St City IOWA CRY State IA Zip Code* 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 7347881810 Email Address* ryanryanhall@gmaii.com Boards & Commissions Select a Board or Commission you are interested in: Planning and Zoning Commission (P&Z) Select a Board or Commission you are interested in: Human Rights Commission Select a Board or Commission you are interested in: Adjustment, Board of 2. How long have you been a resident of Iowa City?* January 2017 3. Occupation:* Student 4. Gender:* Male 5. Experience and/or activities which you feel qualifyyou forthis position:* Three years service in AmeriCorps, Environmental Planning studies, ran for City Council in Iowa City, volunteered as Spanish interpreter for medical and legal clinics. 6. What is your present knowledge of each advisory board you are interested in?* I am familiar with Planning and Zoning codes and the use of Form Based Code. I am familiar with Human Rights issues through rry service in AmeriCorps. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate familyties, during their tenure orforone 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 Citycontract. CityCouncil Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* Yes List potential conflicts of interest [See next page for information regarding conflict of interest]* Employed by Rocks Cole and Cole Law Firm Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. 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). Business list of conflicts of interest Business Name * Cole Law Firm Business Address* 209 E Washington St, Ste 304 8. Do you currently serve on another Iowa City board or commission? No Demographic Information 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: 9. Age 24 10. Country of Origin United States 11. Sexual Orientation Pansexual 12. Religion n/a 13. Do you have a disability? No 14. Ethnicity Caucasian '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant * Misrepresentations on this application will constitute just cause for removal of an 11-21-17 12e Notice The City Council Of Iowa City Is Considering Appointment To The Following Board: Board of Appeals Two Vacancies — Five Year terms January 1, 2018 - December 31, 2022 Licensed Plumber HBA Representative or qualified by experience or training It is the duty of members of the Board of Appeals to hold appeal hearings on matters concerning the International Building Code, International Residential Code, Uniform Plumbing Code, National Electric Code, International Mechanical Code, International Fire Code, and the Iowa City Housing Code. The Board meets the first Monday of each month or at the call of the Building Official. City -appointed members of boards and commissions must be at least 18 years old and reside in the City of Iowa City. The City of Iowa City encourages diversity in the appointment to boards and commissions. Applications must be received by 5:00 p.m., Tuesday, November 14, 2017. An application can be completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the Clerk's office. Questions regarding the Board of Appeals should be directed to Tim Hennes, Sr Building Inspector at 356-5122. Board/Commission Application Cover Board/Commission: Board of Appeals Two vacancies to fill five year terms 1/1/2018-12/31/2022 One licensed Plumber, One HBA Representative or Qualified By experience or training It is hereby established, as a formal policy of the City Council of Iowa City, 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 order to increase the opportunities for new applicants to serve. Council Announcement Date: 9/19/2017 Application Deadline: 11/14/2017 Council Appointment Date: 11/21/2017 Date of Non -Gender Appointment: 12/18/2017 After date above Council may appoint without regard to gender Gender Balance Requirement: 2 Female Current Gender Balance: Female: 0 Male: 3 Gender_ Name and Address 1 Female Andrea French Licensed Plumber Serving 2nd full term Board of Appeals Attendance Record 2015-2016 12/3112017�������1•������© ' = a Advisory Board/Commission Application Form amain AT 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 CITY OF IOWA CITY considered for any vacancy during that time. UNESCOCIY OF UT TURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 10/19/2017 First Name* Andrea Last Name French Home Address* 531 S. 1 st Ave. City IOWA CITY State IA Zip Code* 52245 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3196311152 Emall Address* afrench241@grnaii.com Boards & Commissions Select a Board or Commission you are interested in: Board of Appeals Board of Appeals Category* Licensed Plumber 2. How long have you been a resident of Iowa City? 35 3. Occupation:* Plumber 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I am a licensed Master Plumber and have served on the Board of Appeals for 2 previous terms. 6. What is your present knowledge of each advisory board you are interested in?* I have served on the Board for 2 terms and have attended all the meetings during that time. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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. City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for appointment to Boards and Commissions: A Council Members spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* No S. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 53 10. Country of Origin United States 11. Sexual Orientation Gay 12. Religion None 13. Do you have a disability? No 14. Ethnicity European American *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 in 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, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down Notice The City Council Of Iowa City Is Considering Appointment To The Following Commission: Historic Preservation Commission One Vacancy to fill a three year term July 1, 2016 — July 1, 2019 (1) Jefferson St Representative Duties of the Historic Preservation Commission include: conducting studies for the identification and designation of Historic Districts; reviewing and acting upon all applications for Certificate of Appropriateness; cooperating with property owners and city agencies regarding remedy of dangerous conditions. Furthering the efforts of historic preservation in the City by making recommendations on preservation issues, when appropriate, by encouraging the historical, architectural or cultural value, and by encouraging persons and organizations to become involved in preservation activities. • Applicants for district representatives to the Historic Preservation Commission must reside in the district that is specified. City -appointed members of boards and commissions must be at least 18 years old and reside in the City of Iowa City. The City of Iowa City encourages diversity in the appointment to boards and commissions. Applications must be received by 5:00 p.m., Tuesday, November 14, 2017. An application can be completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the Clerk's office. Questions about the Iowa City Historic Preservation Commission should be directed to Bob Miklo, Sr Planner at 356-5240. 11/1512017 Board/Commission Application Cover Board/Commission: Historic Preservation Commission One vacancy to fill a three year term 7/1/2016 - 7/1/2019 Jefferson St. District Representative It is hereby established, as a formal polity of the City Council of Iowa City, 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 order to increase the opportunities for new applicants to serve. Council Announcement Date: 9/23/2016 Application Deadline: 11/14/2017 Council Appointment Date: 11/21/2017 Date of Non -Gender Appointment: 6/21/2016 Gender Balance Requirement: Current Gender Balance: After date above Council may appoint without regard to gender none Female:0 Male:0 Gender Name and Address No Applications L2' L129j Notice The City Council Of Iowa City Is Considering Appointment To The Following Commission: Human Rights Commission Three Vacancies — Three -Year Terms January 1, 2018 - January 1, 2021 Duties of the Commission include: • disseminating information to educate the public on illegal discrimination and civil rights, such as organizing and facilitating educational public forums that address one or more of the broad range of topics included within the rubric of human rights; • making recommendations to the City Council for such further legislation concerning discrimination as it may deem necessary and desirable; • cooperating within the limits of any appropriations made for its operation with other agencies or organizations both public and private whose purposes are not inconsistent with those of Title 2 of the City Code (Human Rights Ordinance) • planning programs and activities designed to eliminate racial, religious, cultural and other intergroup tensions including but not limited to sex, color, creed, disability, gender identity, sexual orientation, marital status, age, and national origin. Iowa City -appointed members of boards and commissions must be at least 18 years of age and reside in the City of Iowa City. The City of Iowa City encourages diversity in the appointment to boards and commissions. Applications must be received by 5:00 p.m., Tuesday, November 14, 2017. An application can be completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the Clerk's office. Questions about the Human Rights Commission should be directed to Stefanie Bowers, Human Rights Coordinator at 356-5022 or stefanie-bower(a)iowa-citv.org. Board/Commission Application Cover Board/Commission: Human Rights Commission Three vacancies to fill three year terms 1/1/2018 -1/1/2021 It is hereby established, as a formal policy of the City Council of Iowa City, 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 order to increase the opportunities for new applicants to serve. Council Announcement Date: 9/19/2017 Application Deadline: 11/14/2017 Council Appointment Date: 11/21/2017 Date of Non -Gender Appointment: 12/18/2017 After date above Council may appoint without regard to gender Gender Balance Requirement: 2 Female, 1 None Current Gender Balance: Female: 2 Male: 4 Gender Name and Address CMale Ahmed, Ali 1520 McKinley PI Female Anderson, Ingrid I226 Woodridge Ave. — Female aron, arianna 1227 2nd ave Female Beller, Deborah 2178 Willenbrock Cir Female Bergen -Jackson, Kim 15 Brunswick Court Male Besher, Nidal 2604 Bartelt Rd Male Borger Germann, David 108 Colchester Dr. Female Brown, Damita 216 E. Bloomington St. C Female Bushman, Emily 100 Petersen Hall Female Christensen, Julie 0 254 Black Springs Circle Male Clemmensen, Rex 1108 Spruce St Male Coffey, Thomson 1247 Lakeshore Dr Female Davidovic, Jovana 630 Fairchild St Male Drabek, Matt 815 N Johnson St Female Dudley, Sarah 517 Iowa Ave. Female Fixmer-Oraiz, Vanessa 437 S. Governor St. Male Gerlach, Peter 3346 Tulane Avenue Male Hall, Ryan 200 S Summit St Male Harper, Henri 3051 Wayne Avenue #42 Female Higley, Michelle I 1328 lower Muscatine rd Female Johnson, Kristin 415 S. Van Buren St., Apt.1 - Female - - - - - - - ------------- ? Lambertz, Angela 1710 Hollywood Blvd. Female - - - - — y Mahajan, Maya - -- - - - 417 Monroe St Female McDonald, Sharon 1216 Jensen St Female McGinnis, Cathy 1628 Burns Ave Male Munoz, Jonathon 330 Cayman Street Male NOURELDIN, WAIL 342 FINKBINE LANE #3 Female Pacer, Grace 612 South Dodge Street C Female LL Persson, Dorothy 14 Gallup Place Male Petersen, Nolan 603 E. Burlington St. #1 0 Male Pierce, James j 1214 Keokuk Street Female Rands, Emily 615 N Linn st. Male Retish, Paul 66 Pen Fro Dr Female Rose, Clare j 928 E Bloomington St Male Smith, David 1315 Cedar St. Male Vogel, Jeremy 720 S Dubuque St Apt 6 C Male Warren, Ezra 715 Carriage Hill #1 Female — Watson Epting, Susanne i 86 Broadmoor Lane Female White, Lauren 1901 BROADWAY STREET, APT 6 Male Worlds, Solomon i l 1015 Oakcrest St. Apt i4 Female Donahue, Penny 1017 Rider St. Minutes for the Human Rights Commission Regular Meeting September 19, 2017 Helling Conference Room 410 E. Washington Street Iowa City, IA 52240 Member Attendance Sheet Member Term Exp. 1/17/17 221/17 3/14/17 4/25/2017 5/16/17 6/20/17 7/18/17 8/16/17 9/19/17 B. Kutzko 12020 Present Present Present Present Present Excused Present Present Present J. Falk 12020 Present Present Present Present Present Present Present Present Present T. Pena 12020 Present Present Present Present Present Excused J.Coulter 12019 Present Present Excused Present Present Present Excused Present Present A. Adams 12019 Present Present Present Present Present Present Present Present Present E. Willis 12019 Present Present Present Present Excused Present Present Present Present A.Cohen 12018 Present I Present Present Excused Present Excused Excused Present Present K. Hanrahan 12018 Present Present Present Excused Present Present Present Present Present S. Ghoneim 1 12018 Present I Present Present Present Excused Present Excused Present Present Advisory Board/Commission/Committee 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 t.rh qyct�iS rh rA ISS � o "I/ Date of Application z> � - =� Name I 1 �Ii , A \(\ W\ -Q Home Address I S -2- -z, 11 G.\<,\" 4-� S az�6 Contact phone number 3I q� (9 I n cEmail Address q Lt* F Yn, Your home address must be within the corporate limits of Iowa City? How long have you lived in Iow1a City? S„\ �-ZG yo Occupation: SQ MP l� Q _ l 1 ��` �)P-'t V -4:Z) Gender: Male Female Experiences and/or activities which you feel qualify you for this position: What is your present knowledge ryof this advisory board? 1 ILAl v� g f�'W1," O I' 1 ilac�m�+1 �\ry1�S- ; Csn + i m{ s s I'o r\ C)VL-�-C,��owQLl��J�r� -2-n O� -1-1, 1 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 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, 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 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 confW of interest) Please indicate if there are none. 1 INESS Do you currently serve on another Iowa City board or commission? YES_ NO 4 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: Agee Country of Origin t,t q n Sexual Orientation Religion 1 S lq rye Do you have a disability? YES_ INO Race, Color or Ethnic Group `q C *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. y , r -,4 Advisory Board/Commission Application Form 6�i.;P'r � This application is a public document and as such can be reproduced and distributed for N the public. This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESMOTY OF MMYUR NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 3/14/2017 First Name* Ingrid Last Name Anderson Home Address* 226 Woodridge Ave. City IOWA CITY State IA 21p Code* 52245 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-541-3342 Email Address* igronstal@gmail.com Boards R Commissions Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City? 9 years 3. Occupation:* Environmental Compliance Specialist (attorney) 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I have a strong interest in Equity and Human Rights, and I am excited about the opportunity to give back to the Iowa City community. I am an attorney by training. As a student at the University of Iowa College of Law, I took multiple human rights lawcourses, and 1 participated in a Citizen Lawyer Program project to help immigrant victims of domestic violence obtain immigration status through the VAWA and tlVsa programs. Additionally, I served as a Note Editor on the journal Transnational Law and Contemporary Problems, and 1 was involved in several student organizations, including the Organization of Women Law Students and Staff, Law Students for Reproductive Justice, and the Environmental Law Society. I also worked in the UI College of LaWs Legal Clinic. My work included representing indigent clients, primarily women in family law and domestic violence cases, and a project advising the City of Cedar Rapids Civil Rights Comrnission regarding a proposed amendment to the city civil rights ordinance to include source of income as a protected class. While the provision was not ultimately adopted, this project gave me valuable experience regarding both the work of this type of commission and the functioning of human rights ordinances. These experiences helped me understand and advocate for diverse individuals and viewpoints and take a holistic view of problem solving regarding human rights concerns. 1 think this experience will be valuable on the Human Rights Commission. My current position at the University of Iowa includes advising various departments about regulatory requirements and compliance programs as well as considerable relationship building, networking, and community outreach. As a manager of our Biomass Fuel Project, I have organized public events and given presentations educating the public and the community about our project. These skills will likely be beneficial as a Comission member. In addition to my background in human rights and law, I am experienced with volunteer work on committees and boards, and I am an active member of the Iowa City community. I previously served as a board member for the National Alliance on Mental Illness (NAMI) Johnson County. As a University of Iowa employee, I currently serve as a staff representative on the UI Council on the Status of Women and the UI Bicycle Advisory Committee. Within the Iowa City community I am a board member of the Iowa City Cycling Club and Iowa City Women's Cycling. I am also a board member for the Iowa Bicycle Racing Association and I serve as the state's women's racing coordinator. I enjoy participating in these organizations and I am thankful for the opportunity to serve my community. 6. What is your present knowledge of each advisory board you are interested in? I understand that the Human Rights Commission provides the Iowa City community with valuable information and programming intended to educate citizens about discrimination and human rights as well as reduce related tensions within the community. The commission also makes recommendations to the City Council regarding discrimination and human rights and manages the commission's appropriations. The Committee meets monthly, and While I have not yet attended a meeting, I am eager to learn. Having worked with the Cedar '.. Rapids Civil Rights Commission (discussed above), 1 have some background in the activities and duties of this type of organization. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describes some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those writh whom they have business or immediate family ties, during their tenure or for one year thereafter. Section 362.5 of the Code of lowageneraly prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a Citycontract. CityCouncil Resolution # 15-300 established a policythat the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest? No S. Do you currently serve on another Iowa City board or commission?' No Demographic Information 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: 9. Age 34 10. Country of Origin USA 11. Sexual Orientation Heterosexual 12. Religion WA 13. Do you have a disability? No 14. Ethnicity White non -Hispanic "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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* �1rA'�jfM✓/.e/� 11..Nir✓.w Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down I b Advisory Board/Commission Application Form i C1'ft This application is a public document and as such can be reproduced and distributed for the public. This application will be considered for tmlve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CITY Or UTEMMU NOTE: Must be 18 years of age and live vdthin city limits of Iowa City to apply Date of Application 8/17/2017 First Name arianna Last Name* aron Home Address* 1227 2nd ave City IOWA CITY State IA Zip Code 52245 1. Is your home address (listed above) within the corporate limits of Iowa City.? Yes Contact Phone Number* 3193835614 Email Address* arianna.aronl4@gmail.com Boards & Commissions Select a Board or Commission you are interested in: Human Rights Commission 2. How long have you been a resident of Iowa City?* 25 years 3. Occupation: Advocate for Homeless Youth and Teen Parents 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I am an African American woman who was born and raised in Iowa City. I currently work as an advocate for homeless youth and teen parents. In the past, I have worked at HACAP for low income families to have affordable childcare. I was also a services coordinator at The Arc of Eastern lows. I am an AmeriCorp member as well. I have participated in the Big Brothers Big Sister program as a child and served In their school based program last year. I am able to think outside of the box on topics and issues that affect the human rights of individuals. 6. What Is your present knowledge of each advisory board you are interested Ing* I know that the Human Rights Commission focuses on protecting the rights of individuals, brainstorms on difficult topics and as a group thinks of new program that could directly benefit the community. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of Interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, sonir-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same chill, and persons with 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 tens in order to increase the opportunities for new applicants to serve. Council policy is rat 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. 7. Do you currently have a conflict of Interest?* No 6. Do you currently serve on another Iowa City board or commission? No Demographic Information 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 9. Age 25 10. Country of Origin United States 11, Sexual Orientation straight 12. Religion n/a 13. Do you have a disability? No 14. Ethnicity African American '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant * ('VM?W" a -taw Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down 1 Advisory Board/Commission MP lication Form C'f-�� 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 CITY OF IOWA CITY considered for any vacancy during that time. UNESCO Cl YOF LFEEMIURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 10/25/2017 First Name Deborah Last Name Bailer Home Address* 2178 Willenbrock Cir City IOWA CRY State lA Zip Code 52245 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 608-575-8370 Email Address beilerdeb@gmail.com Boards & Commissions Select a Board or Commission you are interested in: Human Rights Commission 2. How long have you been a resident of Iowa City?* 3 months 3. Occupation:* retired 4. Gender:* Female 5. Experience andlor activities which you feel qualify you for this position:* I served in community service as a chief inspector at the elections in Madison Wisconsin for about 10 years. 6. What is your present knowledge of each advisory board you are interested in?* I have a lifelong interest in social justice, and donate monthly to the Human Rights Campaign. I listen and read alternative media. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 lowageneraly prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission? No Demographic Information 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: 9. Age 61 10. Country of Origin United States 11. Sexual Orientation heterosexual 12. Religion Jewish 13. Do you have a disability? No 14. Ethnicity American "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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* KJ�r-o7� 4�/ft Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down CITY OF IOWA CITY UNEXO CITY OF UTEMWU Date of Application 2/16/2017 First Name Kim Last Name Bergen -Jackson Home Address* 15 Brunswick Court City IOWA CITY State IA Zip Code* 52240 Advisory Board/Commission Application Form 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. NOTE: Must be 18 years of age and live within city limits of Iowa City to apply 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319471-2994 Email Address* k.b,ergen.jackson@gmaii.com Boards & Commissions Select a Board or Commission you are interested In:* Human Rights Commission 2. How long have you been a resident of Iowa City?* 2000 3. Occupation:* PhD, RN -Board Certified, Administrator 4. Gender:* Female 5. Experience andlor activities which you feel qualify you for this position:* i am part of the Iowa City community and an Executive at work. I feel strongly that people are treated equally without regard to our differences. I want to become more active in my community. I have faced discrimination in my lifetime as a lesbian. I was told I could not rent an apartment once because "people like you don't exist." I will never forget how that made me feel. I also fight for my children's rights as they grow up with two moms. While I appreciate the bubble Johnson County provides us in protections, when we travel, we are worried. I never went anyone to feel unsafe in Iowa City for any reason. 6. What is your present knowledge of each advisory board you are interested in?* I understand there are monthly meetings and planning activities in the community to improve human rights education. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describea some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son4ri-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest? No 8. Do you currently serve on another Iowa City board or commission?* hlo Demographic Information 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 9. Age 50 10. Country of Origin USA 11. Sexual Orientation Lesbian 12. Religion None 13. Do you have a disability? No 14. Ethnicity Caucasian '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 in finance, and one person who receives rental assistance. (Resolution) Sign"�attyuur/re of Applicant* cid—' kZyr' 0,&Afew Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 11/29/2016 First Name Nidal Last Name * Besher Home Address* 2604 Bartelt Rd city IOWA CITY State IA Zip Code* 52246 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 6822180860 Email Address* nida (free 15@gma il.com Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City?* 2.5 years 3. Occupation:* employee at Reach of Potential company 4. Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* Advisory Board/Commission Application Form 62n11W Ot� This application is a public document and as such can be reproduced and distributed for Ems' the public. This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CITY OF UTHU URE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 11/29/2016 First Name Nidal Last Name * Besher Home Address* 2604 Bartelt Rd city IOWA CITY State IA Zip Code* 52246 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 6822180860 Email Address* nida (free 15@gma il.com Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City?* 2.5 years 3. Occupation:* employee at Reach of Potential company 4. Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* I am active in human rights and writer about issues related to human rights like democracy , civil rights, discrimination , privacy, women rights .. and i think i have abilities to make change and helping other people and do positivist actions . 6. What is your present knowledge of each advisory board you are Interested in?* human rights Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describes some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 Iowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract City Council Resolution # 15.300 established a policythat the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son -In-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 ff reappointed, an individual would be limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve. Council policy is riot 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. 7. Do you currently have a conflict of Interest?* W 8. Do you currently serve on another Iowa City board or commission?* W Demographic Information 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: 9. Age 45 10. Country of Origin Sudan 11. Sexual Orientation helrosexual 12. Religion muslem 13. Do you have a disability? No 14. Ethnicity '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 in 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, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. I A Advisory Board/Commission Application Form It t 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 CITY OF IOWA CITY considered for any vacancy during that time. UNESCOCHY OF UUMMU NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 3/2/2017 First Nam* David Last Name Borger Germann Home Address* 108 Colchester Dr. City IOWA CITY State IA Zip Code* 52245 1. Is your home address (listed above) within the corporate limits of Iowa City? Yes Contact Phone Number* 3193332380 Email Address* david@sanctuaryic.org Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City?* 21 years 3. Occupation:* Clergy 4. Gender:* Male 5. Experience and/or activities which you feel qualifyyou for this position:* - My current role at Sanctuary Community Church includes executive duties within our nonprofit organization (supervising staff, overseeing budget, ensuring vision alignment across all programs, publicity, and facility management to name a few). We are a highly collaborative organization, so I share all of these responsibilities with other staff. This approach requires cultivating healthy communication, constant negotiation, and a commitment to broad goals over personal agendas. - I oversee about a dozen staff and work alongside hundreds of volunteers. Our organization is diverse in age, ability, sexual orientation, gender identity, race, ethnicity, and country of origin. - Our church is a member of the Consultation of Religious Communities that provides funding for local nonprofits as well as performing outreach and service in the community. I attend CRC meetings regularly so I continually learn about community -wide efforts as well as participate in decision making regarding where we invest money and resources. - I help establish and monitor our annual budget (about $475,000), working to manage programs and staff effectively. - Our church is committed to supporting local nonprofits through financial donations. For example, every Faster our church gives a $10,000 donation to a local nonprofit. In 2016, DVIP received that gift. In 2015, Shelter House received the donation. We also connect with nonprofitsthrough volunteering time and hosting collection drives. - I recently helped launch a newfaith-based student organization at Iowa called Love Works. A gay student who was prohibited from serving as a leader at two other faith -based student organizations met with me last fall and shared his story. We decided to start a new organization that would be LGBTQ-inclusive and service- oriented. Love Works meets every other week and engages in regular service activities. (I love serving alongside students!) - I serve on the executive team of Lenore Elementary PTA. This position allows me to hear about the needs within our diverse city and how those needs affect children and schools. - One note about our church that may be helpful to know. We practice an inclusive Christianity that recognizes and affirms the equality and dignity of every person. This approach allows us to form broad alliances with all people and organizations working towards the common good. I personalty am very passionate about building partnerships with diverse organizations, businesses, and public entities for the sake of human flourishing. 6. What is your present knowledge of each advisory board you are Interested in?* I have read the agendas and minutes from the previous Humans Rights Commission meetings. I also attended one meeting to observe and learn how a meeting is organized. I am familiar with almost all of the organizations seeking funding or hosting events that intersect with the comnission's goals. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describes some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son -int -law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 39 10. Country of Origin United Slates 11. Sexual Orientation Heterosexual 12. Religion Christian 13. Do you have a disability? No 14. Ethnicity White '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* o 'e'3 tow e'*t W' Misrepresentations on this application will constitute just cause for removal of an City of Iowa City Advisory Board/COmmission/Committee Application Form MARKED "CONFIDENTIAL.- THIS APPLICATION WILL BE CC MONTHS AND AUTOMATICALLY CONSIDERED FOR ANY W r� 771VT AdvisoryBoard/Commission/Committee Name 4.1 GA Tetra �,=�'• O NAMEr*; r(Swy) HOMEADDRESSL !✓.R I eyinr 7jyl is your home address within the corporate limits of Iowa City? Yes No_ How long have you lived in Iowa Citylxt. 10 Mrs. Gender. Male _ Female _X Contact# 319 399 32. EmailAddress ZI1 I Y'G .J POSITION: —�!I• Cram CONTRIBUTION AND/OR ACTIVITIES wBICH YOU FEEL QUALIFY YOU FOR THIS /� ►` `` ` � t 7!�-n QticaCgit`eahrs.+is r �alnlC",G l0. be as �n ur Cr rid �s a rqdua+e, s}v�l�wi;�� v VI -e rt SxIR ���� S h ce F ►tee rwd eP� d, c P rti 3 ar C"--13 n,a kArs, A nY+he t- -q) a.l. 6',` ctieLs � n fs e s ,�__.t ,,..i- - e' [ up Ai55 A Omkc,q 10 00T kJmokr% S r 6 -HAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I AWA 4cirr,;li`ar W"A 4tt iA '{ 10 W h a�an on �tt a C4t1 V. 1a S i 4e, LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest LW t L( s o o n 6-p— [L p ow4 — H ✓Y�- -e wt 1010 j� 1 XDO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? _Yes No (If yes, Please indicate which board would be your first choice to serve on.) ..srepresenmaons on this application Will constitute just cause for removal of an appointm fail to answer all the questions, Council may not consider your application. CGca'fY,"6 u 6'o On .6/)ae d Our v ers f /,7ctve, beeo �o rvrr,vxvil,' / t✓o���.�n�,i- 14 One u✓aj or ana}1,n�-� vJltiet6�er'af rneav►s Chb q kn 0 �%cto" fir- A l o cK I c('vrl r r'yhtr 6���h7 ?-4CV, S-e,"vi h. 6n T% -P, 54 -"P -Y -i1\5 ('O ynry,!'+Te2 4a� 4� faPaC� Dr�tp,r,i z n4; or) 0 � 3�+aGkr`�cd 6,1 �1Oc)r5' 4o !► aisE AWJC. (2vt2V-T w C4;, i14 pOln4an-f 90C4'ce' !`SSVi'S S +-V Ayf, '13 5Urn e 67 +4 --Lm o S ' �r�SSi✓<S � SS�I^P-S irn�ac.fl`"`� HvmA� �+Sk"� Rnci �rniS work 1n a5 UA A -0A tv�Lt v^b��,dAeQ uv)6 rsA,,,A;'/\5 o a yy\aGv-o o•,d vn►lcro r.Q�AKCNw+%cS �� SC�c1�lJ/�o�; �fCa arA -e C_0 1 G Ion h o v" q v, r S k .s . �` -(lniS u)of`< ✓1 ?i>[;KCaI e4-1 CZ, a•'��ll.c Vn:� s �„ ;5 �� �N Anon i n kA s'}c7o'v1 0,' CO "13 C,1 0115 Kl:.SS zi � C << �O f v, i A l pw p rc A\ -t iCD S -e,' v e� Co,-,:",(ssr`b�ytdl�is�r��: on tssvQ.s-eL0.cAc 4vv,an R�`5�,'S. N D C) rn t� O Q �r BOARD, COMMISSION AND COMMITTEES © : HIM1,1-r", BUSINESS LISTING I1 OF I WA CITY Name of City C "o Board/CommissionfCommittee }'EuyHw K Ki n ktc die c, C a Name '�a,I Lo6t-t-!-Y Grecnh �pGcNrlt- ��r(yCeSn' 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. NOTE: A new form must be completed if the above information changes or an ownership interest is acquiredja.an-addi final business. Applicant 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 April 2015 Page 3 of 7 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective May 1, 2014 Household Size 30% Median Income (Poverty Levell 50% Median Income 60% Median Income 80% Median Income (low income) Median Income 1 $16,700 $27,850 $33,420 $44,550 $55,700 2 19,100 31,800 38,160 50,900 63,600 3 21,500 35,800 42,960 57,250 71,600 4 23,850 39,750 47,700 63,600 79,500 5 25,800 42,950 51,540 68,700 85,900 6 27,700 46,150 55,380 73,800 92,300 7 29,600 49,300 59,160 78,900 98,600 a 31,500 52,500 63,000 84,000 105,000 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 AANN�APPLICANT. 11 " 5- Age � Vcied � i S Religion ® Gender N o Disability J�aIV Income (see table) V / Sexual Orientation DOther (Please explain below) qL� Race, color AA or ethnic group S �i National origin CD --f Human Rights Commission Application C:;-�.� February2015 e �.,., Page 4 of 8 %�",� _ 0. " o 1� I -4 Advisory Board/Commission Application Form `_ y1«:I'f lot� 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 CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CITY OF UTVU7rUU NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 3/8/2017 First Name* Emily Last Name Bushman Home Address* 100 Petersen Hall City IOWA CRY State IA Zip Code* 52242 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 6304530038 Email Address* eryily-bushrTian@uiova.edu Boards & Commissions Select a Board or Commission you are interested in:* Civil Service Commission Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City?* 8 Months 3. Occupation:* Student 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I am an honors student at the University of Iowa studying business. I am a member of the Iowa Women's volleyball team and actively participate in the American Marketing Association group on campus as well. I volunteer with the Program Fuel Up to Play 60 with Mich 1 help teach children how to live a healthy lifestyle. Growing up, my family moved often which exposed me to many new people and experiences. I experienced diversity in every aspect of my life and have many friends that come from diverse backgrounds. I really value diversity and wish to see our community grow in acceptance of equality, this is something that I am passionate about and wish to be more involved with. I self identify as a feminist Mile also fighting against racial, gender, ethnic, or any kind of discrimination. 6. What is your present knowledge of each advisory board you are interested in?* I have just learned about these advisory boards from a presentation in law class that peaked my interest and prompted my to apply for a position to get involved and take action. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describea some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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. CityCouncil Resolution# 15-300 established a policythatthe following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother -in law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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 thatthe Board and Commission is representative of the community and the groups(s) which it serves, please provide your information for the following: 9. Age 19 10. Country of Origin Lis 11. Sexual Orientation Heterosexual 12. Religion Christian 13. Do you have a disability? No 14. Ethnicity Caucasion '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* N � Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down City of Iowa City IF I 1. i Advisory Board/Commission/Committee Application Form 2016 QCT 25 A'. !0: 2 THIS APPLICATIOAi IS .A PUBLIC DOCUMENT' w1T'H TAti EXCEYTIOI�C„Ufi ASpE- p AGE MONTF— MARKED "CONFIDENTiA4." THIS APPLICA770N ,VIL4 BF. CONSI>� LS AND Ai1T0lLAT7CALLY CONSID p = FOR A INY VACANCY DURING fIWr TirMH. Advisory Board/Corm isaioo/Commirtee Name Vl F Term_ (? NQIn J fln, (� ZC2 D NAMELVfn/ I I (//-) S¢1'} HOMEADDRESS�sef glk f� ;,„„�M�, 1"A Ctl[� Is your home addnm within the cooperate limits of Iowa City? Yes s/No How long have you lived in Iowa City? trnvrlirlS Gender: Male _Female Y'`_ SHs �on # (p t J��i3 W Email Address t; -t'1 t'i's t'�1•Pv't''lP. +'ll�� (J2 _ alL .. -- -� ,�`— CONTRIBUTIONAND/ORACTIVITIESW1nenvorfNEBLQUaI.IFYY UFORTnISa,edw POSr1LON! WHAT Is YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? FSct. aiiuciLrj I LISTnterest POTENT`jAL CONFLICTS OF INTEREST; See page 1 for Information regarding Coniilct of DOJYOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION?le�N_yea o (If yes, please indicate which board would be your fust choice to aervaon.) oaisrepresentaltous on this application wig consQtWe just eaasefor remava fall to answer ati the questlons, Council may net consider your appiication. June 2016 Addendum to application — Human Rights Commission, City of ou 6VFE D f~ Applicant: Julie J. Christensen ZM OCT 2G ilP M. 2; CITY CLE -7: n fnntriFv Minn ad/nr arfivifice whirh vm, fool nnalifv vnn fnr taj� ,IAV", J : r In full transparency, I am new to Iowa City, having moved to the area just 5 months ago from Upstate NY. However, one of the first things that I did when I arrived was look for opportunities to get involved In the community. Due to my deep commitment to social justice issues, I quickly found the Iowa City Human Rights Commission's web page, and was able to connect with Stefanie Bowers early in the summer. The intent was just to get a sense of what is happening in the community as i look for ways to get involved and give back as a new Iowa City resident. Perhaps I should be a resident longer before throwing my name into consideration for a vacancy on the Commission, but I thought it worth noting some of my background and experience — which I offer as a potential Commission member, or simply as a resident who supports the work of the Commission. I am a social worker by training, and have focused about a decade of my career on working with academically and behaviorally at -risk students in Rochester, NY. Working in a district where over 90% of students were living at or below poverty, I because quickly immersed in community coalition building to support struggling families. I also worked at a teen runaway and homeless youth shelter as a part-time counselor for 8.5 years, where I provided crisis support counseling, and worked within a community consortium that focused on combating chronic homelessness, as well as serving the unique transition needs needs of families impacted by such issues as mental health, gender identity, and resettlement (refugee and asylum families). In the past 8 years, I worked at the University of Rochester focusing on creating inclusive communities — and specifically addressing the needs of individuals with Intellectual and developmental disabilities. It is in this capacity that I was recruited to come to the University of Iowa to work at the Center for Disabilities and Development, where I am engaged in public policy, research & evaluation, and technical assistance and training. This provides a brief snapshot of my experiences and interests. In my short time in Iowa City, I see many of the same systemic and community Issues faced here as were areas of concern in Rochester. I believe strongly in coalition building, and that the community has a responsibility to care for all of its members. In this respect, I am excited to get Involved as a community member in Iowa City to work towards inclusive communities for all citizens. What is your present knowledge of this advisory board? In my meeting with Stefanie Bowers, she provided an overview of the work of the Commission, Including a history of the many events and programs that the Commission has sponsored over the years. I also had an opportunity to read past meeting minutes from the past 2 years, which gave me a good sense of some of the discussions and issues on the forefront. I am particularly attracted to the Commission's focus on civil rights, social justic$CanUelim ng discrimination (P of all kinds in our community. I also had the honor of attending the Awards Breakfast this morning, and was thrilled and moved by the great work thItcpgni�Q4 jfj'tVcommunity. CITY aplA, List of Potential Conflicts of Interest: ;QVIA CITY, ICS;A None BOARD, COMMISSION AND Comm, 46F- { BUSINESS LISTING 2416 OCT 25 hri IZIW�bl IOWA CITY Name of City++ �1 Y , 0 L 4 .. BoardtCommissionlCornmittee y��r",, yylfyj/^���)/ (;�T'1',',�%; t012G 1(p Name, S. UJlt A l t/{✓rStCirlS2t� 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. NOTE; A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Applicant 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 April 2615 Page 3 of 7 `e. TABLE OF INCOME GUIDELINES AND DEPINITIONFII/ITY Effective May 1, 2014 Household 30,6 Median Income 60% Median 90% Medierf�6 size (Poverty Lovell Income_ income i Ey - BZtia r{ciz, Median (low lnpm come $18,700 527,850 $33,420.x, gip' n•a $557 _ 2 19,100 31,800 38,160 �(0ii 9 b� 3,600 3 . 4 21,500 23,850 35,800 39,750 42,060 47,700 57_250 71,600 -- 83,600 79500 5 25,800 42,950 51,540 �68,7D0 _ 85,900 27,700 46,150 55380 73,800 82,300 F—i7—E 29,60049300 _ 58,160 76,800 9$,600 31 500 1 152.600 I 63,000 _ 84,000 1()5,90D 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. 943647, 11-8-94) OPTIONAL: PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN CHOOSING AN APPLICANT. "12 Age ltivla - Gender �i tan Income (see table) 5tvtm Sexual Orientation W, Other (Please explain below) Human Rights Commission Application February2015 page 4 of 8 Religion no",, Disability A✓Cusui'n Race, color or ethnic group National origin I-41 Advisory Board/Commission Application Form This application is a public document and as such can be reproduced and distributed for wry the public. This application vill be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CIN OF U FEMMU NOTE: Must be 18 years of age and live within city limits of lova City to apply Date of Application 10/24/2017 First Name Rex Last Name Clemmensen Home Address* 1108 Spruce St city IOWA CITY State IA Zip Code 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 515-257-3096 Email Address* clew nsen@yahoo.com Boards & Commissions Select a Board or Commission you are interested in: Human Rights Commission 2. How long have you been a resident of Iowa City?* 45 years 3. Occupation:* Retired from ACT 4. Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* While working at ACT I moderated fairness calls with representatives of various group, ran numerous meetings, and established procedures to ensure all ACT testing material and other material was fair and inclusive. Also worked with a diverse group and tried to ensure that ACT hired a diverse group of people. Additionally, I was raised by parents who were models of integrity. They instilled in me a sense of fairness and decency. 6. What Is your present knowledge of each advisory board you are interested In?* I followthe news regarding human rights internationally, nationally, and at the local level including the actions of the Human Rights Commission. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 Citycontract City Council Resolution # 15-300 established a policythatthe following persons shall not be eligible appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, sor-irt-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, rdece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest? ND 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 64 10. Country of Origin United States 11. Sexual Orientation Heterosexual 12. Religion Agnostic 13. Do you have a disability? No 14. Ethnicity White '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* Owc/rrW'W1Gta Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down r -rb #:min r t wy._ CITY OF IOWA CIN UNESCO CITY OF UTEMTURE Date of Application 10/8/2017 First Name Thomson Last Name Coffey Home Address* 1247 Lakeshore Dr City IOWA CRY State IA Zip Code* 52246 Advisory Board/Commission Application Form 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. NOTE: Must be 18 years of age and live within city limits of Iowa City to apply 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 2054519241 Email Address* Thorrison-Coffey@uiowa.edu Boards & Commissions Select a Board or Commission you are interested in: Human Rights Commission 2. How long have you been a resident of Iowa City? 8 years 3. Occupation: Student 4. Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* As a student, I have been studying Human Rights and have an in-depth understanding of what is entailed by protecting such rights. Also, through my class we have met with attorneys who work in the Hunan Rights department for the city and they encouraged members of our class to apply for this commission. Also, I have been a resident of lows City for nearly half my life and for all of my formative years; I would love to give back to my City and make sure it remains as inclusive as it has always been. 6. What is your present knowledge of each advisory board you are Interested In?* I understand that the Committees responsibilities are included by not limited to disseminating and looking into acts of discrimination or violations of civil rights, recommend legislation to the City Council on protecting rights of the citizens of the city, as well as put on educationals for the public to know about their rights and how to prevent discrimination. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of Interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federallyassisted activity, or 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 line Code of lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-irHaw, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest? No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 19 10. Country of Origin United States 11. Sexual Orientation Straight 12, Religion Christian 13. Do you have a disability? No 14. Ethnicity White '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicaa�nt* f 4WIAIW &Offer, V Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down Advisory Board/Commission Application Form 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 CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CITY Of UTEMTUS1 NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 11/1612016 First Name* Jovana Last Name Davidovic Home Address* 630 Fairchild St city IOWA CITY State lA Zip Code* 52245 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-321-4573 Email Address* jovana-davidovic@uiowa.edu Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City?* 4.5 years 3. Occupation:* Philosophy Professor 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I am a professor of philosophy whose primary teaching duty is teaching undergo and grad classes on human rights at the University of lova. I also write extensively on conceptual and practical issues related to the human rights, like issues of transitional justice, international law, humanitarian military intervention, terrorism, etc. I have also years of experience working as the Global Links Coordinator- putting on informative cultural programs at University of Maine. 6. What is your present knowledge of each advisory board you are interested in? I have read through the recent agendas and have seen this board present or participate in a number of events I have been a part of. It seems to me its primary roles are promotion of human rights and prevention of violations of human rights, through publicizing human rights issues (for promotion) and through affecting local ordinances and advising the city council on issues that night relate to human rights. It seems to me that today it is more than ever important for this board to remain active and vocal- Mich is My I am hoping to be a part of d. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of Interest. The following describes some but not all potential conflicts. Potential Conflicts of Intent 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, or agreement with respect to a federally -assisted activity, or 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 lowagenerelly prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, soil -int -law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same chill, and persons with whom ft 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 tern 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. 7. Do you currently have a conflict of Interest?* 0 8. Do you currently serve on another Iowa City board or commission?* ND Demographic Information 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: 9. Age 38 10. Country of Origin Yugoslavia 11. Sexual Orientation Heterosexual 12. Religion Atheist 13. Do you have a disability? No 14. Ethnicity Serbian '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 in 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, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. NOTE: Must be 16 years of age and live within city limits of Iowa City to apply Date of Application 10/27/2017 First Name; Matt Last Name Drabek Home Address* 615 N Johnson St City IOWA CITY State LA Zip Code* 52245 1. Is your home address (listed above) within the corporate limits of Iowa City? Yes Contact Phone Number* 502-693-2926 Emall Address* rrkatt.drabek@grriaii.com Select a Board or Commission you are Interested in: Human Rights Commission 2. How long have you been a resident of Iowa City?* 10 years 3. Occupation:* Content Specialist, ACT 4. Gender:* Male 5. Experience and/or activities which you feel qualityyou for this position:* Advisory Board/Commission Application Form �R 1% 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 CITY OF IOWA CITY considered for any vacancy during that time. UNESMOTY OF LITERATURE NOTE: Must be 16 years of age and live within city limits of Iowa City to apply Date of Application 10/27/2017 First Name; Matt Last Name Drabek Home Address* 615 N Johnson St City IOWA CITY State LA Zip Code* 52245 1. Is your home address (listed above) within the corporate limits of Iowa City? Yes Contact Phone Number* 502-693-2926 Emall Address* rrkatt.drabek@grriaii.com Select a Board or Commission you are Interested in: Human Rights Commission 2. How long have you been a resident of Iowa City?* 10 years 3. Occupation:* Content Specialist, ACT 4. Gender:* Male 5. Experience and/or activities which you feel qualityyou for this position:* I have lived in Iowa City for 10 years. During that time, I have been both a student and faculty member at The University of Iowa, as well as an employee of Iowa City's largest private employer not affiliated with either the university or the public school system. I have personally w1nesses some of the successes and failures in our growth and local housing market, renting from both good and bad landlords and renting at both reasonable and inflated housing prices. I hope to bring to this position a broad range of connections and insights from these experiences. 6. What Is your present knowledge of each advisory board you are Interested In?* I knowthat the Hanan Rights Commission participates in selection of grant proposals for city grants in the areas of social justice and racial equity. I also know that the HRC participates in the education of both the public and the city council concerning issues of human rights and relevant legislation. In particular, I think the HRC is critical to seeing that Iowa City maintains its Municipal Equality Index score and builds on its current successes as it works to grow and develop in away that is both sustainable and inclusive. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-irHaw, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 order to increase the opporturdties 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. 7. Do you currently have a conflict of Interest?* Pio S. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 34 10. Country of Origin USA 11. Sexual Orientation bisexual/queer 12. Religion None/Atheist 13. Do you have a disability? No 14. Ethnicity white '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 in 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, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down Advisory Board/Commission/Committee CITY OF IOWA CITY Application Form UNESCO CITY OF LITERATURE -,a This application is a public document and as such can be reproduced and distrlbuted,for the public. This application will be considered for twelve months only and autonthtically . considered for any vacancy during that time.00 Advisory Board/Commission/CommitteeName Low Rtl mc� lJ Date of Application , / �.� Name , Y I r/1 Vl Y 1 J I�1 A Home Address Q I I _I.() V(A ,/ Aj( lrj(j IOUA Ut IS�WW Contact phone number C1l t, )��r��O� ail Address a�,f1Tinc u i awa , edq Your home address must be within the corporate limits of Iowa City? How long have you lived in Iowa City? ' ( nfi s Occupation: Gender: Male Female •y�,� n c y Experiences and/or activities which you feel qualify you for this position: t i I 1 �" �/0 I Orn -Y lmC.4 erIGi dYt ) (fir 1 Zig -� cue i* In an c�q o n 1 Bald os�sUw Aoedhq �Am6ssadcc Trko +o �itrnaq V -491,4s c1as,- What is your present knowledge of this advisory board? Tom abcoadew�� elQPb� �rx69je e, & s my uod-&-ordtr) � +bxrc� -i h IS prcrc 3- ord edenV orrvel ae - \ndlne o 4 ��es ltd I fo\Acr ua I I �r i�-e ras xty �� �a (cc and t s�tlr t- �trOCA nc1) �h I I� I (bnoe&-ed t -e nam( Leve 9 Please contact the city attorney at 319-356-5030 to discuss questions or concerns regarding a Potential conflict of interest. .j 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 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 order to increase the opportunities for new applicants to serve. Council policy is not to permit an individual to serve on two Boars 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. 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 � / COCountry of Origin On` C56�eS Sexual Orientation )I tnk 14 Religion Q, mst , Do you have a disability? YES_ NO Race, Color or Ethnic Group 06 LXMS U -n *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 perTho 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. Advisory Board/Commission Application Form This application is a public document and as such can be reproduced and distributed for r• ��' the public. This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNEXO On OF OTE MU NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 3/7/2017 First Name Vanessa Last Name Fixrner-Oraiz Home Address* 437 S. Governor St. City IOWA CITY State IA Zip Code 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 919-923-6211 Email Address* vfixneroraiz@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City?* 5 years 3. Occupation:* Community Planner 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I am a gender -queer, queer, person of color who has worked to empower the voices of other marginalized communities throughout my adulthood (I am a bit surprised that the 'Gender' categories of this application are so limited!). My mother immigrated to the United States from the Philippines when she was nine years -old and when she met and married my father much later in fife, I was raised in a household that celebrated our mixed - race culture. In the past I have volunteered with Planned Parenthood's Teen Council program to talk with youth about queer issues and reproductive health. Previously I worked as an education outreach coordinator for a Rape Crisis Center and engaged with a wide range of ages on the importance of body sovereignty and have experience organiang with LGBTO youth and fardlies. I have served as a panelist for a United Action for Youth event to discuss queer relationships with local youth and their parents. As a non -gender conforming citizen I feel as though this work is important in our community given that I have experienced hate crimes first-hand in Iowa City. My work as a community planner offers me the privilege of working wtth marginalized communities on many topics, from clean water access to native sovereignty issues. Our current political climate has emboldened a side of the American people that is fundamentally detrimental to the well-being of our communities and I believe there is a responsibility for those of us who can respond to these attacks to do so at every level of our society. I feel as though the work of the Human Rights Commission serves the Iowa City community in a way that feels more important than ever 6. What Is your present knowledge of each advisory board you are interested in? I have been to events sponsored by the Human Rights Commssion and read their agendas online; thus I am familiar with the duties involved. I also know and respect Kim Hanrahan and am grateful for all of the years of service she has given our community. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describes some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with wham they have business or immediate family ties, during their tenure or for one year thereafter. Section 362.5 of the Code of Iowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a Citycontract. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-ir-law, daughter-in-law, mother -in law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-ir-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 tern 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 38 10. Country of Origin USA 11. Sexual Orientation Queer 12. Religion Spiritual 13. Do you have a disability? No 14. Ethnicity Philippine -American '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 in 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, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down t Advisory Board/Commission Application Form rY _ ��C2tYF �t This application is a public document and as such can be reproduced and distributed forM. the public. This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESCOCITY OF UTMTURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 3/6/2017 First Name* Peter Last Name Gerlach Home Address* 3346 Tulane Avenue City IOWA CITY State A Zip Code 52245 1. Is your home address (listed above) within the corporate limits of Iowa City? Yes Contact Phone Number* 319.325.5361 Email Address* peter. a. gerlach@g mail. com Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City?* 3.5 years 3. Occupation:* International Student Advisor 4. Gender:* Male S. Experience andlor activities which you feel qualify you for this position:* Experience as an AmeriCorps and Peace Corps volunteer has engrained in me a commitment to giving back to my community, both on the local and global level. I have also had the good fortune of going to graduate school in a department of Cultural Foundations of Education, a social -justice oriented program focusing on issues such as race, class, gender, and disability. In my current role as International Student Advisor, I am the primary contact for international students, for all immigration concerns, as Hell as advancing internationalization at Coe College. I also serve on the Gender Task Force and as a Title IX sexual misconduct investigator. My focus on social justice, higher education, service, and globalism, I think, in many Heys, stens from my childhood and being raised in a bi-cultural and bi-lingual household with parents who valued these things. My father Hes an immigrant from Germany and my mother was raised in a conscious -aware 1960s and 70s US. At this point in my life, a newfather and a new home owner, it is the right time for me to be more engaged again and to give back to the city where I live. 6. What Is your present knowledge of each advisory board you are interested in?* My understanding of the Human Rights Commission is, if appointed by the City Council, I would be one of a panel of 9 residents focusing on eliminating human rights offenses and abuses of all kinds in Iowa City and also educating citizens about civil rights more generally. This would include, among other things, sharing educational information with the general public, holding public forums monthly (or more as needed), working with other public and private groups to advance a welcoming and respectful community, and engaging with the community to proactively confront bias, discrimination, and crime. Additionally, and crucially, this commission would work together, with others in Iowa City, to recommend legislation around civil and human rights that advances a fair, responsible, and collaborative agenda for Iowa City. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describea some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 lowagenerally proHbits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policy that the following persons shall riot be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, stepchildren, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, untie, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 order to increase the opportunities for new applicants to serve. Council policy is rat 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. 7. Do you currently have a conflict of Interest?* 0 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 36 10. Country of Origin United States 11. Sexual Orientation Heterosexual 12. Religion Unitarian 13. Do you have a disability? No 14. Ethnicity White `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 in 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, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 11/13/2017 First Name Ryan Last Name Hall Home Address* 200 S Surnrnit St City IOWA CITY State IA Zip Code' 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 7347881810 Email Address" ryanryanhall@gwil.com Boards & Commissions Select a Board or Commission you are interested in: Planning and Zoning Commission (P&Z) Select a Board or Commission you are interested in: Human Rights Commission Select a Board or Commission you are interested in:r` Adjustment, Board of 2. How long have you been a resident of Iowa City? January 2017 3. Occupation:* Advisory Board/Commission Application Form °Ii�lr�'4 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 CITY Or IOWA CITY considered for any vacancy during that time. UNESCO CITY OF LITEMTURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 11/13/2017 First Name Ryan Last Name Hall Home Address* 200 S Surnrnit St City IOWA CITY State IA Zip Code' 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 7347881810 Email Address" ryanryanhall@gwil.com Boards & Commissions Select a Board or Commission you are interested in: Planning and Zoning Commission (P&Z) Select a Board or Commission you are interested in: Human Rights Commission Select a Board or Commission you are interested in:r` Adjustment, Board of 2. How long have you been a resident of Iowa City? January 2017 3. Occupation:* Student 4. Gender:* Male 5. Experience and/or activities which you feel qualifyyou for this position:' Three years service in AmeriCorps, Environmental Planning studies, ran for City Council in Iowa City, volunteered as Spanish interpreter for medical and legal clinics. 6. What is your present knowledge of each advisory board you are interested in? I am familiar with Planning and Zoning codes and the use of Form Based Code. I am familiar with Human Rights issues through my service in AmeriCorps. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 lowagenerally prohibits, with certain important exceptions, a member of a C ity Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-hWaw, sister-ir-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with whom the employee is in an intimate relationship Res. 415-300 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 tens 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. 7. Do you currently have a conflict of Interest?* Yes List potential conflicts of Interest [See next page for Information regarding conflict of interest] ` Employed by Rocks Cole and Cole Law Firm Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. List all businesses in which you or your spouse/domestic partner, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporations stockholdings). Business list of conflicts of interest Business Name * Cole Law Firm Business Address * 209 E Washington St, Ste 304 9. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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 communityand the groups(s) which it serves, please provide your information for the following: 9. Age 24 10. Country of Origin United States 11. Sexual Orientation Pansexual 12. Religion nla 13. Do you have a disability? No 14. Ethnicity Caucasian '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* �w w Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down t ' = L Advisory Board/Commission Application Form rY 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 CITY OF IOWA CITY considered for any vacancy during that time. UNESCOCITY OF UTMTURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 11/2/2017 First Name Henri Last Name Harper Home Address* 3051 Wayne Avenue #42 City IOWA CITY State LA Tip Code 522240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3199366611 Email Address* henri.harper05@gmail.com Boards & Commissions Select a Board or Commission you are interested in: Human Rights Commission 2. How long have you been a resident of Iowa City?* 22 3. Occupation:* Iowa City Police 9 Outreach) 4. Gender:* Male 5. Experience and/or activities which you feel qualifyyou for this position:* I have worked and lived in Iowa City for over 20 years with extensive community advocacy work. Also working Wth families and agencies to further diversity within the Iowa City community 6. What is your present knowledge of each advisory board you are interested in?* The Fuman Rights commission is a board I am extremely interested in to further the advancement of all of it citizens. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a Citycontract. CityCouncil Resolution # 15-300 established a policythat the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-ir-law, sister -ii -law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 60 10. Country of Origin USA 11. Sexual Orientation Married 12, Religion Baptist 13. Do you have a disability? No 14. Ethnicity Black '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* ' Iewfe- (a?ets2 Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down Advisory Board/Commission Application Form 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 CITY OF IOWA CITY considered for any vacancy during that time. UNESCOCITY OF UTE TUU NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 11/3/2017 First Name Michelle Last Name Higley Home Address* 1328 lower Muscatine rd City IOWA CITY State IA Zip Code 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3196219314 Entail Address* disgobean@yahoo.com Boards & Commissions Select a Board or Commission you are interested in: Human Rights Commission 2. How long have you been a resident of Iowa City?* 16 years 3. Occupation:* Rockwell Collins 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I have a bachelor's degree in human behavior and grew up gay in the south. I've lived in Iowa city for quite some time and have been engaged In this community for a good long while. 6. What is your present knowledge of each advisory board you are interested in?* I feel i have quite a bit to offer from muy perspectives and observations. I have knowledge of laws governing discrimination and a desire to make life better for all around me. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* ND 6. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 48 10. Country of Origin United States 11. Sexual Orientation Lesbian 12. Religion Buddhist 13. Do you have a disability? Yes Please explain: Cancer 14. Ethnicity Caucasian '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 in 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, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down tt11 Advisory Board/Cornmission Application Form s"°�'f �t This application is a public document and as such can be reproduced and distributed for r®F�i the public. This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESCOCITY OF UTE TUU NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 4/5/2017 First Name* Kristin Last Name Johnson Home Address* 415 S. Van Buren St., Apt.1 City OWA CITY State IA Zip Code 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-594-1032 Email Address* sunshineariel99@gmail.com Boards & Commissions Select a Board or Commission you are interested In:* Library, Board of Trustees Select a Board or Commission you are interested in:* Community Police Review Board (CPRB) Select a Board or Commission you are interested in:* Human Rights Commission Select a Board or Commission you are interested in:* Housing and Community Development Commission(HCDC) 2. How long have you been a resident of Iowa City?* 22 years 3. Occupation:* volunteer 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I am active in some support groups Mich help me stay connected to the community and help me to take good care of myself, and interact with an interesting and diverse population in this city. 6. What is your present knowledge of each advisory board you are Interested In?* I am aware that the library board term is a period of 6 years and helps determine policies and practices. I am aware that the Community Police Review Board is designed to help those concerned with criminal justice in this community. And I am aware that the Human Rights Commission is designed to help protect people with disabilities to be treated fairly in this community. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describes some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding ft 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, or agreement with respect to a federally -assisted activity, or 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 lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a Citycontract CityCouncil Resolution # 15-300 established a policythat fhe following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter -int -law, mother-in-law, father -int -law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: g. age 64 10. Country of Origin USA 11. Sexual Orientation heterosexual 12. Religion Episcopal 13. Do you have a disability? Yes Please explain: I have a mental health condition which I manage with medication and social activities and healthful activities. For example, I volunteer at a local peer support recovery center, volunteer for New Pioneer Co-op,& garden in the city garden. I also advocate with letters and phone calls to our elected representatives for a combination of issues I am concerned about, such as mental health parity, the environment and social justice.) also receive rental assistance. 14. Ethnicity Caucasian `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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* cAbQax07wtrveer Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. r Advisory Board/Commission Application Form 4 p1:2tiFl�'1:9t 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 CITY OF IOWA CITY considered for any vacancy during that time. UNESCOCFN OF UTEi MU NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 212 212 01 7 First Name* Angela Last Name Lambenz Home Address* 1710 Flollywood Blvd. City IOWA CITY State IA Zip Code* 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3196219837 Email Address* cawfee73@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Housing and Community Development Commission(HCDC) Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City?* 3 years 3. Occupation:* Content Specialist I, Technical 4. Gender:* Female S. Experience and/or activities which you feel qualify you for this position:* I have lived in various unsafe buildings because of lack of funding for affording safe housing. I am an LGBTQ activist who would like to participate more directly in the government of my community. 6. What is your present knowledge of each advisory board you are interested in?* I have attended a couple City Council meetings and keep up to date on local news through social media outlets and the local newspaper. I have read through the Duties descriptions of each advisory board on the iowa- city.org website. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describes some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, stepchildren, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* No S. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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 9. Age 43 10. Country of Origin United States 11. Sexual Orientation Bisexual 12. Religion Wccan 13. Do you have a disability? No 14. Ethnicity Caucasian '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 in 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, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down II _4 Advisory Board/Commission Application Form Ct — It This application is a public document and as such can be reproduced and distributed for M. _1.45-1041% ' the public. This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. - ONESCOCITYOFNTat MU NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 3/8/2017 First Name* Maya Last Name* Mahajan Home Address* 417 Monroe St City IOWA CITY State IA Zlp Code* 42256 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3193831283 Email Address* maya.mahajan@me.com Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City?* Around 8 years 3. Occupation:* Philosophy major at the University of Iowa 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I have served on the Iowa City School District Equity Committee for around a year, and am currently Secretary of this committee. Before this, I was chair of the West Hgh School Student Senate Task Force Committee, and I worked to get programs implemented to target high achieving minorities and encourage them to take AP and honors classes. I also worked with the school's diversity club to push for implicit -bias training for our teachers and administrators. 6. What is your present knowledge of each advisory board you are interested in?* I am currently enrolled in a Law and Legal Studies Seminar and Stephanie Bower just gave a presentation to us about the responsibilities of the Commission. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describea some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-ir-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* W Demographic Information 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: 9. Age 18 10. Country of Origin United States 11. Sexual Orientation Straight 12. Religion Atheist 13. Do you have a disability? No 14. Ethnicity Hispanic, Indian, Wide '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* t N_ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down -r} #'�ni�ir r®�1.1 wy _ CITY OF IOWA CITY UNESCOcmofurE TUBE Date of Application 2/16/2017 First Name Sharon Last Name McDonald Home Address* 1216 Jensen St City IOWA CITY State IA 27p Code* 52246 Advisory Board/Commission Application Form 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. NOTE: Must be 18 years of age and live Within city limits of Iowa City to apply 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3196318270 Email Address* smcdonaid2l2B@grrkaii.com Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission Select a Board or Commission you are interested in:* Housing and Community Development Commission(HCDC) 2. How long have you been a resident of Iowa City?* 29 3. Occupation:* Director, non-profit campus based child care center 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* My organizing for Obama since 2011 has made me very aware of the issues faced by our immigrant and refugee community. I have had the pleasure of interacting with many international families at my center. I did a lot of canvassing in my precinct, which included the section 8 housing off Walden and parts of the Pheasant Ridge community. I want to help Iowa City become as inclusive as It can be, I want to advocate for human rights for all, especially our marginalized communities. I also worked part time nights for 14 years (ending only two years ago). That work put me in close contact with a very diverse population. I would like to know that we're doing as much as we can, as a community, to make everyone in our community feel included and valued. 6. What Is your present knowledge of each advisory board you are Interested in?* Sadly, I have to acirrlit I don't know much. However, I am a quick study and I really wan to make a positive contribution to our community, especially in this arena. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of Interest. The following describes some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 64 10. Country of Origin us 11. Sexual Orientation private 12. Religion 13. Do you have a disability? Yes Please explain: I have double scoliosis. My spine has been fused twice. The few un -fused vertebrae in my neck have begun to curve again, into my lung. it makes walking difficult but I gel around with a walker and/or a cane. I also have pretty severe arthritis, wfiich combined with my body's general curvature, gives me trouble. 14. Ethnicity caucasion '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* CW" Wn06W/1e Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down Advisory Board/Commission Application Form y WN �t 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 CITY OF IOWA CITY considered for any vacancy during that lime. UNESCO CnT OF UTEMTURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 10/28/2017 First Name Cathy Last Name McGinnis Home Address* 1628 Burns Ave City IOWA CITY State IA Zip Code* 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-321-1525 Email Address* eferris23@hotniaii.com Boards & Commissions Select a Board or Commission you are interested in: Human Rights Commission 2. How long have you been a resident of Iowa City?* 23 years 3. Occupation:* Probation Officer 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I have worked in social services for nearly 20 years, and have worked for the Department of Correctional Services for the past 10 years. I am a Certified Aloohol and Drug Counselor as well as a Licensed Mental Flealth Worker. I have also worked for the past 7 years as an Adjunct Faculty at Kirkwood Community College, serving a diverse community. Through these positions I have worked with a variety of populations, and have worked closely with many people with substance abuse issues, mental health concerns, developmental disabilities, and people struggling with homelessness. I am very involved in my Labor Union, holding a local office and acting as a Steward. Through my work with the Union I have had the opportunity to advocate for fair and equal treatment for my colleagues at an agency level as well as a statewide level, working to influence legislation that will represent workers' rights. Over the past 20 years I have gravitated toward opportunities to advocate for those wfio are not always able to advocate for themselves, and I would like to continue to do so. I believe that my experience would be an asset to this team. 6. What is your present knowledge of each advisory board you are Interested in?* I understand that the Human Rights Cornn fission is focused on educating the community and working to eliminate discrimination and protecting civil rights. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son4ri-law, daughter-ir-law, mother-ir-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission? Mo nPmnnranhir, Infnrmntinn _......,.Z7. `..r,. — .....,, , . --- 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: 9. Age 42 10. Country of Origin USA 11. Sexual Orientation Heterosemal 12, Religion Catholic 13. Do you have a disability? No 14. Ethnicity Caucasian "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 in 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, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down _ ^Ip Advisory Board/Commission Application Form ` This application is a public document and as such can be reproduced and distributed for .gay._ r the public. This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CITY OF UTO TORE NOTE: Must be 18 years of age and live within city limits of lows City to apply Date of Application 11/8/2017 First Name Jonathon Last Name Munoz Home Address* 330 Cayman Street City IOWA CITY State IA Zip Code 52245 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 956-463-8301 Entail Address* jjamunoz@gmail.00m Boards & Commissions Select a Board or Commission you are interested in: Human Rights Commission 2. How long have you been a resident of Iowa City? 3 years 3. Occupation:* Attorney 4. Gender: Male 5. Experience and/or activities which you feel qualify you for this position:* I believe that my legal experience and my service to marginalized communities qualify me for this position. I am currently an attorney at a general practice law firm based in Cedar Rapids, focusing on criminal, and family law. I have a deep commitment to serving marginalized groups, especially those who find it hard to exercise their legal rights. I worked for Iowa Legal Aid's Farmworker Project, providing legal services to migrant farnimrkers and 1+2A workers from Mexico. I have provided services to the invnigrant community in Iowa City through my work at the University of Iowa Legal Clinic, and have worked on naturalization applications, immigration bond motions, and asylum claims. Furthermore, I believe that my academic background shows my deep commitment to the modern day human rights regime. For example, I have taken courses in European Union Law, Human Rights Law, Immigration Law, International Law, and Philosophy of Human Rights. I am especially interested in re -conceptualizing human rights in constitutional terms so as to further integrate human rights norms into United States domestic law, e.g. the right to education and the right to healthcare. I also have experience in the field. My last semester at the University of Iowa College of Law, I was on a team that created a set of materials for Kosovo to use Men applying for UNESCO membership. 1 firrnly believe that I can bring a new and fresh perspective to the Human Rights Commission. I am originally from Weslaco, Texas, which is located on the US -Mexico border. I graduated from Georgetown University in 2012. 1 taught high school for two years before law school. In all rry experience, nothing compares to the level of civic engagement I see from community members in Iowa City. I would very much appreciate the opportunity to contribute my experience and perspective to the ongoing dialogue on how best to ensure that Iowa City "recogniz[es] the inherent dignity and the equal and inalienable rights of all members of the human family.- (UDFR). 6. What is your present knowledge of each advisory board you are interested In? 1 am familiar with the basic functions of the Human Rights Commission (HRC). 1 learned about the great work that the Commission does through their outreach, e.g. the Fluman Rights Awards, However, I first became aware of the basic function of a municipal HRC through a project I was involved with in the Legal Clinic, where our team disseminated legal information on a Waterloo HRC ordinance that provided more protection to victims of domestic violence. I am deeply aware that many marginalized groups face discrimination on a daily basis, and those who most need legal protections are in no position to exercise their rights. I firmly believe that the work of a municipal HRC can rectify the structural distribution of inequities many community members face. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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 arty contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate fami ly fies, during their tenure or for one year thereafter. Section 362.5 of the Code of lowagenerelly prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract City Council Resolution # 15-300 established a policythat the following persons shall riot be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-irHaw, sister-ir-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 27 10. Country of Origin United States 11. Sexual Orientation Fleterosexual 12. Religion Catholic 13. Do you have a disability? No 14. Ethnicity Hispanic/Latino 'NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefor:, 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 in 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, except demographics, Council will not consider your application. I -4 i - CITY OF IOWA CITY UNESCO Ol Or UTEMTUU Advisory Board/Commission Application Form 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. NOTE: Must be 18 years of age and live within city lints of Iowa City to apply Date of Application 11/9/2017 First Name WAIL Last Name* NOURELDIN Home Address* 342 FINKBINE LANE k3 City IOWA CRY State IA Zip Code" 52246 1. Is your home address (listed above) within the corporate limits of Iowa City?* Not Sure Contact Phone Number* 3192297888 Email Address* WAIL. M. NOUREL DIN@OUTLOOK. COM Boards & Commissions Select a Board or Commission you are interested in: Human Rights Commission 2. How long have you been a resident of Iowa City? 4 YEARS 3. Occupation: VOLUNTEER 4. Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* I KNOW WHAT THE OTHERS NEED. 6. What is your present knowledge of each advisory board you are interested in? LAW . Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of Interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federaly-assisted activity, either for themselves or those with whom they have business or immediate familyties, during their tenure or for one year thereafter. Section 362.5 of the Code of lowageneraly prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a Citycontract. City Council Resolufion # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, stepchildren, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest? No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 10. Country of Origin 11. Sexual Orientation 12. Religion 13. Do you have a disability? 14. Ethnicity `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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* 1 10, Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down d r _,� Advisory Board/Commission Application Form '�t This application is a public document and as such can be reproduced and distributed for m r Ems' the public. This application will be considered for twelve months only and automatically CITY OF IOWA CIN considered for any vacancy during that time. UNEKOCIT OF UTE TURE NOTE: Must be 18 years of age and live Wthin city limits of Iowa City to apply Date of Application 2/28/2017 First Name'" Grace Last Name* Pacer Home Address* 612 South Dodge Street City IOWA CITY State IA Zlp Code* 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 8159803945 Email Address* gracepacer@comcast.net Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City?* Since Fall 2017 3. Occupation:* Server at Etre Restaurant Group 4. Gender:* Female 5. Experience and/or activities which you feel qualifyyou for this position:* I am an International Relations Major at the University of Iowa with a strong interest in international mechanisms for the protection and promotion of human rights. I have experience both in leadership and event planning for various organizations. As a gay woman I feel compelled to work for equality for all marginalized members of our community. 6. What Is your present knowledge of each advisory board you are interested in?* I recently attended a presentation by Stefanie Bowers which outlined the history, activities, and responsibilities for members of the Human Rights Commission. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describes some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDGlHOME 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, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate familyties, during their tenure or for one year thereafter. Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a Citycontract. CityCouncil Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Members spouse, domestic partner or partner by cohabitation, children, stepchildren, children for whom the Council Member assumes parental responsibility, mother, father, son-ir-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest? No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 20 10. Country of Origin United States 11. Sexual Orientation Lesbian 12. Religion None 13. Do you have a disability? No 14. Ethnicity White *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 in 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, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 10/29/2017 First Name't Dorothy Last Name Persson Home Address - 14 Gallup Place City IOWA CITY State IA Zip Code 52246 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-337-3347 Email Address' dorothy-persson@uiom.edu Boards & Commissions Select a Board or Commission you are interested in: Human Rights Commission 2. How long have you been a resident of Iowa City?* since August, 1972 3. Occupation: retired academic librarian 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* Advisory Board/Commission Application Form lade 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 CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CITY OF UTEMTUa NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 10/29/2017 First Name't Dorothy Last Name Persson Home Address - 14 Gallup Place City IOWA CITY State IA Zip Code 52246 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-337-3347 Email Address' dorothy-persson@uiom.edu Boards & Commissions Select a Board or Commission you are interested in: Human Rights Commission 2. How long have you been a resident of Iowa City?* since August, 1972 3. Occupation: retired academic librarian 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I have volunteered for Shelter House since 2001, and I am currently serving on the Shelter House Board. I finished a term on the Housing and Community Development Commission in the spring of 2017. When employed, I was active in the Iowa Library Association and am a past president of that organization. As a retiree, I still serve on an awards committee for the American Library Association. When employed, I served on committees within the American Library Association related to my duties within my organization. 6. What Is your present knowledge of each advisory board you are interested in?* I know people who have served. I have followed their decisions and decision-making process as reported in the press. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-ir-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 68 10. Country of Origin USA 11. Sexual Orientation heterosexual 12. Religion Lutheran --Christian 13. Do you have a disability? Yes Please explain: I am hearing impaired. 14. Ethnicity White '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* 0W.V,,iw ow. &'W ddow Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down r-41 -3 �; v Tt ray _ r CITY OF IOWA CITY eNMOCRY OF UTfMM" Advisory Board/Commission Application Form 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. NOTE: Must be 18 years of age and live vdthin city limits of Iowa City to apply Date of Application 2/16/2017 First Name Nolan Last Name Petersen Home Address* 603 E. Burlington St. #1 City IOWA CRY State IA 21p Code* 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 563-209-1997 Email Address* nolan.petersen@gmaii.com Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City?* 8 years 3. Occupation:* Realtor 4. Gender:* Male 5. Experience andlor activities which you feel qualify you for this position:* As a queer -identified man, who also works to be a social justice advocate in my personal and community life, see the Human Rights Commission as one which fits into my vuridview and sense of civic duty. I also hold a strong value of making my presence make a difference, and this position may give that value even more weight in my daily fife. As for qualifications, I don't know if there would be speck qualifications for an appointment like this: I have extensive exposure to people from alt over the world, I am lucky to have lived in near -poverty as well as comfortably middle-class, and I realize the privilege I hold as a white, cis -gender man in US society --and my duty to use that privilege to push against the systems that allow people like me to have undue influence in our culture and society. 6. What is your present knowledge of each advisory board you are interested in?* I have a limited understanding or exposure to the work done on the Human Rights Commission of lows City, truthfully. I have yet to fully find a my to engage, eagerly, in local government, but I believe this commission may be just that opportunity. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describes some but not all potential conflicts. Potential Conflicts 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 arry contract, subcontract, or agreement with respect to a federally -assisted activity, or 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. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, stepchildren, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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. K reappointed, an individual would be limited to one reappointment to a full term 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 26 10. Country of Origin USA 11. Sexual Orientation Queer 12. Religion Generally Faithful 13. Do you have a disability? No 14, Ethnicity While '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 experfise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* ww" JVAK"'Aor Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down _ _.4 Advisory Board/Cortission Application Form mr t ttE�t This application is a public document and as such can be reproduced and distributed for M.' the public. This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESCOCIT OF UTEMTURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 10/26/2017 First Name James Last Name Pierce I Home Address* 1214 Keokuk Street City IOWA CITY State IA Zip Code* 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-461-1569 Email Address* jimniypiercel@gmaii.com Boards & Commissions Select a Board or Commission you are interested in: Human Rights Commission 2. How long have you been a resident of Iowa City? Since August 1st, 2017 3. Occupation:* Student 4. Gender:* Male 5. Experience and/or activities which you feel qualifyyou for this position:* As an openly gay student in a committed relationship I feel that I bring a unique perspective that would benefit this commission. There are many issues we must address regarding discrimination and civil rights with regard to the LGBTQ+ community, people of color, students, the poor, and when all of those situations intersect. I am currently a student at the University of Iowa and I am working towards being a lawyer and plan to get my Paralegal Studies degree as well from Krkwood Comrnunhy College. I believe serving on this commission would be an opportunity to use my interest in law to advocate for those in this city that are all too often unheard. I want to use my knowledge and skill to help the people that are still left being and feel like the city, the school, and the rest of the world doesn't care about them or the disdimination they face. 6. What Is your present knowledge of each advisory board you are Interested In?* The Human Rights commission works to educate the public about discrimination and civil rights through a variety of means. These include public forums on various topics within the broad category of human rights. The commission also serves to make recommendations to the city council about steps it can take to address these issues. I believe this is where I would excel. I believe I would be able to work with the members of the city council to bring about real action to address these concerns. I have always been the type of person who wants to build bridges between people and different communities. I believe the commission should work harmoniously with the city council and forge the kind of working relationships that result in real progress for the citizens of the city. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of Interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Members spouse, domestic partner or partner by cohabitation, children, stepchildren, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, fattier -in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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. U reappointed, an individual would be limited to one reappointment to a full term 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* Demographic Information 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: 9. Age 23 10. Country of Origin United States 11. Sexual Orientation Gay 12. Religion Not religous 13. Do you have a disability? No 14. Ethnicity White '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 in 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, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down - -'t 04 CITY OF IOWA CITY UNESCOCITY OF uTEMMU Date of Application 11/14/2017 First Name Emily Last Name Rands Home Address* 615 N Linn at. City IOWA CITY State LA Zip Code 52245 Advisory Board/Commission Application Form 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. NOTE: Must be 18 years of age and live within city limits of Iowa City to apply 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-594-6624 Email Address* emilyrrands@gma il.com Boards & Commissions Select a Board or Commission you are Interested in: Human Rights Commission 2. How long have you been a resident of Iowa City? 2 months 3. Occupation:* Job Placement Specialist at Goodwill 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I recently relocated back to Iowa from the east coast to begin my family and have always been inspired by my grandfathers (Henry Vargas) commitment to activism. In September, I was able to see him inducted into the 2017 Iowa Latino Hall of Fame and now feel the desire to follow his example and take a more active role in advocating for social justice. I have many fond memories of the Davenport LULAC from my childhood and successfully ran for queen in 2000. As an adult, I possess over 7 years of experience working with people with disabilities in various roles and have thoroughly enjoyed assisting them in becoming more actively involved in their community. I have also volunteered for the Dubuque county Democrats in the past, as well as candidates in Davenport and Rhode Island. I believe it is important to work for the inclusion of all our community members because with greater exposure to different views and cultures, we are better able to see our similarities. I would greatly appreciate the opportunity to assist in any capacity with the Human Rights Comrmssion. 6. What is your present knowledge of each advisory board you are interested in? * The Hunan Rights Commission mission is to educate the community on civil and human rights. They plan events to bring people together and work with the City council on legislation regarding discrimination. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate family fies, during their tenure or for one yearthereafter. Section 362.5 of the Code of lowageneraly prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible appointment to Boards and Commissions: A Council Members spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-ir-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* IVO 8. Do you currently serve on another Iowa City board or commission?* W Demographic Information 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 communityand the groups(s) which it series, please provide your information for the following: 9. Age 34 10. Country of Origin United States 11. Sexual Orientation Heterosexual 12. Religion None 13. Do you have a disability? No 14. Ethnicity Hispanic '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 in finance, and one person who receives rental assistance. (Resolution) Signature ofApplicant* " W Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down I ? 1 Advisory Board/Commission/Committee 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/Conmtission/Committee Name _ U tt, / i c IS �.Y h, 1 s rr r Date of Application __- It ( 7-0 /��✓_ ___ Name Home Address Contact phone number3/`( fsl( UJ Email Address �q� c -YP i P Vir- u Your home address must be within the corporate limits of Iowa City? How long have you lived in Iowa City?/ c J Occupation. � 4, -f, ( I Gender: Male I Female,--- Experiences emale IP/✓rlC6` Ex erieoces and/or activities which you feel qualify Let _ P y q /fy you for this position: 7lu 1 ,L ✓ �'^ /1a 6 1 �d^�.� �� Cl, l� w �7'�( �N � �: � • fry What is ,your present knowledge of this advisory board? 'T Ct, �. G-, Ci't'L-` (� d 4. c 1 ntt.`i `^c (C / 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 or gain inside information with regard to such activities, may obtain a financial interest or benefit front 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 415-300 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 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_ NOZ / Do you currently serve on another Iowa City board or commission? YES NO If so which one do you prefer? '0:1 U R AG149102 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 -77 Country of Origin U S Sexual Orientation _- - N—r-+".✓C SsV Religion Do you have a disability? YES_ NO Y Race, Color or Ethnic Group _ LV w p *Note: The Human Bights 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 L CITY OF IOWA CITY UNESCO On Of UUMMU Date of Application 2/16/2017 First Name Clare Last Name Rose Home Address* 928 E Bloomington St City IOWA CRY State IA Zip Code* 52245 Advisory Board/Commission Application Form 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. NOTE: Must be 18 years of age and live within city limits of Iowa City to apply 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3192130477 Email Address* cmartin204@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City?* 24 years 3. Occupation:* Technical Project Manager 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I am currently a technical project manager for the accessibility group at Pearson. My job is to ensure that legal and Heb content standards are followed in our products allowing people with disabilities equal access to content. As a result of this Hark I am familiar with details of the ADA, and ESSA. Additionally, I received my bachelor's at the University of Iowa in Political Science, with an emphasis on Middle East studies. I studied abroad in Amman, Jordan and Harked on research projects on the Israeli/Palestiman conflict and refugee issues. During the summer of 2005, 1 also interned for a small social justice think tank in Washington DC called the SpiritHouse Project Mich Hes run by Ruby Sales, a prominent player in the SNCC during the height of the civil rights movement. 6. What is your present knowledge of each advisory board you are interested in? My knoWedge is fairly limited as this is my first attempt to become involved in human rights issues in my community, however I have read through the Human Rights Commission's duties and feel that I have a good understanding of these duties and my potential role in them. I have also studied Title 2 of the Iowa City City Code. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describea some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. CityCouncil Resolution # 15-300 established a policythat the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-iri-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 34 10. Country of Origin United States 11. Sexual Orientation Heterosexual 12. Religion Atheist 13. Do you have a disability? No 14. Ethnicity White '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* &&MIOW, Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down NOTE: Must be 18 years of age and live within city limits of love City to apply Date of Application 10/24/2017 First Name David Last Name Smith Home Address* 1315 Cedar St. City IOWA CITY State LA Tap Code* 52245 1. Is your home address (listed above) within the corporate limits of Iowa City? Yes Contact Phone Number* 319 530 7594 Entail Address oso8lds@gmail.com :1.. GME .Iu .M Select a Board or Commission you are interested in: Human Rights Commission Select a Board or Commission you are Interested in: Housing and Community Development Commission(HCDC) 2. How long have you been a resident of Iowa City?* 10 yrs 3. Occupation:* Midamerican Energy 4. Gender:* Advisory Board/Commission Application Form This application is a public document and as such can be reproduced and distributed for r the public. This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. uNESCOan of MERAWRE NOTE: Must be 18 years of age and live within city limits of love City to apply Date of Application 10/24/2017 First Name David Last Name Smith Home Address* 1315 Cedar St. City IOWA CITY State LA Tap Code* 52245 1. Is your home address (listed above) within the corporate limits of Iowa City? Yes Contact Phone Number* 319 530 7594 Entail Address oso8lds@gmail.com :1.. GME .Iu .M Select a Board or Commission you are interested in: Human Rights Commission Select a Board or Commission you are Interested in: Housing and Community Development Commission(HCDC) 2. How long have you been a resident of Iowa City?* 10 yrs 3. Occupation:* Midamerican Energy 4. Gender:* Male S. Experience and/or activities which you feel qualify you for this position:* White, gay adoptive parent of a black child in the ICCSD. Also foster parent of a trans daughter within the district. 6. What is your present knowledge of each advisory board you are interested in?* I keep informed of issues related to racial and gender based biases within the community. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 ldwagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a Citycontract. City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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. M 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: 9. Age 56 10. Country of Origin us 11. Sexual Orientation Gay 12. Religion Agnostic 13. Do you have a disability? No 14. Ethnicity White *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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant "Zoc;��4 Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down CITY OF IOWA CITY ueEscoan of ureuruU Advisory Board/Commission Application Form 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. NOTE: Must be 18 years of age and live within city limits of lows City to apply Date of Application 2/22/2017 First Name'" Jeremy Last Name Vogel Home Address* 720 S Dubuque St Apt 6 City IOWA CRY State IA Zap Code 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 4026504556 Email Address * jeremy-vogel@outlook.com Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City? 3 1/2 years 3. Occupation:* Student / food service 4. Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* I have been involved with various human rights awareness groups on the University of Iowa campus during my time as a student. I have helped plan events such as the annual Human Rights Awareness Week and the annual UISG Multicultural Formal. I have also served in student government where we evaluated funding requests ranging from $1500 to $5000. 1 feel these experiences directly relate to the duties that the Human Rights Commission is assigned. 6. What is your present knowledge of each advisory board you are interested in?* I understand that the Commission primarily works to provide education, resources, and advice to the City Council and the public in relation to human rights, civil rights, and bias. There is also a funding component in which the Commssion reviews applications for funding support for initiatives and programs related to the goals of the Commission. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describea some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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. City Council Resolution# 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son -in law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest? No 8. Do you currently serve on another Iowa City board or commission?* W Demographic Information 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: 9. Age 22 10. Country of Origin United States 11. Sexual Orientation Queer 12. Religion Non -religious 13. Do you have a disability? No 14. Ethnicity White '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* rw l Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down _ i r Advisory Board/Commission Application Form *� #�,C�►.��4 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 CITY OF IOWA CITY considered for any vacancy during that time. UNE5000n OFUnMTURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 3/9/2017 First Name* Eua Last Name Warren Home Address* 715 Carriage Hill #1 City IOWA CrfY State IA Zip Code* 52246 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 5632606811 Email Address* e2ra.warren24@gma il.00m Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City?* 8 years 3. Occupation:* Student/Parks and Recreation 4. Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* I was originally a freshman at Iowa in 2007. After two years I dropped out due to some health issues. In that time I worked for 5 years at New Pioneer coop here in lova City and really started to feel "at home", in Iowa City. I then moved back to Muscatine for lwo years where I earned my associates degree in business management, Mile also working for the City of Muscatine parks department. After earning my associates degree I returned to lowa City to finish my Bachelors degree in Sport and Recreation Management. rve worked the last year as the park management Intern for the city of lowa City. I have also spent time working for the University athletic department with the turf management and facility management staff as well. I am on track to graduate this December. With all of my combined experience I feel I have a unique sense of where Iowa City was 10 years ago, I have seen the changes lova City has endured in that time, and I have a sense the places lova City can potentially go. I also have strong connections with UIFIC, having lived there a month and ultimately having my life saved after a traumatic brain injury in 2005. All of these experiences have made it so I feel a strong connection with the city of Iowa City and it's residents. it would be an honor to have the opportunity to apply my experiences and knowledge in order to help Iowa City blossom by serving on the Human Rights Commission. 6. What Is your present knowledge of each advisory board you are Interested In?* I really don't knowtoo much about the Human Rights Boards other than the general ideas, theories and issues around Human Rights. I have taken several ethics classes (Business Ethics & Sport Ethics) as well as Hunan Relations and the University of Iowa's Career Leadership Academy program. I believe that from these classes I have a solid foundation surrounding ethical issues, topics, and other concerns in regard to overall human rights Issues. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of Interest. The following describes some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 tens 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. 7. Do you currently have a conflict of Interest? No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 27 10. Country of Origin United States 11. Sexual Orientation Male 12. Religion Christian/Agnostic 13. Do you have a disability? Yes Please explain: I have weakness in my right leg/arm as well as epilepsy and major depressive disorder/ptsd which I developed after my Traumatic Brain Injury/Surgeries in 2005. 14. Ethnicity Caucasian '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 is purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* E Luliiiii Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down I Mill CIN OF IOWA CITY UNESCO CITY OF LITERATURE Date of Application 10/25/2017 First Name Susanne Last Name Watson Epting Home Address* 86 Broadmoor Lane City IOWA CITY State IA Zip Code* 52245 Advisory Board/Commission Application Form 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. NOTE: Must be 18 years of age and live within city limits of Iowa City to apply 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 563-554-0209 Emall Address* skv,etsonepting@aol.com *. a I Sit •M Select a Board or Commission you are interested in: Human Rights Commission 2. How long have you been a resident of Iowa City?* 25 yrs. total, but gone 15, back now 1 3. Occupation:* retired clergy 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* As someone who served in human services here for many years, I have experience with people with disabilities of all kinds. I worked at the Free Medical Clinic for years as the HN coordinator and know about the hurdles in early years. I lobbied for a sane AIDS policy and one of the first hate crimes laws in the nation. I was awarded the Isabel Turner Award from the Conmission in 1996. 1 am currently involved in an effort to establish a racial justice center at Old Brick. I worked with the UN Commission on the Status of Women while living in New York. I am aware of my privilege as a white woman and of some of the stereotyping that comes with being an "old" woman. I have always been passionate about human rights and have spent my life working in that area in a variety of ways. 6. What Is your present knowledge of each advisory board you are interested Ing* I am aware of the work of the Human Rights Commission and was around in the early years of its establishment. I am proud that Iowa City maintains this tradition and has expanded this important work over the years. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federafty-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 lowageneraly prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a Citycontract. CityCouncil Resolution # 15-300 established a policythat the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same chid, and persons with 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 lens 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. 7. Do you currently have a conflict of Interest?* W 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 68 10. Country of Origin USA 11. Sexual Orientation straight 12. Religion Episcopalian 13. Do you have a disability? No 14. Ethnicity '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 in 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, except demographics, Council will rat consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down I Advisory Board/Commission Application Form `1 a! �;4'Plt'►F7"`1 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 CITY OF IOWA CITY considered for any vacancy during that time. NNESCOCIT OF EITEMWRE NOTE: Must be 18 years of age and live within city limits of lows City to apply Date of Application 11/9/2017 First Name Lauren Last Name* White Home Address* 1901 BROADWAY STREET, APT 6 City IOWA CITY State IA Zip Code 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 312-768-0805 Email Address* Inv4hfte9@gmail.com Boards & Commissions Select a Board or Commission you are interested in: Human Rights Commission 2. How long have you been a resident of Iowa City? 2 years 3. Occupation:* Program Manager 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* Anti -Defamation League (ADL) - Peer Trainer 6. What is your present knowledge of each advisory board you are interested in?* Program planning among other responsibilities of members providing the public information on the how to eliminate racial, religious, cultural issues in relation to sex color, creed, disability, gender/ identity, sexual orientation, marital status, age and national origin. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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 ary contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate familyties, 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. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, stepchildren, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?'� No Demographic Information 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. H 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: 9. Age 35 10. Country of Origin US 11. Sexual Orientation 12. Religion 13. Do you have a disability? No 14. Ethnicity Non Hispanic '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* 4406W ,yj. ifi1� Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down I r _4 ftAdvisory Board/Commission Application Form y�'�Ir4 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 CITY Of IOWA CITY considered for any vacancy during that time. uNEscoaTY of LITERATURE NOTE: Must be 18 years of age and live within city lints of Iowa City to apply Date of Application 10/29/2017 First Name Solomon Last Name' Worlds Home Address* 1015 Oakcrest St. Apt A City IOWA CITY State w Tip Code 52246 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number 7608807407 Email Address" solomonfuriousworlds@gmail. corn Boards IS, Commissions Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City?* 4+ years 3. Occupation:* Hospital Administration 4. Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* Mental Health First Aid certification U President's Black Student Advisory Committee LGBTQ Safe Zone Facilitator Volunteer with the Public Defender's office on immigration matters Taskforce to Support Immigrant Students and their Families through ICCSD Equity and Engagement Intern through ICCSD City Council Intern in Iowa City Managed a local campaign for a candidate focused on housing, economic, and mental health policy 6. What is your present knowledge of each advisory board you are interested in?* The Human Rights Commission regularly sends recommendations to the City Council on matters pertaining to human rights. Past proposals have focused at proclamations and policies supporting various communities within Iowa City. The Rapid Response Team, however, is the topic that continually peaks my interest. During my time as an intern with the Iowa City Community School Dislrid's Equity and Engagement department, 1 was heavily involved in a taskforce created to support immigrant students and their families. I see a rapid response team as a necessary component to prepare and an excellent backup plan in the event of a raid/seiatre, mass or otherwise. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally assisted activity, or with respect to the proceeds of the federalty-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 Iowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-inlaw, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with whom the employee is in an intimate relationship Res. #15-300 stales 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 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* Y Demographic Information 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. kx 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: 9. Age 22 10. Country of Origin United States 11. Sexual Orientation Heterosexual 12. Religion Christian 13. Do you have a disability? No 14. Ethnicity Black `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 intend, when possible to have at least one person with expertise in construction, at least one person with expertise in 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, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down 1 r i Advisory Board/Commission/Committt eE CITY OF IOWA CITY Application Form "1911 NOV 13 PM 2:22 UNESCO CITY OF LITERATURE This application is a public document and as such can be reproduced and distributed MiWe public. This application will be considered for twelve months only and automatically considered for any vacancy during that time. Advisory Board/Commission/Committee Name Date of Application nrti a) cmp,,l Name Home Address V3N-) VA,\(a' Contact phone numberM \ J Q'RU Email Address Your home address must be within the corporate limits of Iowa City? ,U\ How long have you lived in Iowa City? \ vw Occupation: Gender: Male Female J Experiences and/or activities which you feel qualify you for this position: v� vv o9A "SLQ a �„c, nnspOR.Q What is your present knowledge of this advisory board? ��.'°,� • �- � � ossa "� �oo,1N� �°� �4,J, VtA Please contact the city attorney at 319-356-5030 to discuss questions or concerns regarding a potential conflict of interest. Potential Conflict of Interest F 1 L E ; ; The Housing and Community Development Commission makLI111e�d�} t� the City Council regarding the distribution of federal CBDG/HOME funds. a gene}a Ie that no persons who exercise or have exercised any functions or responsibiliaff yi�r%44 o federally funded activities, or who are in a position to participate in the d�j -Mjm or gain inside information with regard to such activities, may obtain a financial interesefit 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 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_ NOJ List potential conflicts of interest (See last page for information regarding conflict of interest) Please indicate if there are none. I BUSINESS NAME I BUSINESS ADDRESS I 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. f j� In order to ensure that the board and commission is representative of thcr cUbfiwuEvGd the groups(s) which it serves, please provide your information for the following: Age -)3 2617 NOV 13 PM 2: 22 CITY CLERK Country ofOriginll IOVlA CITY, loiN i Sexual Orientation �(\\ \\3 p + Religion � 1 a ) \ Ar"'Al— ltiQ �oX �M &V\D Do you have a disability? YES_ NO Race, Color or Ethnic Group �du,SM I:An`J *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. 12h 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, 2018 -January 1, 2022 The duties of the members of the Parks and Recreation Commission are. to recommend and review policies, rules, regulations, ordinances, CIP (Capital Improvement Program)funds 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. The Parks and Recreation Commission meet the second Wednesday of each month. Iowa City -appointed members of boards and commissions must be 18 years of age and live in Iowa City. The City of Iowa City encourages diversity in the appointment to boards and commissions. Applications must be received by 5:00 p.m., Tuesday, November 14, 2017. An application can be completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the Clerk's office. Questions about the Iowa City Parks and Recreation Commission should be directed to Julie Seydell Johnson, Parks & Recreation Director at 356-5104. Board/Commission Application Cover Board/Commission: Parks and Recreation Commission Two vacancies to fill four year terms 1/1/2018-1/1/2022 It is hereby established, as a formal policy of the City Council of Iowa City, 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 order to increase the opportunities for new applicants to serve. Council Announcement Date: Application Deadline: 9/19/2017 11/14/2017 Council Appointment Date: 11/21/2017 Date of Non -Gender Appointment: 12/18/2017 After date above Council may appoint without regard to gender Gender Balance Requirement: 2 Male Current Gender Balance: Female: 4 Male: 2 Gender Name and Address Male CLAUSSEN, CLAYTON Currently serving 2nd term 27 Green Mountain Dr Female Evans, Lindsey 1413 Keokuk St Male Russell, Ben 907 Canton St Female Smith, Angie Currently serving an unexpired term 3310 Lower WEst Branch Rd Female Smith, Vero Rose 916 Kirkwood Avenue Male Warren, Stephen 2139 Abbey Lane PARKS AND RECREATION COMMISSION September 13,2017 Page 5 PARKS AND RECREATION COMMISSION ATTENDANCE RECORD NAME D b D TERMo i N ~ ~ n EXPIItES Suzanne 1/1/17 X X O/E X NM X X X • X X X Bentler Larry Brown 1/1/18 X X X X NM OX X X LQ X O/E X Clay 1/1/18 X X X X NM X X X LQ X X X Claussen Maggie 1/1/17 X O/E X Elliott Wayne Fett 1/1/19 O/E X X X NM X X X LQ X X X Cara 1/1/20 X X X O/E NM X X X LQ X X X Hamann Lucie 1/1/10 X X X X NM X X X LQ * O/E X Laurian Paul Roesler 1/1/18 X X O/E Angie Smith 1/1/18 * * * * * O/E X X LQ X X X Jamie 1/1/20 * * * X NM X X X LQ X X X Venzon Joe Younker 111/20 O/E X X X NM O/E X X LQ X X X KEY: X = Present O = Absent WE = Absent/Excused NM = No meeting LQ = No meeting due to lack of quorum * = Not a member at this time Advisory Board/Commission Application Form 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 CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CITY OF UTUTATURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 10/9/2017 First Name CLAYTON Last Name CLAUSSEN Home Address* 27 Green Mountain Dr City IOWA CITY State IA Zip Code* 52245 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-331-9911 Email Address* clayclaussen@gmail.com Boards & Commissions Select a Board or Commission you are interested in: Parks and Recreation Commission 2. How long have you been a resident of Iowa City?* Since 1966 wdperiods out of the area 3. Occupation:* REALTOR 4. Gender:* Male 5. Experience and/or activities which you feel qualifyyou for this position:* 1981-2002, Management & Consulting, Fitness/Wellness/Recreation/Heefth Promotion. Managed private health club for 4 years, Rockwell Recreation Center (60,000 SF corporate fitness/wellness on-site facility) for 14 years, consulted for Ertl Toy company, John Deere, Quaker Oats, Trilogy Softvrar, Dell JCC and Performance Fitness. Founded Core Fitness and created their original business plan in 2002-2003. Trained at Cooper Aerobics Instiitute, Dallas,Tx as Health Promotion Director. Pioneered local mufti -purpose health clubs and integration of physical therapy and training in commercial & private fitness operations. Coached for 8 years and served on the Iowa City Girls Softball Board in the'70's &'80's. 6. What Is your present knowledge of each advisory board you are Interested in?* I have had the privilege to serve on the Parks & Recreation Commission for the past eight years, seven as Chair. I served on the selection committee for the current Director and participated in screening candidates for City Manager Men Tom Markus was hired. I have been involved with creation of the current Master Plan and numerous individual projects including the Eastside Sports Park and all major projects over the past eight years. I believe our Parks & Recreation facilities and services are a vital part of our community and must be sustained and improved with a vision of a better future within budget constraints. And Men we are obstructed, I have a history as a problem solver in seeking innovative solutions, especially with finances, programaring and creating income streams.. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of Interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with wham they have business or immediate family ties, during their tenure or for one year thereafter. Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a Citycontract. CityCouncil Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, stepchildren, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister -in law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with whom the employee is in an intimate relationship Res. #15-300 states fhat 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 order to increase the opporturities 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* 0 Demographic Information 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: 9. Age 69 10. Country of Origin USA 11. Sexual Orientation Hetero 12. Religion Catholic 13. Do you have a disability? No 14. Ethnicity Caucasian `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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* �`�l2Jlar /s�t!'�l2aJdAr Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down Kellie Fruehling From: Sent: To: Cc: Subject: Dear Council Members: Clay Claussen <clayclaussen@gmail.com> Monday, October 09, 2017 6:43 PM Council Juli Seydell Johnson, Geoff Fruin Parks & Recreation Commission Appointment My term expires at the end of this year and I would very much like to continue for another term. I have had the privilege and honor to have served as Chair for the past seven years and have been involved in the planning of the current and future services and facilities for our fellow citizens. The department has a lot of irons in the fire and I will appreciate your consideration to continue to provide the very best support and guidance I can. Best regards, Cloy Clayton M Claussen 27 Green Mountain Drive Iowa City, IA 52245-3812 Cell: 319-331-9911 Home: 319-351-HAWK(4295) clavcla ussen LaDcmail.com _I I_.& ^°1 Advisory Board/Commission Application Form �F �4 application is a public document and as such can be reproduced and distributed for This a p p ' the public. This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CITY OF UTER TURE NOTE: Must be 18 years of age and live within city limits of lovra City to apply Date of Application 12/14/2016 First Name Lindsey Last Name ` Evans Home Address* 1413 Keokuk Sl City IOWA CITY State A Zip Code 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3195945155 Email Address* lindseyturnbu1127@gmaii.com Boards & Commissions Select a Board or Commission you are interested in:* Parks and Recreation Commission 2. How long have you been a resident of Iowa City?* 9 years 3. Occupation:* Mother 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* This past summer I visited all the parks with my two young daughters and took pictures and wrote reviews on google to try and help other parents navigate the Iowa City parks. I had so much fun and learned a lot about our parks in the process. I would love the opportunity to continue this journey and share my perspective as a parent and park enthusiast with the commission. 6. What is your present knowledge of each advisory board you are interested in?* rve been to all established parks and have studied the park projects on display at the rec center. I'm familiar with the rec center offerings. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describea some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a Citycontract. CityCouncil Resolution # 15-300 established a policy that the following persons shall not be eligible appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother -in law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest? No 8. Do you currently serve on another Iowa City board or commission?* hlo Demographic Information 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: 9. Age 29 10. Country of Origin United States 11. Sexual Orientation Heterosexual 12. Religion None 13. Do you have a disability? No 14. Ethnicity White American `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 in 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, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. d r _.& Advisory Board/Cormtission Application Form � -111-1 F� Rl 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 CITY OF IOWA CITY considered for any vacancy during that lime. UNEXO CITY OF UTFMTURE NOTE: Must be 18 years of age and live within city limits of lowa City to apply Date of Application 11/30/2016 First Nam* Ben Last Name Russell Home Address* 907 Canton St City IOWA CITY State IA Zip Code* 52245 1. is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-621-2999 Email Address* beniarrun.k.russell@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Parks and Recreation Commission 2. How long have you been a resident of Iowa City?* 21 years total 3. Occupation:* Commercial Banking Officer 4. Gender:* Male 5. Experience and/or activities which you feel quality you for this position:* [grew up in Iowa City and graduated from Regina High School. While growing up in love City, I used many of the parks and recreational facilities such as the pools and rec center. I was a part of the rec center's summer carte program each year and went though the counselor in training program. I have lived in Iowa City for a total of approximately 21 years and recently built a house in Iowa City for long-term use. I have worked for "its Bank and Trust Company for over 6 years total and love volunteering in the community that involve the City's parks and facilities. Iowa City is and always will be rry home. 6. What is your present knowledge of each advisory board you are interested in? This commission involves understanding the City's policies, rules, regulations, ordinances and budgets relating to the parks and recreation centers. Throughout one's time on this commission, people recommend and review reports to the City Council that is deemed to be in the good of the public interest. This commission works with the City to help stay on task throughout the year relating to new and existing developments/projects/plans as well as financially being responsible. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describes some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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. City Council Resolution # 15-300 established a policy that file following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?"` W 8. Do you currently serve on another Iowa City board or commission?* W Demographic Information 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: 9. Age 31 10. Country of Origin South Korea 11. Sexual Orientation Male 12. Religion Catholic 13. Do you have a disability? No 14. Ethnicity Asian `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 in 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, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 10/12/2017 First Name Angie Last Name Smith Home Address* 3310 Lower WEst Branch Rd City IOWA CRY State IA Zip Code* 52245 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3196217734 Email Address* angiesmith3310@gmaii.com Boards & Commissions Select a Board or Commission you are interested in: Parks and Recreation Commission 2. How long have you been a resident of Iowa City?* 16 years 3. Occupation:* Psychologist 4. Gender:* Female 5. Experience andlor activities which you feel qualify you for this position:* Advisory Board/Commission Application Form tThis 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 CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CRY OF UTEMNRE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 10/12/2017 First Name Angie Last Name Smith Home Address* 3310 Lower WEst Branch Rd City IOWA CRY State IA Zip Code* 52245 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3196217734 Email Address* angiesmith3310@gmaii.com Boards & Commissions Select a Board or Commission you are interested in: Parks and Recreation Commission 2. How long have you been a resident of Iowa City?* 16 years 3. Occupation:* Psychologist 4. Gender:* Female 5. Experience andlor activities which you feel qualify you for this position:* Have been on the IC Parks and Rec Board since March 2017, Lemma PTA President 2012, serve on Little Hawk Athletic Booster Board, IC Music Auxiliary 2014-2017, am the parent of three active children who enjoy many activities offered through the IC Parks and Rec commission, am an active individual who enjoys the parks in our community on a weekly basis 6. What is your present knowledge of each advisory board you are interested in?* I have served on the board since March, so am beginning to develop a base knowledge of the board and the responsibilities of the board Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a Citycontract. CityCouncil Resolution # 15-300 established a policythat the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, stepchildren, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* Plo Demographic Information 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: 9. Age 43 10. Country of Origin United States 11. Sexual Orientation heterosexual 12. Religion Protestant 13. Do you have a disability? No 14. Ethnicity Iowa City '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 in 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, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down NOTE: Must be 18 years of age and live within city limits of lova City to apply Date of Application 12/1/2016 First Name Vero Rose Last Name Smith Home Address* 916 Kirkwood Avenue City IOWA CITY State A 71p Code 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 6306317218 Email Address* verorose.smith@gmil.com Boards & Commissions Select a Board or Commission you are interested in:* Public Art Advisory Committee Public Art Advisory Committee Category* Art or Design Professional Select a Board or Commission you are interested in:* Parks and Recreation Commission 2. How long have you been a resident of Iowa City?* 3 years 3. Occupation:* Curator at the University of Iowa Museum of Art Advisory Board/Commission Application Form This application is a public document and as such can be reproduced and distributed for T w.r._ the public. This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CITY OF UTEMWft NOTE: Must be 18 years of age and live within city limits of lova City to apply Date of Application 12/1/2016 First Name Vero Rose Last Name Smith Home Address* 916 Kirkwood Avenue City IOWA CITY State A 71p Code 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 6306317218 Email Address* verorose.smith@gmil.com Boards & Commissions Select a Board or Commission you are interested in:* Public Art Advisory Committee Public Art Advisory Committee Category* Art or Design Professional Select a Board or Commission you are interested in:* Parks and Recreation Commission 2. How long have you been a resident of Iowa City?* 3 years 3. Occupation:* Curator at the University of Iowa Museum of Art 4. Gender:* Female S. Experience and/or activ[ties which you feel qualify you for this position:* As an artist with a specialization in the production of public art and as an art historian, I am able to offer a passionate and multi -faceted perspective to the Public Art Advisory Committee. My current position as Assistant Curator at the University of Iovm Museum of Art is the summation of the nearly 8 years I have spent working with public art initiatives, advocating for art education, and academic museums. While pursuing both my first master's degree at University of Iowa and my second master's degree at Harvard University, I simultaneously directed non-profit event spaces. In both kme City and Cambridge, I identified a dire need for community art spaces, and developed programs to utilize the respective organizations I directed as a community art space. Creating space, physically and culturally, for art is one of my chief passions. Regarding my interest in the Parks and Recreation Commission, I hold an undergraduate degree in environmental studies. Additionally, I have worked with both the Quad City Botanical Center and the Arnold Arboretum to develop interpretive materials to enhance visitor experiences. Furthermore, my work as an artist primarily concerns relationships between people and the natural world (you can viewexamples of this work here: hftp://verorosesmith.conitrecentprojects.html). Advocating for the care and maintenance of green spaces is crucial to our community's future, and I would be honored to be a part of this commission. Thank you for your time and consideration, Vero Rose Smith 6. What is your present knowledge of each advisory board you are interested in?* I am aware that the Public Art Advisory Committee administers and determines the placement of public art, as well as the logistics of commissioning new art works, and accepting gifts of art. Regarding the Parks and Recreation Commission, I understand that this entity reviews policies rules, regulations, ordinances, and budgets relating to public green spaces. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describes some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policy that the following persons shall rat be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, stepchildren, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother -i -law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 26 10. Country of Origin United States of America 11. Sexual Orientation Straight-ish 12. Religion Atheist 13. Do you have a disability? No 14. Ethnicity White '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* tLwlzs;—r- — Micrcnrcconfafinnc nn fhic annliraf inn will rnnefifi do ii i f rni icc fnr romnvnl of nn Advisory Board/Commission Application Form �; p1It :niS This application is a public document and as such can be reproduced and distributed for the public. This application will be considered for tmIve months only and automatically CITY OF IOWA CIN considered for any vacancy during that time. UNESCO CITY OF MMMU NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 12/11/2016 First Name Stephen Last Name Warren Home Address* 2139 Abbey Lane City IOWA CITY State IA Zip Code 52246 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 309 7811871 Email Address* stephen-varren@uiovm.edu Boards & Commissions Select a Board or Commission you are interested in:* Parks and Recreation Commission 2. How long have you been a resident of Iowa City?* 2 1/2 years 3. Occupation:* Professor 4. Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* In Rock Island I served on the Hstoric Preservation Commission. In both Rock Island and Iowa City, I have coached kids' youth soccer and basketball. I am the parent of three young children. Two attend Flom, and the oldest attends Northwest Junior Hgh. Here in Iowa City, as a year-round bicycle commuter, I have grown particularly concerned about bicycle safety. I live near Kiwanis and Willow Creek parks, and I love the fact that these parks are used by people from all walks of life. I want to ensure that our parks remain opening and inclusive places that facilitate neighborliness and civic engagement. 6. What is your present knowledge of each advisory board you are interested in?* During Last Saturdays presentation by the Parks Commission at the Robert A.Lee Center, Julie Seydell Johnson let me know that there was an open seat on the parks board.i also had a long and thoughtful conversation with Wayne Fett about bicycle safely. Both conversations peaked my interest in serving Iowa City and the Parks Commission, specifically. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describes some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDGlHOME 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 acfivity, or have a financial interest in any contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate familyties, during their tenure or forone yearthereafter. Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, stepchildren, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. lbu will be asked to resign from one if appointed to another. 7. Do you currently have a conflict of Interest? No 8. Do you currently serve on another Iowa City board or commission? No Demographic Information 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: 9. Age 46 10. Country of Origin United States 11. Sexual Orientation Heterosexual 12. Religion Christian 13. Do you have a disability? No 14. Ethnicity Caucasian `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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* ,rte �2C2'rbt' Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. 11-21-17 12i Notice The City Council Of Iowa City Is Considering Appointment To The Following Committee: Public Art Advisory Committee Two Vacancies — Three Year -Term January 1, 2018 — January 1, 2021 One public art professional Duties of the 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; • overseeing expenditures of the Public Art Program budget. • overseeing the Poetry in the Public Program. Iowa City appointed members of boards and commissions must be at least 18 years of age and reside in the City of Iowa City. The City of Iowa City encourages diversity in the appointment to boards and commissions. Applications must be received by 5:00 p.m., Tuesday, November 14, 2017. An application can be completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the Clerk's office. Questions about the Iowa City Public Art Advisory Committee should be directed to Marcia Bollinger, Neighborhood Outreach Coordinator, 356-5237 or Marcia-Bollinger@Iowa-City.org. Board/Commission Application Cover Board/Commission: Public Art Advisory Committee Two vacancies to fill three year terms 1/1/2018 -12/31/2021 1 Public Art Professional, 1 At -Large It is hereby established, as a formal policy of the City Council of Iowa City, 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 order to increase the opportunities for new applicants to serve. Council Announcement Date: 9/19/2017 Application Deadline: 11/14/2017 Council Appointment Date: 11/21/2017 Date of Non -Gender Appointment: 12/18/2017 After date above Council may appoint without regard to gender Gender Balance Requirement: 1 Male, 1 None Current Gender Balance: Female: 2 Male: 1 Gender Name and Address Female Mitchell, Samantha Public Art Professional 1330 Highland Ave Female Purington, Nancy Public Art Professional 1706 Prairie du Chien Road Female Smith, Vero Rose Public Art Professional 916 Kirkwood Avenue Female Truitt, Andrea At -Large Public Art Advisory Committee Attendance Record 2016-2017 Name Term Expires 3/3 5/5 8/4 9/15 11/3 1/5 2/5 3/2 4/6 Bodkin Bryk, Tam 01/01/19 O/E x x O/E x X x O/E O/E Brown, Wendy 01/01/20 -- -- -- -- -- -- x x x En elbrecht, John 01/01/18 X x O/E X X I X x I x I O/E Hemann, Sa uri Sasaki 01/01/18 X X X X X X x O/E x Erin Fitzgerald 01/01/20 -- -- -- — -- -- — x Knoche,Ron X X X X X X x x tx� 5e dell -Johnson, Juli X X X O/E x x x x Key: X = Present O = Absent OJE = Absent/Excused — = Not a member r Z CITY OF IOWA CITY UNESCOCPN OF UTERATUM Date of Application 11/16/2016 First Name* Samantha Last Name Mitchell Home Address* 1330 Highland Ave City IOWA CITY State IA Zip Code 52240 Advisory Board/Commission Application Form 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. NOTE: Must be 18 years of age and live within city limits of Iowa City to apply 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 540-435-2013 Email Address* sarriantha-rritchell@uiowa.edu Boards & Commissions Select a Board or Commission you are interested in:* Public Art Advisory Committee Public Art Advisory Committee Category* Art or Design Professional 2. How long have you been a resident of Iowa City?* 5 years 3. Occupation:* Metalsmith and Healthcare professional in Quality and Safety 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I'm a local artist, with an MFA, and BFA, in metaisndthing. My work has shown nationally at the Walker Art Center in MN, the Greenville Museum of Art, NC, and Arrowmont School of Craft, TN. 0 has also shown internationally in Holland, France, and Lithuania to name a few. Last year 1 was featured in American Craft Magazine, Metalsmith Magazine, and wrote for Art Jewelry Magazine.Locally I partner with U's ArtShare to provide outreach workshops to smaller communities across Iowa. 6. What is your present knowledge of each advisory board you are interested in?* I know that board reviews public arts submissions, allocates funds, oversees donations, creates bylaws, oversees maintenance. Communicates with the community to discuss their wishes and relay board decisions. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describes some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate familyties, during their tenure or far one year thereafter. Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-im4aw, mother-ir-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with whom the employee is in an intimate relationship Res. 415-300 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 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. T. Do you currently have a conflict of Interest?* No 6. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 31 10. Country of Origin Lis 11. Sexual Orientation Heterosexual 12. Religion Atheist 13. Do you have a disability? No 14. Ethnicity caucasian '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* lRlfAI& 40VI Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. t ' Advisory Board/Commission Application Form _ re #;�°�S ®'O: 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 CITY OF IOWA CITY considered for any vacancy during that time. UNESCOCITY OF LITERATURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 11012017 First Name" Nancy Last Name Purington Home Address" 1706 Prairie du Chien Road city IOWA CRY State IA Zip Code" 52245 1. Is your home address (listed above) within the corporate limits of Iowa City?" Yes Contact Phone Number" 3195946789 Email Address" nancypuringion@gmail.com Boards & Commissions Select a Board or Commission you are interested in: Public Art Advisory Committee Public Art Advisory Committee Category" Art or Design Professional 2. How long have you been a resident of Iowa City?" 40 years 3. Occupation:" Art Consultant, visual Artist 4. Gender:" Female 5. Experience and/or activities which you feel qualify you for this position:* MFA Usual Art. Pubic Art Consultant, 28 years experience. Helped to design the Iowa City Public Art Program via the Arts/Business Partnership Committee of the lowa city Area Chamber of Commerce 1997. Past President of Arts Iowa City and member since 1976. Designed concept narrative for the Iowa Avenue Literary Walk with the City of lows City as a Public Art Consultant. 6. What Is your present knowledge of each advisory board you are Interested in?* While president of Arts Iowa City, I helped to design and propose the lova City Public Art Program via the Arts/Business Partnership Committee of the Iowa City Area Chamber of Commerce 1996. Public Art Programs across the country were reviewed and incorporated. Accepted by IC City Council 1997. Served on first PAAC committee as both member and Chair. As a senior citizen, I once again have the time to devote to working as a volunteer to help the lova City Public Art Proposal maintain and grow its nhission. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of Interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a Citycontract. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and hall -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* W 8. Do you currently serve on another Iowa City board or commission? No Demographic Information 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: 9. Age 70 10. Country of Origin 11. Sexual Orientation 12. Religion 13. Do you have a disability? 14. Ethnicity multi "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 in 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, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down I i I �:�m�r11rti CITY OF IOWA CIN UNESCO CITY OF UTEMYUNE Date of Application 1 W 12016 First Name* Vero Rose Last Name* Smith Home Address* 916 Kirkwood Avenue City IOWA CITY State IA Zip Code* 52240 Advisory Board/Commission Application Form 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. NOTE: Must be 18 years of age and live within city limits of Iowa City to apply 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 6306317218 Email Address* verorose.srrith@gmil.com Boards & Commissions Select a Board or Commission you are interested in:* Public Art Advisory Committee Public Art Advisory Committee Category* Art or Design Professional Select a Board or Commission you are interested in: Parks and Recreation Commission 2. How long have you been a resident of Iowa City?* 3 years 3. Occupation:* Curator at the University of Iowa Museum of Art 4. Gender:* Female S. Experience and/or activities which you feel qualltyyou for this position:* As an artist with a specialization in the production of public art and as an art historian, I am able to offer a passionate and multi -faceted perspective to the Public Art Advisory Committee. My current position as Assistant Curator at the University of Iowa Museum of Art is the summation of the nearly 6 years I have spent working with public art initiatives, advocating for art education, and academic museums. While pursuing both my first master's degree at University of Iowa and my second master's degree at Harvard University, I simultaneously directed non-profit event spaces. In both Iowa City and Cambridge, I identified a dire need for community art spaces, and developed programs to utilize the respective organizations I directed as a community art space. Creating space, physically and culturally, for art is one of my chief passions. Regarding my interest in the Parks and Recreation Commission, I hold an undergraduate degree in environmental studies. Additionally, I have worked with both the Quad City Botanical Center and the Arnold Arboretum to develop interpretive materials to enhance visitor experiences. Furthermore, my work as an artist primarily concerns relationships between people and the natural world (you can view examples of this work here: hftp://verorosesmith.co"recentprojects.htni). Advocating for the care and maintenance of green spaces is crucial to our community's future, and I would be honored to be a part of this commission. Thank you for your time and consideration, Vero Rose Smith 6. What is your present knowledge of each advisory board you are interested in?* I am aware that the Public Art Advisory Committee administers and determines the placement of public art, as well as the logistics of commissioning new art works, and accepting gifts of art. Regarding the Parks and Recreation Commission, I understand that this entity reviews policies rules, regulations, ordinances, and budgets relating to public green spaces. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of Interest. The following describea some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 exceptons, a member of a City Board or Commission from having an interest in a City contract City Council Resolution # 15300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, stepchildren, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter -in law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest? No S. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 26 10. Country of Origin United States of America 11. Sexual Orientation Straight-ish 12. Religion Atheist 13. Do you have a disability? No 14. Ethnicity White '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* hAicronrocontntinnc nn this annlirnfinn will rnnctiti rfo ii i f rai mo fnr ronnnv�l of nn a! :b Advisory Board/Commission Application Form 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 CITY OF IOWA CITY considered for any vacancy during that time. VNESCOCIn OF OTEMTME NOTE: Must be 18 years of age and live within city limits of owe City to apply Date of Application 11/12/2017 First Name Andrea Last Name Truitt Home Address 815 N. Johnson St. City IOWA CITY State IA Tip Code 52245 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-359-8388 Emall Address* and rea.m.tru itt@gma il. oom Boards & Commissions Select a Board or Commission you are interested in: Public Art Advisory Committee Public Art Advisory Committee Category* At -Large 2. How long have you been a resident of Iowa City?* 3.5 years 3. Occupation:* Adnlnistrative Professional 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* My work and academic experience within the field of American art history make me a strong candidate for the Public Art Advisory Conw ittee. I would love to combine my knowledge of American art with my love of Iowa City and interest in Its collective well-being, of which public art is integral. I am currently on the board of the Association of Historians of American Art, acting as Web Coordinator since January 2017. We are an organization consisting of university faculty, museum professionals, and independent scholars who study American art (broadly defined as fine art, popular art, architecture, and material culture) from the seventeenth century to the present. We meet virtually, once per quarter, and because of this virtual format, clear and concise communication is key to success. I can easily transfer these skills over to the Public Art Advisory Committee and would love to be involved in more frequent and interactive committee work that has local relevance. I also hold a PhD in art history from the University of Mnnesota, studying the American built environment, of which public art is most certainly a factor. People experience and interact with buildings and outdoor areas every day, and they are affected in different ways given race, gender, and socicecononic status. I understand this as both an historian and as a citizen of bwe City. it is not enough to make an aesthetic judgment on an artwork or to know only about the artwork itself,, we must understand the location of installation, the demographics of the area it will be placed, and the history of Iowa City in order to fully centextualize the artwork. I understand all of this, and I know that I would be a valuable committee member. 6. What is your present knowledge of each advisory board you are interested in?* I understand that the advisory committee takes pre of many practical issues of public art projects, from the administering of grants to artists, to advising the city on appropriate artists and locations of projects to meaningfully enhance Iowa City and its quality of fife for residents. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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. City Council Resolution # 15-300 established a policy that the following persons shall riot be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, stepchildren, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-indaw, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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. ff reappointed, an individual would be limited to one reappointment to a full term 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. 7. Do you currently have a conflict of Interest? W 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 33 10. Country of Origin USA 11. Sexual Orientation 12. Religion 13. Do you have a disability? No 14. Ethnicity White '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 in 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, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down 1 11-2 12j Notice The City Council Of Iowa City Is Considering Appointment To The Following Commission: Senior Center Commission Two vacancies — Three -Year Term January 1, 2018 - December 31, 2020 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 at least 18 years of age and live in Iowa City. The City of Iowa City encourages diversity in the appointment to boards and commissions. Applications must be received by 5:00 p.m., Tuesday, November 14, 2017. An application can be completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the Clerk's office. Questions about the Iowa City Senior Center Commission should be directed to Linda Kopping, Senior Center Coordinator at 356-5225 Board/Commission Application Cover Board/Commission: Senior Center Commission Two vacancies to fill three year terms 1/1/2018 -12/31/2020 It is hereby established, as a formal policy of the City Council of Iowa City, 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 order to increase the opportunities for new applicants to serve. Council Announcement Date: 9/19/2017 Application Deadline: 11/14/2017 Council Appointment Date: 11/21/2017 Date of Non -Gender Appointment: 12/18/2017 After date above Council may appoint without regard to gender Gender Balance Requirement: 1 Male, 1 None Current Gender Balance: Female: 3 Male: 2 Gender Name and Address Female Clamon, Cheryl] 1023 Village Green Blvd Male Honohan, Jay Previously served 6 terms 1510 Somerset Ln Approved Minutes August 17, 2017 Senior Center Commission Attendance Record Year 2017 Name Term Expires 9/15/16 10/20/16 11/17/16 12/8/16 1/19/17 2/16/17 3/16/17 4/20/17 5/18/17 6/15/17 7/20/2017 8/17/2017 — — -- '- — - X X Kenn Bowen 12/31/20 X NM X X X X X NM NM X O/E X Cheryll Clamon 12/31/18 — — — X X X NM NM X X O/E Lorraine Dorlinan 12/31/19 O/E NM X O/E -- — -- -- — -- - -- Jack Hobbs 12/31/16 X NM X X X X X NM NM X X X Mark Holbrook 12/31/18 X NM X X -- -- -- -- — -- -- - Jay Honohan 12/31/16 X NM X X X X X NM NM X X X Kathy Mitchell 12/31/19 X NM X O/E X X X NM NM X X X Margaret Reese 17/31/17 Hiram (Rick) 12/31/20 - — -- — -- -- - -- — X O/E X Weber Key: X = Present O = Absent O/E = Absent/Excused NM = No meeting — = Not a member _ t .'b Advisory Board/Commission Application Form e 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 CITY OF IOWA CITY considered for any vacancy during that time. UNESCO On OF LFTEMMU NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 1111412017 First Name Cheryll Last Name Clamon Home Address* 1023 Village Green Blvd city IOWA CITY State IA Tip Code* 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319 331 9086 Email Address* c.damon@mchsi.com Boards & Commissions Select a Board or Commission you are interested in: Senior Center Commission 2. How long have you been a resident of Iowa City? 41 years 3. Occupation:* retired 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I have served on the senior commission for one term and am a regular participant in senior center activities 6. What is your present knowledge of each advisory board you are interested in?* see above Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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 lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest? No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information 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: 9. Age 72 10. Country of Origin use 11. Sexual Orientation heterosexual 12. Religion none 13. Do you have a disability? No 14. Ethnicity caucasian `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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* tYfCL�tL�i7I//i3Y Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Drop-down 12 d CITY OF IOWA CITY UNESOOOO OF AMKE Date of Application 11/1312016 First Name Jay Last Name Honohan Home Address* 1510 Somerset Ln city IOWA CITY State IA Zip Code* 52240 Advisory Board/Commission Application Form 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. NOTE: Must be 18 years of age and live within city limits of Iowa City to apply 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319 338-6990 Email Address* nroamer@aol.com Boards & Commissions Select a Board or Commission you are interested in:* Senior Center Commission 2. How long have you been a resident of Iowa City?* 66 years 3. Occupation:* attorney 4. Gender:* Male 5. Experience and/or activities which you feel qualifyyou for this position:* I have been commission chair for several years. I am a volunteer attorney at the Center. I attend classes and events at the Center. I am active in community affairs. 1 am the President of the Center's Foundation. I have served on the Ad Hoc Committee for Seniors. I have served as police judge and City Attorney for Iowa City. I know the rule about serving consecutive terns but would like the Council to waive that rule in my case. This will be rry last hurrah on the Commission. I vent very much to serve in helping the goal of the City and the Commission to increase the non -tax funding of the Center. 6. What is your present knowledge of each advisory board you are interested in? * Having served on the Commission since 1998, 1 know the Conrrrssion's role and have worked well with the staff over the years. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of Interest. The following describes some but not all potential conflicts. Potential Conflicts 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, or agreement with respect to a federally -assisted activity, or 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. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, stepchildren, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law, sister-ir-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons who are parents of the same child, and persons with 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 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. 7. Do you currently have a conflict of Interest?* hlo S. Do you curre ntly serve on another Iowa City board or commission? No Demographic Information 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 9. Age 86 10. Country of Origin USA 11. Sexual Orientation Married to my vlfe for 58 years. 12. Religion Methodist 13. Do you have a disability? No 14. Ethnicity Irish to the core. Father's side County Cork, Mother's side County Tyrone '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 in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* Ar W. 191AVIA" Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: TELECOMMUNICATIONS COMMISSION One vacancy— Three -Year Term July 1, 2017 — July 1, 2020 • The duties of the Telecommunications Commission include serving as a review board to resolve disputes between any subscriber or potential subscriber and the cablevision company • reviewing and auditing reports by the cable company to the City as required by the Cable Television Ordinance; working with the public, the media, the City, and the Cablevision company for the purpose of making recommendations on various issues; • monitoring and promoting community programming and the use of the local access channels by a wide range of individuals, institutions, and organizations; • informing and educating citizens on matters related to cable TV and other communications systems; • and monitoring and reviewing State and Federal legislative and regulatory action or change. • Iowa City -appointed members of boards and commissions must be at least 18 years of age and live in Iowa City. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. The Telecommunications Commission meets the fourth Monday of each month at 5:30 p.m. Applications must be received by 5:00 p.m., Tuesday, November 14, 2017. An application can be completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the Clerk's office. Questions about the Iowa City Telecommunications Commission should be directed to Ty Coleman, Media Production Services Coordinator, at 356-5454. 11/15/2017 Board/Commission Application Cover Board/Commission: Telecommunications Commission One Vacancy to fill a three year term 7/1/2017- 7/1/2020 It is hereby established, as a formal policy of the City Council of Iowa City, 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 order to increase the opportunities for new applicants to serve. Council Announcement Date: 3/11/2017 Application Deadline: 11/14/2017 Council Appointment Date: 11/21/2017 Date of Non -Gender Appointment: 6/19/2017 Gender Balance Requirement: Current Gender Balance: After date above Council may appoint without regard to gender 1 Female Female:1 Male:2 Gender Name and Address No Applications