HomeMy WebLinkAboutStockman, AdamI Advisory Board/Commission Application Form
' - rY
It This application is a public document and as such can be reproduced and distributed for
�:W'
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 LITERATURE
If appointed to a Board/Commission, all other applications will be removed from
consideration.
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
12/18/2018
First Name
Adam
Last Name
Stockman
Home Address*
32 Ealing Drive
City
IOWA CITY
State
IA
Zip Code
52246
Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
3194003321
Email Address*
iowaadamstockman@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Telecommunications Commission
Preference on first choice
If multiple boards are being applied for.
I would be interested in hearing about other
board/commission opportunities
How long have you been a resident of Iowa City?*
37 years total
Occupation:*
Director of Clinical Operations at Iowa Lions Eye Bank
Gender*
"This question is rrandatory in order for the aty to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" xray
be provided in the Derrographics sectionof the application below.
V Male
r Female
Experience and/or activities which you feel qualifyyou for this position:*
As a lifelong resident of Iowa City (minus 2 years I lived in Coralville) I feel that I am in touch with what people in
Iowa City expect and want from their cable provider. In regards to working within a regulated profession, I work
in the highly regulated field of tissue donation and have to interpret and ensure compliance with federal
regulations on a daily basis. I currently serve on the Accreditation Board for the Eye Bank Association of
America and travel the country on a regular basis performing inspections to ensure compliance with all
appropriate regulations. Learning regulations inside and out is something I am familiar with and would love to
expand my experience into fields outside of healthcare such as this Commission.
What is your present knowledge of each advisory board you are interested in?*
Admittedly, my present knowledge of the workings of this Commission is not great. I knowwhat I have been
able to find online from reading past meeting minutes.
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 orfor one yearthereafter.
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.
Do you currently have a conflict of Interest?*
No
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:
Age
39
Country of Origin
United States
Sexual Orientation
Heterosexual
Religion
Agnostic
Do you have a disability?
No
Ethnicity
Non -hispanic
Race
White
Gender identity
Male
*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.