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HomeMy WebLinkAbout2022-11-15 AppointmentItem Number: 14.a. ..71441 CITY OF IOWA CITY www.icgov.org November 15, 2022 Board of Adjustment - One vacancy to fill a five-year term. January 1, 2023 - December 31, 2027. (Term expires for Gene Chrischilles) ATTACHMENTS: Description Vacancy Notice/Coversheet Board Demographics/Attendance Baker, Larry - Application Bopp, Ty - Application NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF ADJUSTMENT One Vacancy: Five -Year Term January 1, 2023 — December 31, 2027 • 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 at least 18 years of age and live in Iowa City. The City lowa City encourages diversity in the appointment of citizens to boards and commissions. Applications must be received by 5 p.m., Tuesday, November 8, 2022. An application can be completed and submitted on the City of Iowa City website at www.icgov.org or by contacting the City Clerk's office. Questions about the Iowa City Board of Adjustment Commission should be directed to Kirk Lehmann, Planner at 356-5247. Board/Commission Application Cover Board/Commission: Adjustment, Board of One vacancy to fill a five-year term January 1, 2023 - December 31, 2027 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: 10/3/2022 Application Deadline: 11/8/2022 Council Appointment Date: 11/15/2022 Date of Non -Gender Appointment: 1/1/2023 After date above Council may appoint without regard to gender Gender Balance Requirement: None Current Gender Balance: Female: 2 Male: 2 Gender Name and Address Male BAKER, LARRY 73 Brentwood Drive Male Bopp, Ty 210 S Clinton St Apt 208 Adjustment, Board of Demographic Report Name Term Term Stop Type Number Term 3ryce Parker Full 1 Paula Swygard Unexpired Mark gusto Nancy Carlson Full VACANT Full Resident Occupation •Gender* rAge* Country of Sexual Religion` 'Disability* Ethnicity Gender Race* Years Origin' ;Orientation` Identity 12/3112024 : 15 years 12/31/2023 38 years 12/31/2026 18-19 years 12/31/2025 51 years 12131/427 Higher Education 'Administration/ Program ;Manager retired Male i 36 USA 'Female Straight self-employed, 'Male 71 USA Hete€o designer retired Female 73 US. F Please note: The information provided is the information provided on the application at the time of submission. * Information is voluntary Lutheran 'No European/ Male Human WASP :White T —` Board of Adjustment June 8, 2022 Page 7 of 7 BOARD OF ADJUSTMENT ATTENDANCE RECORD 2021 - 2022 NAME TERM EXP. 7/14 8/11 9/8 10/13 1218 3/9 4/13 6/8 CHRISCHILLES, GENE 12/31/2022 O/E X X X X X X X PARKER, BRYCE 12/31/2024 X X U X X X O/E X PRETORIUS, AMY 12/31/2023 X X X X X X X O/E CARLSON, NANCY 12/31/2025 X X X 0/E X X X X RUSSO, MARK 12/31/2021 X X X X X O/E X X Key: X = Present 0 = Absent 0/E = Absent/Excused -- -- = Not a Member CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 6/23/2022 First Name* LARRY Last Name* BAKER First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 73 Brentwood Drive City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-519-2789 Email Address * icwriter@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Adjustment, Board of Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 40+years Occupation: * writer Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * Extensive experience as a former Councilmember, P&Z Commissioner, and a former member of BoA. What is your present knowledge of each advisory board you are interested in?* Five years prior experience on this particular Board. I am seeking to fill the recent short-term vacancy. I see myself as a an experienced "bridge" until the Council appoints someone for a full five year term in 2023. 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-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 (Optional) 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 Country of Origin Sexual Orientation Religion Do you have a disability? Ethnicity Race Gender identity *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/9/2022 First Name* Ty Last Name* Bopp First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 210 S Clinton St Apt 208 City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3192599412 Email Address * ty.bopp21@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Adjustment, Board of Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? June 2022 Occupation: * Manager at Hy-Vee Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I have a pre -law track degree that consist of History and American Politics. I interned for State Rep Dave Jacoby and State Senate Minority Leader Zach Wahls. I answered emails, meet with lobbyist, sat in on committees and debates. I also ran for state hours but stepped down after the primary to focus on my masters degree. What is your present knowledge of each advisory board you are interested in?* The Board of Adjustments is a civilian panel that reviews specials cases and considers appeals in disagreements about an administrative decision by the city. The panel members act like judges as they review zoning regulations or to resolve disputes about administrative zoning decisions. The decision the board comes up with is final unless the individual appeals to the District Court. 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-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 (Optional) 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 23 Country of Origin United States of America Sexual Orientation Gay Religion Methodist Do you have a disability? No Ethnicity White 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. Item Number: 14.b. ..71441 CITY OF IOWA CITY www.icgov.org November 15, 2022 Climate Action Commission - Three vacancies to fill three-year terms, January 1, 2023 - December 31, 2025. (Terms expire for Clarity Guerra, Kasey Hutchinson, & Becky Soglin) ATTACHMENTS: Description Vacancy Notice/Coversheet Board Demographics/Attendance Fitsimmons, Elizabeth - Application Gade, Jamie -Application Halley, Michael -Application Haralson, Zach -Application Nielsen, Rebecca -Application Patricio, Garry - Application Sillman, Michelle -Application Smith, Angela - Application Turben-Fuhrman, Ethan -Application NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: CLIMATE ACTION COMMISSION Three Vacancies: Three -Year Term January 1, 2023 — December 31, 2025 • Duties of the Climate Action Commission include advising the City Council on climate issues; • researching, analyzing and promoting climate actions, with particular attention to equity; • educating and engaging with the public on climate action and the City's climate and sustainability goals; assisting City staff, City Council, and members of the community with implementing approved initiatives that support the City's climate and sustainability goals, including the Climate Action and Adaption Plan and any related or updated plan here after. • The Climate Action Commission meets the first Monday of each month at 3:30 p.m. in the MPO (Metropolitan Planning Organization) Conference Room at City Hall, 410 E. Washington Street, subject to change. Iowa City -appointed members of boards and commissions must be at least 18 years of age and Iowa City residency is preferred, but members are not required to be Iowa City residents as long as they are residents of Johnson County and meet the requirements of knowledge and expertise for guiding climate objectives. The City lowa City encourages diversity in the appointment of citizens to boards and commissions. Applications must be received by 5:00 p.m., Tuesday, November 8, 2022. An application can be completed and submitted on the City of lowa City website at www.icctov.orq or by contacting the City Clerk's office. Questions about the lowa City Climate Action Commission should be directed to Sarah Gardner, Climate Action Engagement Specialist Coordinator, at 887-6162. Board/Commission Application Cover Board/Commission: Climate Action Commission Three vacancies to fill a three-year term. January 1, 2023 - December 31, 2025 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: 10/3/2022 Application Deadline: 11/8/2022 Council Appointment Date: 11/15/2022 Date of Non -Gender Appointment: 1/1/2023 After date above Council may appoint without regard to gender Gender Balance Requirement: 3-Female Current Gender Balance: Female: 1 Male: 5 Gender Name and Address Female Fitzsimmons, Elizabeth 220 River St Apt 1G Female Gade, Jamie 245 S Stewart St Male Halley, Michael 310 Finkbine Lane #2 Male Haralsan, Zach 410 N Governor St Female Nielsen, Rebecca 611 Potter St Male Patricia, Garry 1984 Mackinaw Dr. Female Sillman, Michelle 760 Silver Charm Lane Female Smith, Angela 3310 Lower West Branch Rd Male Turben-Fuhrman, Ethan 2892 Coral Court Climate Action Commission Demographic Report Name Term Term Stop Resident Occupation Gender* Age* Country 'Sexual Religion' Disability' :Ethnicity" !Gender !Race" Type Number Term Years of !Orientation ° ,Identity'' Origin` i Benjamin Grimm Unexpired .1 12l3112D2312+years Grounds Male :41 USA straight Buddhist No ;Caucasian :male 'Caucasian *Full i Manager Matt Krieger Full :1 1213112023 15 years .Architect Male '39 United iNo Caucasian Male, He, ;White States :Him Matthew Walter Unexpired 12131120231.5yrs inIC ;Banking Male .32 United heterosexual athmst No male caucaaianlw (12 yrs IC 1 States kite area) John Fraser [ Full 1 12/31/2024 34 years 1Menagement Male 78 iUSA Straight Protestant No ;American Male White ' Consultant Michal Eynon- Full 1 12131/2024; Entrepreneur, Female Lynch !Philanthropist Gabriel Full 1 12/3112024 201 years ;self employed Male Stu reevant and student 'Vacant Full 12/31/2025 Vacant Full 12131/2025 :Vacant Full 12151;2025 CLIMATE ACTION COMMISSIONATTENDANCE RECORD 2022 NAME TERM EXP. F�-k N 1/10/2022 12/6/2021 N.)CO j N N.)N N N 4/4/2022 C`JS N N N C) N N Na 7/11/2022 r CO 0 N 9/12/2022 10/10/2022 Michel Eynon- Lynch 12/31/2024 — NM X X _ X X X X NM X X X John Fraser 12/31/2024 X NM X X X X X X NM X X X Stratis Giannakouros UI Rep X NM X 0/EX X X O/E NM X X X Clarity Guerra 12/31/2022 — NM X X X X O/E X NM X X X Ben Grimm 10/31/2023 X NM O/E X X O/E X X NM X X O/E Grace Holbrook* 12/31/2021 O/E NM -- Megan Hill* 12/31/2022 X NM X X X X X -- NM -- — — Kasey Hutchinson 12/31/2022 X NM X X X X X X NM X X X Matt Krieger 12/31/2023 X NM X X X X O/E X NM X O/E X Jesse Leckband MidAmerican Rep O/E NM X O/E X X X X NM X O/E X Becky Soglin 12/31/2022 X NM X X X X X X NM X X X Gabe Sturdevant 12/31/2024 -- NM X X X X O/E X NM X X O/E Eric Tate* 12/31/2021 X NM Matt Walter 12/31/2023 -- NM — -- — -- — — NM X O/E X 6 CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/24/2022 First Name* Elizabeth Last Name* Fitzsimmons First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 220 River St Apt 1 G 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* 5632581206 Email Address * erfitzsimmons@uiowa.edu Boards & Commissions Select a Board or Commission you are interested in: * Climate Action Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 4 years Occupation: * Student Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I am a senior at the University of Iowa and will graduate with a Bachelor of Science in Environmental Science in the spring. Currently, I am taking a course on Prairie Restoration, which involves direct, hands-on work to create and maintain sustainable landscapes in Iowa City. I have also completed the Climate Ambassador training and take part in climate -related volunteer opportunities whenever I can. What is your present knowledge of each advisory board you are interested in?* To my knowledge, the Climate Action Commission works to research, promote, and implement various plans and initiatives to help the city reach its sustainability goals. 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, 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 (Optional) 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 21 Country of Origin United States Sexual Orientation Bisexual Religion Do you have a disability? Yes Ethnicity Race White Gender identity Woman *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* ( i a4 C a&*tWHtotld 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/4/2022 First Name* Jamie Last Name* Gade First Name ( Phonetic spelling ) Optional Jay -me Last Name ( Phonetic spelling ) Optional Home Address* 245 S Stewart St City* North Liberty State IA Zip Code* 52317 Is your home address (listed above) within the corporate limits of Iowa City?* No Contact Phone Number* 3196885865 Email Address* jgade@johnsoncountyiowa.gov Boards & Commissions Select a Board or Commission you are interested in: * Climate Action Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 2014 - 2018, 2020 Occupation: * Public Health Systems Analyst Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * Experience with the CDC BRACE framework and applying it at Johnson County Public Health Launched a heat assessment in Johnson County to measure health vulnerabilities: https://healthyjoco.com/community-health-assessments/ What is your present knowledge of each advisory board you are interested in?* I have worked with Iowa City Climate Staff on climate related activities such as sharing of the heat assessment and future collaboration regarding results. 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-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 (Optional) 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 27 Country of Origin Johnson Sexual Orientation Straight Religion Do you have a disability? No Ethnicity Non Hispanic Race White Gender identity Female *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11 /1 /2022 First Name* Michael Last Name* Halley First Name ( Phonetic spelling ) Optional 6412330445 Last Name ( Phonetic spelling ) Optional Home Address* 310 Finkbine Lane #2 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* 641-233-0445 Email Address* mhalley25@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Climate Action Commission Preference on first choice If multiple boards are being applied for. Climate Action Commission How long have you been a resident of Iowa City? 1 month Occupation: * Account Manager Ideal Energy Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity' may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I'm currently enrolled in the city's Climate Ambassador Program, have 12 years experience working on community sustainability initiatives as a Fairfield city council member, and have been working in the solar industry for the past six years. What is your present knowledge of each advisory board you are interested in?* I know more about the Climate Action Commission than the Human Rights Commission, mostly through the Climate Ambassador Program. 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-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 (Optional) 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 47 Country of Origin United State Sexual Orientation Heterosexual Religion Do you have a disability? No Ethnicity European -American 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/5/2022 First Name* Zach Last Name* Haralson First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 410 N Governor St City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 4175299017 Email Address * zoharalson@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Climate Action Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 8.5 years Occupation: * Applied physicist at Collins Aerospace Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I have studied renewable energy since college, and after obtaining my PhD in experimental physics from the University of Iowa, I worked for 3 years on a fusion energy reactor development project. I pursued this as my contribution to the fight against climate change, and now that I have moved away from that job, back to Iowa City, I am excited to contribute in a different way on the Climate Action Commission. In Jan -Mar 2022, I went through the City's Climate Ambassador program, where I learned about the Climate Action Plan and how it is being carried out. Since then, I have been active with activities organized by the Climate Action Office --volunteering in the Energy Blitz, participating in several facility tours to learn more about City operations, and giving an interview with KCRG to promote the application period for the next class of the Climate Ambassador Program. What is your present knowledge of each advisory board you are interested in?* I have sat in on a few meetings of the Climate Action Commission, gaining a feel for how the meetings work and the mission. Then, during the Climate Ambassador Program, I learned the details of the Commission's mission and the Action Plan. 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, 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 (Optional) 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 33 Country of Origin United States Sexual Orientation Gay Religion Agnostic Do you have a disability? No Ethnicity 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* Z4 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/4/2022 First Name* Rebecca Last Name* Nielsen First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 611 Potter St City* Tiffin State IA Zip Code* 52340 Is your home address (listed above) within the corporate limits of Iowa City?* No Contact Phone Number* 319-688-5872 Email Address * rnielsen@johnsoncountyiowa.gov Boards & Commissions Select a Board or Commission you are interested in: * Climate Action Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? Occupation: * Emergency Preparedness Planner Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * As part of my work in emergency preparedness, I have focused in the impact climate change has had on natural disasters and how to adapt preparedness plans to mitigate this impact. What is your present knowledge of each advisory board you are interested in?* The Climate Action Committee advises on Iowa City's climate and sustainability goals and works to meet those goals through education, community programs, and other initiatives. 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-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 (Optional) 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 Country of Origin Sexual Orientation Religion Do you have a disability? Ethnicity Race Gender identity *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 6/28/2022 First Name* Garry Last Name* Patricio First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 1984 Mackinaw Dr. City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-981-6098 Email Address * garry.patricio@outlook.com Boards & Commissions Select a Board or Commission you are interested in: * Climate Action Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? Occupation: * Engineer Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I am the Director of Energy Delivery for Engie North America's utility operations at the University of Iowa. As the head of operations and maintenance for the concession agreement between the University of Iowa Energy Collaborative (UIEC) and the University of Iowa, I am responsible and directly oversee all utility -related sustainability initiatives on campus within our scope. This includes coal to oat hull and biomass pellets fuel replacement in the university's main power plant boilers. Prior to Engie, I was involved in the construction, commissioning, and commercial operation of a 170 MWe solar photovoltaic power plant, and demand -side electric power reduction activities at the Radford Army Ammunition Plant in Radford VA. What is your present knowledge of each advisory board you are interested in?* I understand that the Climate Action Commission is a body that advises the City Council regarding equitable climate actions in support of Iowa City's Climate Action and Adaptation Plan, as well as the Accelerating Iowa City's Climate Action Plan to reduce greenhouse gas emissions in our community. Iowa City's goals align with the Paris Climate agreement and have reduction targets of 25% reduction by 2025, and 80% by 2050. 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-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 (Optional) 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 45 Country of Origin Philippines Sexual Orientation Heterosexual Male Religion Roman Catholic Do you have a disability? No Ethnicity Race Gender identity *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 t (27 rJttltYil 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 6/14/2022 First Name* Michelle Last Name* Sillman First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 760 Silver Charm Lane City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-499-8110 Email Address * mtswrites@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Climate Action Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 4 years Occupation: * Communications and Stakeholder Relations Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I have read the Climate Action and Adaptation Plan for the City of Iowa City, attended the Electric Bus Bash, drive a hybrid car, am growing a pollinator -friendly, non pesticide habitat in my yard, purchase locally grown food, including eggs and chicken from a farmer, compost, and am reducing waste at my house through purchasing practices. I currently work for Engie North America as part of the University of Iowa Energy Collaborative. Engie is an energy company that is committed to implementing clean energy and is helping the Utilities at the Ul transition to sustainable energy by 2025. My role is engaging the university community on sustainability initiatives, teaching audiences about clean energy, and building private/public collaboration opportunities. What is your present knowledge of each advisory board you are interested in?* The Climate Action Commission meets monthly to advise the council and assist staff on climate actions and initiatives that will help the City of Iowa City meet its climate and sustainability goals. 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-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 (Optional) 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 57 Country of Origin United States Sexual Orientation heterosexual Religion Do you have a disability? No Ethnicity Hispanic Race white Gender identity female *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* rfrt�e;t,+srnet 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/2/2021 First Name* Angela Last Name* Smith First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 3310 Lower West Branch Rd City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3196217734 Email Address * angiesmith3310@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Climate Action Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 20 Occupation: * Psychologist Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I have served on the Parks and Recreation since 2017 and have enjoyed this higher level of civic engagement. My term ends at the end of this year and wish to continue this level of civic engagement. I am very concerned about the climate and read extensively about the climate. I believe we can make real tangible change in our own community and hope my participation in the Climate Action Committee would help promote change in my community. Iowa City is known as a leader in the state and there are still many action items our community we can do to be leaders in regards climate. I gained a great deal of knowledge regarding our tree inventory as a member of the Parks and Recreation committee as well. What is your present knowledge of each advisory board you are interested in?* I am aware of press releases and have read some agendas/minutes of the 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 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, 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?* Yes Board current serving on* Parks and Recreation Commission (Optional) 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 48 Country of Origin US Sexual Orientation Religion Do you have a disability? No Ethnicity Race Gender identity *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/28/2021 First Name* Ethan Last Name* Turben-Fuhrman First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 2892 Coral Court City* Coralville State IA Zip Code* 52241 Is your home address (listed above) within the corporate limits of Iowa City?* No Contact Phone Number* 9522215544 Email Address * fuhrman.ethan.j@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Climate Action Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? Two years Occupation: * Environmental Safety Coordinator Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * During my graduate career at the University of Iowa, I was the Sustainability Director for the Graduate and Professional Student Government. In that position, I spearheaded an attempt to reconcile the climate adaptation and waste reclamation efforts of the City and the University. The academic focus of my graduate career was on topics relevant to the scope of this commission, namely assessing impacts of local activities on air pollution. I earned a Master of Science in Chemistry in 2021 for this work. I presently serve as an Environmental Safety Coordinator with the University of Iowa Environmental Health and Safety Office, and the purpose of my position is, among others, to assist the University in waste reduction and reclamation efforts. On a personal level, I am an avid amateur prairie enthusiast, and I have delved quite deep into understanding the pre -settlement ecology of the area we now call Iowa and protecting what remains of its original grandeur. I believe that these experiences, interests, and activities constitute a significant breadth and depth of understanding of the issues involved with climate adaptation and building community climate resilience. What is your present knowledge of each advisory board you are interested in?* My understanding of the Climate Action Commission is that it exists to advise the City Council on issues related to climate, research climate issues, implement initiatives that support climate action, and assist in the implementation and/or setting of climate goals and actions. 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, 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 (Optional) 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 27 Country of Origin USA Sexual Orientation Straight Religion NA Do you have a disability? Yes Ethnicity Caucasian Race White Gender identity Cisgender *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. Human Rights Commission - January 1, 2023 - December Lindley, Mark Pries) Item Number: 14.c. _'"ewr�� CITY OF IOWA CITY www.icgov.org November 15, 2022 Three vacancies to fill a three-year term, 31, 2025. (Terms expire for Jason Glass, Ashley ATTACHMENTS: Description Vacancy Notice/Coversheet Board Demographics/Attendance Ali, Asma -Application Arnold, Matt -Application Beltre, Ines -Application Burr, Darla - Application Cellman, Christie - Application Channon, Suyun - Application Dedeaux-Norris, T.J. -Application Gilmore Sr., Kim -Application Hagerla, Denise - Application Hall, Ryan -Application Halley, Michael -Application Hawthorne, Thorn -Application Ismail, Ahmed -Application Jennings, Ashley - Application Krebs, Marie - Application Kreger, Grace - Application Kuku, Badri -Application Mohammed, Wifag -Application Pandya, Jahnavi -Application Patel, Kiran -Application Pries, Mark -Application Simon, Michael - Application Stevenson, Holly -Application Taylor, Janis -Application Tran, Catherine - Application Wiewel, Mitchell -Application NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: HUMAN RIGHTS COMMISSION Three Vacancies: Three -Year Term January 1, 2023 — December 31, 2025 • 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. • The Human Rights Commission meets the third Tuesday of each month at 5:30 p.m. in the Lobby Conference Room at City Hall, 410 E. Washington Street. 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, November8, 2022. An application can be completed and submitted on the City of Iowa City website at www,icgov.orq or by contacting the City Clerk's office. Questions about the Iowa City Human Rights Commission should be directed to Stefanie Bowers, Human Rights Coordinator at 356-5022. Board/Commission Application Cover Board/Commission: Human Rights Commission Three vacancies to fill a three year term. January 1, 2023 - December 31, 2025 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: 10/3/2022 Application Deadline: 11/8/2022 Council Appointment Date: 11/15/2022 Date of Non -Gender Appointment: 1/1/2023 After date above Council may appoint without regard to gender Gender Balance Requirement: 1 - Female, 2-Male, 1-None Current Gender Balance: Female: 3 Male: 2 Gender Name and Address Male Ali, Asma 1222 4th Ave Male Arnold, Matt 1830 F St Female Beltre, Ines 984 Westside Drive Female Burr, Darla 784 Mission Point Rd Female Gellman, Christie 128 Arabian Ct Female Channon, Suyun 3335 Limerick Ln Female ; Dedeaux-Norris, T.J. 332 S Linn St 418 Male Gilmore Sr, Kim 915 Harlocke Street, Unit 12 Female Hagerla, Denise 174 Shrader Rd Male Hall, Ryan 18 Kenneth Dr Male Halley, Michael 310 Finkbine Lane Female Hawthorne, Thorn 327 Highland Drive Male Ismail, Ahmed 2033 Keokuk St Apt 5 Female Jennings, Ashley 742 Perry Ct Female Krebs, Marie 3312 E Washington St Female Kreger, Grace 20 S, Lucas Street, Apartment D Male Kuku, Badri 2409 Bartelt Rd. Apt 7B Female mahammed, wifag 740 Mikael st Female Pandya, Jahnavi 1015 West Benton Street, Apartment 33 Female Patel, Kiran 817 1/2 N Linn St Male Pries, Mark 1128 Denbigh Drive Male Simon, Michael 706-4 Carriage Hill Female Stevenson, Holly 4430 E Court St Female Taylor, Janis 201 North lst Ave., Apt. 105 Female Tran, Catherine 283 Haywood Drive Male Wiewel, Mitchell 3216 Shamrock Dr Human Rights Commission Demographic Report Name Term Stop Term Resident Occupation Gender' Age' Country of Sexual Religion' Disability` Ethnicity' Gender Pace' Type Years Origin' Orientation* Identity' Roger Unexpired 4 12/31/2023 22 Years President /CEO Male 45 Demouatic Straight Non. No African Male Lusala Full at MYEP4 Mayor' Republic of Denominalio Youth Congo n empowerment Program) BIJOU Fult 12/31/2023 23 years Transtaloritnterpr Female United States Cllnslian No Female White MALIABO et Kelsey Unexpired 12/31/2023 Over 4 years Program Officer, Female 31 Canada/USA' Heterosexual Protestant No Female Black Paul Mass Violence Christian Shantz and Atrocities Prevention, Stanley Center Sylvia Jogs Full 12/31/2024 2 years Lead. Global Female Partnerships and Fellowships at the Institute of International Educ Doug Unexpired 12/31/2024 Managing Male 44 USA Gay None No Male Kallasch Consultant Vacant Unexpired 12/31/2024 Vacant Full 12/31/2025 Vacant Full 12/31/2025 Vacant Full 12/31/2025 Black/Africa n American Human Rights Commission ATTENDANCE RECORD YEAR 2022 NAME TERM EXP. 1/25 2/22 3/29 4/26 5/24 6/28 7/11 7/26 8/23 9127 10/25 11/22 12/27 Jason Glass 2022 P P P P P - P P P P P Ashley Lindley 2022 P P P P P - P P P P P [Hark Pries 2022 P P P P P - P P P P P Roger Lusala 2023 P P P P P - P P A P Bijou Mallabo 2023 P P P P P - P P P P P Kelsey Paul Shantz 2023 - - - - - P P P P VACANT 2024 P A P P P P P P P - Sylvia ions 2024 P A P P P - A P P P A Doug Kollaseh 2024 - - - - P P KEY: P = Present A — Absent R = Resigned I r t ®t , ■ alls._ M CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240- 1 826 (319) 356-5000 (319) 356-5009 FAX www.icgov.org City Council Agenda — November 15, 2022 — Formal Meeting Information submitted between distribution of packet on Thursday and 4:OOpm on Monday. Late Handout(s): Regular Agenda 14. Council Appointments 14.c & 14.d Human Rights Commission — See revised demographic report. Human Rights Commission Demographic Report Name Term Term Stop Resident Occupation Gender* Age* Country of Sexual Religion* Disability* Ethnicity* Gender Race* Type Num Term Years Origin* Orientation* Identity* Kelsey Unexpired 12/31/2023 Over 4 years Program Female 31 Canada/USA' Heterosexual Protestant No Female Paul Officer, Mass Christian Shantz Violence and Atrocities Prevention, Stanley Center Roger Unexpired + 1 12/31/2023 22 Years President /CEO Male 45 Democratic Straight Non- No African Male Black Lusala Full at MYEP( Republic of Denominatio Mayor Youth Congo n Empowerment Program) BIJOU Full 1 12/31/2023 23 years Translator/Inter Female United States Christian No Female Black/Afric MALIABO pret an American Sylvia Jons Full 1 12/31/2024 2 years Lead, Global Female Partnerships and Fellowships at the Institute of International Educ Doug Unexpired 12/31/2024 Managing Male 44 USA Gay None No Male White Kollasch Consultant Vacant Unexpired 12/31/2024 Vacant Full 12/31/2025 Vacant Full 12/31/2024 Vacant Full 12/31/2024 Please note: The information provided is the information provided on the application at the time of submission. *Information is voluntary Late Handouts Distributed (Date) CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/27/2021 First Name* Asma Last Name* Al i First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 1222 4th Ave City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3195944619 Email Address * asma12610@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 20 Occupation: * Arabic Language teacher, Substitute Teacher and Arabic interpreter -School Dist Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I feel qualified for this position when I was assigned the position of Vice President of the Sudanese Community in Iowa City, Chairman of the Social Committee of the Iowa City Mosque, and also my work in the Ministry of Education in Iowa, Cedar Rapids and Iowa City. All this and that gave me the ability to deal with a number of different peoples of the world and gain many experiences in the field of resolving family disputes without causing harm and creating friendly relations between members of some communities that suffer from the inability to open up to others within the United States of America. I also feel that I am qualified for this position due to the number of courses and studies I have received in the academic field in Sudan and America. What is your present knowledge of each advisory board you are interested in?* None. 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, 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 (Optional) 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 Country of Origin Sexual Orientation Religion Do you have a disability? Ethnicity Race Gender identity *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/1/2021 First Name* Matt Last Name* Arnold First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 1830 F St City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 612-803-5592 Email Address * mrmatthewarnold@yahoo.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 12 years Occupation: * consultant and adjunct lecturer Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * Over the past 18 months I've created and hosted a podcast called the Iowa Idea Podcast which focuses on themes of creativity, persistence, collaboration, and innovation. It is designed to focus on traditionally underrepresented voices. Themes of restorative justice, diversity, and regenerative approaches have been shared. My professional experience has been related to innovation and design, with an emphasis on team dynamics. We know that diverse orgs are more innovative. My interests are in how we can ensure Iowa City is doing its best to provide dignity and opportunity to all citizens. I'm a graduate of The Iowa City Area Business Partnership's Community Leadership Program. Additionally, my wife is a professor in the College of Ed and her work has focused on social justice. For the past year I have served as a volunteer organizer for One Million Cups Iowa City and have seen the power of collaboration to assist minority -owned business... and have seen how much more work there is to do to support Human Rights and equal opportunity in lowa City. I believe this combination of background and interest could help me serve our constituents in this volunteer capacity. What is your present knowledge of each advisory board you are interested in?* I was introduced to the commissions work through a presentation from Stefanie Bowers in the 2019-2020 Community Leadership Program. 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, 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 (Optional) 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 50 Country of Origin United States Sexual Orientation straight, cisgender Religion Do you have a disability? No Ethnicity European American Race White Gender identity Male, cisgender *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 8/30/2022 First Name* Ines Last Name* Beltre First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 984 Westside 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* 787-426-1037 Email Address * beltrei@yahoo.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? around 2.5 years (6 years in Iowa) Occupation: * Employment Manager (HR) Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * Currently part of the Diversity and Inclusion Committee for Johnson County. Also part of LULAC in Iowa City. I try to be on every activity regarding human rights, diversity and inclusion as well as keep up to date with news and changes, participate in symposiums and conferences. What is your present knowledge of each advisory board you are interested in?* it currently has 8 members, the Chair is Jason Glass. I read the minutes to keep tracking what the commission is doing for our 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 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. Do you currently have a conflict of Interest?* No Do you currently serve on another Iowa City board or commission?* No (Optional) 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 35 Country of Origin Dominican Republic Sexual Orientation Religion Do you have a disability? Yes Ethnicity Race Gender identity Female *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* 'd tYen, e:' 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 6/28/2022 First Name* Darla Last Name* Burr First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 784 Mission Point Rd City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 707-290-1984 Email Address * Darlaburr2014@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? One week Occupation: * Transitioning teacher Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * Teacher in a title 1 school for 4 years in CA with extensive experience advocating for students and their families. Living with a chronic illness since birth and I help run several support groups, as well as an ambassador for the Oley Foundation. What is your present knowledge of each advisory board you are interested in?* Human rights are a passion of mine and I would love to be a part of a commission that helps ensure human and civil rights are not violated. To be a part of community and educational programs for human 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 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. Do you currently have a conflict of Interest?* No Do you currently serve on another Iowa City board or commission?* No (Optional) 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 35 Country of Origin United States Sexual Orientation Female Religion Do you have a disability? Ethnicity Race Gender identity *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* titga_ strut. 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/27/2022 First Name* Christie Last Name* Cellman First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 128 Arabian Ct City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3199306177 Email Address * christie-cellman@uiowa.edu Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? Iowa City Occupation: * Graduate Research Assistant and DEI Director at the Daily Iowan Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I am a current MSW candidate, a graduate research assistant at the Law, Health Policy, & Disability Center, the DEI Director at the Daily Iowan, and I am heavily involved in the community - giving several public speeches and rallying for the greater good. Public speeches include a voter inauguration ceremony in 2018 call hosted by the NAACP, and two public speeches regarding the overturning of roe versus wade this year - one in Iowa city and one at the capital and Des Moines. What is your present knowledge of each advisory board you are interested in?* Disseminating information to educate the public on illegal discrimination and civil rights and making recommendations to City Council. 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, 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 (Optional) 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 35 Country of Origin United States Sexual Orientation Pan Religion Atheist Do you have a disability? Yes Ethnicity Race White Gender identity Non -binary *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 8/30/2022 First Name* Suyun Last Name* Channon First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 3335 Limerick Ln 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* 3195308074 Email Address * suyunma@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 15 Occupation: * University staff Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * - Global External Relations Officer, International Programs, The University of Iowa - Co-chair, Iowa City Area Chinese Association - Member, Iowa City Foreign Relations Council - Member, International Task Force, Iowa City Area Development Group What is your present knowledge of each advisory board you are interested in?* I am very familiar with the programs, awards, and funding opportunities provided by the Human Rights Commission. In fact, under my leadership, the local Chinese-American community is actively working with the Human Rights Commission to embrace and further improve diversity, equity, and inclusion in Iowa City and its surrounding area. 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, 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 (Optional) 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 Country of Origin Sexual Orientation Religion Do you have a disability? Ethnicity Race Gender identity *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* fl Gft L-`-/'edarevet 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 8/28/2022 First Name* T.J. Last Name* Dedeaux-Norris First Name ( Phonetic spelling ) Optional Dee Dough Last Name ( Phonetic spelling ) Optional Home Address* 332 S Linn St 418 City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 8184005236 Email Address* tj-dedeaux-norris@uiowa.edu Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 6 years Occupation: * Associate Professor/ Artist Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * T.J. Dedeaux-Norris is a mixed -media artist who employs painting, fiber, performance, video, and music to explore the somatic impacts of racial, gender, and class socialization. In form and content, their work poses a philosophical inquiry into the distinction between Self and Other, with the body as a social microcosm of distinct yet discursive dynamics to observe and question. Everything is both permeable and fractile. Dedeaux-Norris completed their BA at University of California at Los Angeles and their MFA at Yale University. Their work has been presented internationally at the Contemporary Arts Museum Houston, Mission Creek Festival, Nasher Museum of Art, Performa, Prospect New Orleans, Rotterdam Film Festival, The Studio Museum in Harlem, Sundance Film Festival, and The Walker Art Center - among other institutions. Dedeaux- Norris has participated in residencies at Grant Wood Colony, MacDowell, Skowhegan, and Yaddo. They are a 2019-2020 Pollock -Krasner Foundation grantee, a 2022 Iowa Artist Fellow, and a tenured Associate Professor at University of Iowa. What is your present knowledge of each advisory board you are interested in?* I am newly acquainting myself with the HRC and feel that within my art practice and teaching pedagogy that I embody and already practice the ideologies and concerns of the commission. Having lived in Cedar Rapids/Iowa City for the past 6 years, I believe I've gotten great lived experience in understanding the needs and gaps of needed programming and advocacy. I'm also an eager learner. 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, 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 (Optional) 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 43 Country of Origin Guam, USA Sexual Orientation NA Religion Do you have a disability? Ethnicity Black American Race multi raced (black/white/native/creole) Gender identity Fluid she/they pronouns *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* f d'ga'eae4V mat t 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/17/2021 First Name* Kim Last Name* Gilmore Sr First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 915 Harlocke Street, Unit 12 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* 319-981-1553 Email Address * kdavid5@yahoo.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 10/1/2021 Occupation: * VA Human Resource Specialist Employee/Labor Relations Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * The experience and activities that I feel qualify me for a seat on the Human Rights Commission are the following: 1) Avalon Park Local School Council (Chicago, II) - Vice -Chair and Parliamentarian - 1993 to 1996 2) City of Chicago 8th Ward Legislative Liaison for Alderman Lorraine Dixon — 1992 to 1993 3) National Forum of Black Public Administrators Chicago Chapter - Treasurer and Board Member -2000-2007 4) New Mexico Coalition for Literacy Board Member (Albuquerque, NM) -2012 to 2013 5) Salvation Army Corps Certified Disaster Worker (Orlando, FI) — 2017 to 2021 What is your present knowledge of each advisory board you are interested in?* My present knowledge of the Human Rights Commission is that it identifies organizations working to create a positive cultural impact through their activities for grant sponsorship. The Human Rights Commission champions actions that result in a level playing field for all people no matter how old or what color they are, what they believe in, what sex they identify with, where they are from, or whether they are disabled or married. The Human Rights Commission has three subcommittees that focus on housing, equity in health, and anti - racism. I would most effectively serve on the Housing Subcommittee, but I am willing to be placed on any committee. The Human Rights Commission also commissions surveys/studies that identify opportunities for improving the quality of life for disadvantaged Iowa City 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 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 (Optional) 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 58 Country of Origin United States Sexual Orientation Straight Religion Christian Do you have a disability? No Ethnicity African American Race African American 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* r� Cy7TlsIretp, 0.17t. 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. ra.arr�_ CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 6/29/2022 First Name* Denise Last Name* Hagerla First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Hey-girl-uh Home Address* 174 Shrader Rd City* Iowa City State IA Zip Code* 52245-4920 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 7732181287 Email Address* didihag@yahoo.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 7 months Occupation: * Clinical Social Worker Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I've spent much of my 20+ years as a social worker serving marginalized populations and providing education and support to other professionals working with the LGBTQIA+ community. I am always seeking opportunity to create, live, and work in community that strives to uphold the values of diversity, equity, and inclusion. This is a big impetus for my recent move to lowa City. What is your present knowledge of each advisory board you are interested in?* I've been watching the educational initiatives of the Human Rights Commission over the past several months and have been impressed with the level of community engagement and the breadth and scope of ways in which this committee reaches out to community for education and impact. I also have watched several hours of the committee meetings to witness the content and purpose of these meetings. 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-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 (Optional) 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 50 Country of Origin United States Sexual Orientation Lesbian/Queer Religion UUS Do you have a disability? No Ethnicity N/A Race White Gender identity Gender non -conforming *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* PE#I, � f{-Q +C,Q- 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 7/22/2022 First Name* Ryan Last Name* Hall First Name ( Phonetic spelling ) Optional 3192486400 Last Name ( Phonetic spelling ) Optional Home Address* 18 Kenneth Dr City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3158706939 Email Address* rhall@newpi.coop Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Select a Board or Commission you are interested in: * Historic Preservation Commission (HPC) Historic Preservation Commission Category* At -Large Preference on first choice If multiple boards are being applied for. Human Rights Commission How long have you been a resident of Iowa City? 7 years Occupation: * Information Technology and Data Analysis Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below, Male Female Experience and/or activities which you feel qualify you for this position: * > Political Science Honors graduate of the University of Iowa with a focus in bias, protest, and political revolution. Published academically on related topics. > Grew up in a poor single parent household and became a first generation college student. Understands the struggles of navigating our educational system without any prior experience or guidance. > Familiar with boards and their functions through my work with the board at New Pioneer Food Co-op > Very passionate about Iowa City's history and it's relationship with underserved communities. > Appreciative of the inclusivity that Iowa City offers while understanding that our work has just begun What is your present knowledge of each advisory board you are interested in?* > Familiar with the functions of the committees and their relationship with Iowa City as a whole > Understands the limits of the boards as well as their importance > Good sense of board relationships and how to constructively and inclusively navigate topics and build solutions 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-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 (Optional) 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 33 Country of Origin United States Sexual Orientation Heterosexual Religion None Do you have a disability? No Ethnicity Race White Gender identity Cisgender *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* /4&-129 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/6/2022 First Name* Michael Last Name* Halley First Name ( Phonetic spelling ) Optional 641-233-0445 Last Name ( Phonetic spelling ) Optional Ha -lee Home Address* 310 Finkbine Lane City* #2 State IA Zip Code* 52246 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 641-233-0445 Email Address * mhalley25@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? One week Occupation: * Account Manager at Ideal Energy, LLC Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * Served 12-years on Fairfield, Iowa city council and completed the Iowa League of Cities Certified Elected Municipal Official program, so I'm very familiar with city government. More recently I served as an unofficial advisor to the City of Fairfield Diversity, Equity, and Inclusion Committee, though I was not an official member. I've advocated for human rights during my time as an elected official and would like to expand that work here in Iowa City. What is your present knowledge of each advisory board you are interested in?* I read information provided on the city's website, read the most recent meeting minutes, and watched the most recent meeting on Channel 4. I have a general understanding of the commission's responsibilities and activities. 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, 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 (Optional) 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 47 Country of Origin United States Sexual Orientation Heterosexual Religion None Do you have a disability? No Ethnicity White 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* itOottitap 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/4/2022 First Name* Thorn Last Name* Hawthorne First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 327 Highland 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* 8179805820 Email Address * hello@thornhawthorne.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? Occupation: * Communications Specialist Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * As a communications specialist working in the next town over, I serve alongside city council and every board and commission. I've become extremely familiar with everything about the process and would really love to be able to do the same work in Iowa City since I live here. I'm transgender, disabled, and a descendant of refugees, so I'm also particularly well versed in related social justice and human rights issues. What is your present knowledge of each advisory board you are interested in?* I've been interested in and watching public meetings since I moved to Iowa 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, 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 (Optional) 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 26 Country of Origin America Sexual Orientation Queer Religion Do you have a disability? Yes Ethnicity Not Latino Race Middle Eastern / White Gender identity Transgender / Agender *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/5/2022 First Name* Ahmed Last Name* Ismail First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 2033 Keokuk St Apt 5 City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3196210813 Email Address * ahmedi2144@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 17 years Occupation: * Software Engineer Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * After finishing High School, I went on to pursue an industrial engineering degree at ISU. While there I got involved with a nonprofit called the National Society of Black Engineers. I served as the President of the Iowa State Chapter and then went on to serve on the national board, where I helped oversee 300+ collegiate chapters and launch a strategic plan to graduate 10k black engineers annually by 2025. I did this alongside the executive director and strategy consultants. I believe these experiences combined with my ability to advocate make me a great fit for the role. Furthermore, I also started a BLM chapter and have worked with the president of ISU to push for more equitable change within the university. What is your present knowledge of each advisory board you are interested in?* The commission is responsible of doing the following: 1) 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 2) Making recommendations to the City Council for such further legislation concerning discrimination as it may deem necessary and desirable 3) 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) 4) 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. 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-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 (Optional) 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 25 Country of Origin Sudan Sexual Orientation Religion Islam Do you have a disability? No Ethnicity Sudanese Race Black 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. ra.arr�_ CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 5/21/2022 First Name* Ashley Last Name* Jennings First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 742 Perry Ct City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 6414854760 Email Address * ashljennings@gmail.com 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 Select a Board or Commission you are interested in: * Housing and Community Development Commission(HCDC) Do you receive rental assistance? (?) Yes No Do you have expertise in construction?* (9) Yes ,3 No Do you have expertise in finance?* (7) Yes " No Select a Board or Commission you are interested in: * Library, Board of Trustees Select a Board or Commission you are interested in: * Parks and Recreation Commission Preference on first choice If multiple boards are being applied for. Civil Service How long have you been a resident of Iowa City? 6 years Occupation:* Learning Experience Designer Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity' may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I am a former University of Iowa lecturer with an extensive background in service learning and community involvement. I now work for the US Coast Guard's Leadership Development Center as an Instructional Systems Designer, and I strive to promote civic engagement and inclusivity in all I do. What is your present knowledge of each advisory board you are interested in?* I have a surface -level understanding of each of the above, but I'm interested and excited to learn more. 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-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 (Optional) 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 35 Country of Origin United States Sexual Orientation Heterosexual Religion Agnostic Do you have a disability? No Ethnicity Race White Gender identity Female *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 7/5/2022 First Name* Marie Last Name* Krebs First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 3312 E Washington St City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3199361573 Email Address * mariekrebs4@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 26 years Occupation: * Patient Access Specialist Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I am a mixed race woman who has much life experience dealing with racism and sexism. I have made it my life's work to help make change. I have volunteered with DVIP and helped with a women's build for Habitat for Humanity. I was trained and then led Diversity Dialogue Circles with WRAC. What is your present knowledge of each advisory board you are interested in?* I only know what I have read online regarding Human Rights Commission. I understand this to be a group that helps to educate our community on human rights issues and assists members of our community who have/believe to have had human rights violations occur. 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, 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 (Optional) 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 44 Country of Origin United States Sexual Orientation Heterosexual Religion None Do you have a disability? Yes Ethnicity Hispanic Race Japanese, Spanish, German, Apache Gender identity She/her *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* -+Watie LJLfee(' 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/8/2022 First Name* Grace Last Name* Kreger First Name ( Phonetic spelling ) Optional 5157107634 Last Name ( Phonetic spelling ) Optional Home Address* 20 S. Lucas Street, Apartment D City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 5157107634 Email Address* gkreger@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 11 years Occupation: * Program Director Assistant, Reach for Your Potential, Inc. Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I have ten years combined professional experience serving individuals with disabilities and low-income, at -risk youth (MYEP - Direct Support Professional/Program Facilitator, RFYP - Program Director Assistant, NCJC - Youth Counselor). I have extensive professional and volunteer experience working on political campaigns, most recently serving as an elected delegate in 2018 and 2020. I have additional formal volunteer experience with Iowa City Hospice, Iowa Youth Writing Project, and Girls on the Run. As an undergraduate student at the University of Iowa, I studied nonfiction creative writing with a focus on gender studies, social justice, trauma, and empowerment. I am passionate about advocating for and defending the rights of others. What is your present knowledge of each advisory board you are interested in?* The HRC educates the public on discrimination and civil rights via public forums, activities, and programs. The HRC also provides suggestions to City Council regarding legislation concerning discrimination. The HRC meets once a month, and members serve for three years. This is an unpaid, volunteer position. 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, 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 (Optional) 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 31 Country of Origin United States of America Sexual Orientation Bisexual Religion Unitarian Do you have a disability? No Ethnicity Caucasian Race White Gender identity Female *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* Pact KA/la 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. a 1 CITY OF IOWA CITY UNESCO CITY OF LRERATURE Advisory Board/Commission/Committee Application 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: Applicants MUST reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application Which Board or Commission(s) are you interest Which one do you prefer? Applicant Information: First Name* 13 A DR f Last Name* {‹,ti �( u First Name (Phonetic spelling) (Optional) Last Name (Phonetic spelling) ( (Optional) Home Address* 2 L4© 9 e U r4' l.�F i u apt- 71,Ey� City* o W g CAA y State 1 P Zip Code * j_ 24.4 6 Contact phone number* 3 Z at SSS g231 Email Address* load tl KAKu yafoc -co've► 1. Is your home address (listed above) within the corporate limits of Iowa City?* YpSv40 2. How long have you been a resident of Iowa City? /0 -( (,4 i' ' 3. Occupation:* r i_ L De_ I jrlfef 4. Gender* *This question is mandatory in order for the City to comply with the State's gender balance i_e,Guirem6it which treats gender as binary "Gender Identity" may be provided in the demographics section of the applicatt below. r<r" ed in kivh rch<lie Female 5. Experiences and/or activities which you feel qualify you for this position: 6. What is your present knowledge of each advisory board you are interested in? d c� Please contact the city attorney at 319-356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not ail potential conflicts. Potential Conflict of Interest The Housing and Community Development Commissionmakes recommendations to the City Council regarding the distribution of federal CBDG/HOME fiords. 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. 7. Do you currently have a conflict of interest?* YES I, NO Please identify any potential conflicts between membership on the advisory board an 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 propriet f.: artnee, 5%-Or 'ii ore of corporation's stockholdings). — --- I - _... List potential conflicts of interest* (See above for information regarding conflict of=ittterest4.— Please indicate if there are none. " BUSINESS NAME* BUSINESS ADDRESS* 9odartae, l/Y1►41(Atel 5.3,t4 ' A v..6 to, ► a G I52140 -5_ f 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. S. Do you currently serve on another Iowa City board or commission?* YES NO 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: Demographic Information: (optional) 9. Age 10. Country of OriginSlit 4drtc � A/ at 1I. Sexual. Orientation ti 12. Religion 't k l 13. Do you have a disability? YES NO 1!'' 14. EthnicityA-1ic-ci4 A -VA ect ✓t 15. Race t cJ 16. Gender Identity IcArkLe_ 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, except demographics, 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 (rev. 04/30/21) CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 8/29/2022 First Name* wifag Last Name* mohammed First Name ( Phonetic spelling ) Optional +11929434427 Last Name ( Phonetic spelling ) Optional Home Address* 740 Mikael st City* Iowa city State IA Zip Code* 52446 Is your home address (listed above) within the corporate limits of Iowa City?* No Contact Phone Number* 929-434-4274 Email Address * mohammedwifag@yahoo.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 4 years Occupation: * Nordstrom Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * My Story Introduction Despite tremendous social pressure on women in Sudan to stay silent, I've known since I was a child it was important to break the silence and speak out. It was important to become educated and empowered and then to encourage other women to do the same. I founded Haraza Organization for Peace and Development for Women's Empowerment (HOPD) that put me on the front lines assisting and empowering survivors of genocide in Darfur. Through my organization in Sudan . I trained women internally displaced (IDP) by the violence from 2003 to 2012 to participate in all levels of decision -making, including in the home, school, social, religious and political. Collaborations with international non -governmental organizations (INGO's) like United Nations Fund for Women (UNIFEM) and United Nations Mission in Darfur (UNAMID), the World Food Program WFP and United Nations Children's Fund (UNICEF) allowed me to channel funding to build health clinics, schools and water pumps for desperate villagers, and to provide food, clothing and basic services to women and children in IDP camps. These INGO's and others allowed me to produce a training manual and workshops that prepared IDP women to actively participate in the Abuja and Doha Peace Talks in 2006 and 2010. I was known for my persistence as the "Iron Lady." Sadly, I was forced into exile after armed Sudanese security forces threatened to kill me for speaking out about violence against women as a tool of the genocidal war in Darfur. While attending an international peace conference, I had shared horrible stories of women I met, like the mother and daughter who had been horribly raped and mutilated in front of each other. These stories reached the International Criminal Court (ICC) and became evidence included in the indictment of Sudanese President Omar al Bashir for War Crimes, Crimes Against Humanity and finally, Genocide. Early Life & Education I was born in Nyala, South Darfur, in Sudan on July 21, 1982 into an activist family of politicians committed to freedom. Many of my brothers and sisters worked for justice. Yet, from early on I witnessed discrimination in my family. My father had a high school education, my mother had none, and I could see the difference that made. The boys and men got attention, education, resources and support. Girls, including me, were submitted to female genital mutilation (FGM) and women experienced a lack of appreciation and opportunity. My father wanted me to get married young, but I was inspired by my older sisters who were educated. I insisted on going to school like them. I was so grateful my sisters helped me to get on that track that I knew I eventually wanted to pass it on to others. In 1999 I moved to Khartoum to study at the prestigious Khartoum University. Although I wanted to become a doctor, that path was not open to me because I was a Darfurian woman. I studied and got my BA degree from the College of Public and Environmental Health in 2002. At this time Darfurians were being targeted in Khartoum, so it was impossible for me to get a job. War in Darfur Despite the Darfurians best efforts to get the Government of Sudan (GoS) to provide basic services in areas like roads, electricity, drinking water, education and health, the central government in Khartoum did little to develop Darfur. People who spoke out or organized were imprisoned, tortured, killed and forced into exile. Once the Sudanese Air force started bombing villages, we lived in tear tor our lives. In 2003, a Darturian rebel group struck back, attacking El Fashir airport. They destroyed some of the planes that were used to bomb villages. In response, the government of Sudan initiated a campaign of terror. They increased their bombing of villages, training and arming militias called the Janjaweed. Darfurian men and children were killed; women were brutally raped; crops and stores of food were destroyed, and animals were slaughtered. Survivors fled as their villages burned to the ground, escaping with only those items they could carry on their backs. So many villages were demolished that soon refugees flooded the cities, seeking safety, shelter, food and medical care. Children arrived malnourished and died in their mothers' arms. Those of us who lived in cities faced a wall of discrimination that blocked Darfurians from getting jobs. Darfurian men had no avenues open to them and were channeled into the armed forces or local police forces. The GoS pushed our men to serve in the very group that was destroying us. Men who didn't follow this path became idle and frustrated, the most capable went to college in Khartoum, while others went into exile or joined the rebels. Women and children were left without their men. Amid such suffering, Darfurians became a miserable people. Establishing Haraza Organization for Peace and Development (HOPD) In 2002 I was seeing women and children trying to deal with the outbreak of civil war in Darfur. I decided to found the Haraza Organization for Peace and Development for Women's Empowerment. I named my non- governmental organization (NGO) after a tree called a haraza. This tree is dry in spring and stores water for the dry season. When no other trees have leaves or fruit or provide shade, the haraza offers solace. I formed a board that helped set goals and implement programs to help the victims. Haraza received funding from, and worked with, the international aid agencies listed above and groups from the European Union. Haraza worked in numerous camps; Kalma, Ottach, Derig and Salaam camps. There was so much need. Here are our areas of focus: • Providing for urgent needs: food, shelter, clothing • Capacity building workshops * Health education, HIV prevention and care * Violence Against Women (VAW) and Gender Based Violence (GBV) * Income Generating Activities • Training IDP women to be leaders in their communities * Peace Culture and Peace Building * Psychosocial support for women traumatized from rapes and witnessing the deaths of loved ones * Support for women prisoners • Training IDP women to understand their rights provided for under UNSC Resolution 1325 * Prepare women to participate in peace keeping * Trained IDP women to attend and participate in the Abuja Peace Talks (2006) and the Doha Peace Conference (2011) I collaborated with UNIFEM and made a training manual on Conflict Resolution and Negotiating Skills for Peace Building and Decision Making for IDP Women Leaders in South Darfur. We organized a ten day training to make sure women leaders got what they needed to participate in the ongoing peace talks. They contributed fresh, workable solutions to seemingly intractable struggles. This training was essential to ensure women's involvement in mechanisms that could prevent conflict, stop war and stabilize regions damaged by warfare. The workshop goals were: 1) To build skills for decision -making, leadership, negotiation and conflict resolution, 2) To involve displaced women in the negotiation process side by side with men and 3) To introduce UNSC 1325 and other international protections for women's rights in the context of the war in Darfur. Although the GoS Security forces barred me from attending the peace talks, I trained over 250 women and 50 men; sending thirty IDP women to actively participate in these high level negotiations. The Government Arrests Me For My Work The war in Darfur spread, eventually leaving over 4,000 villages burnt to the ground, over 300,000 people dead and nearly half the population of 6 million internally displaced, living in camps lacking every necessity, including security from attack. In 2008 ICC indicted Omar Al Bashir on War Crimes, Crimes Against Humanity and eventually charged him with the crime of Genocide. The GoS then expelled many of the most effective international aid agencies and began a campaign to find and get rid of anyone suspected of providing evidence to the ICC — either by killing them or forcing them into exile. I 1nrac nna of thnca tarnatari Ac a rnncaniianra of my uinrk in tha ramnc %nrith internatinnal airs ananriac 11nrac harassed, arrested, tortured, given death threats and eventually had to flee for my life. Here's why: With the international aid agencies gone, the Government of Sudan (GoS) soldiers and Janjaweed militias reignited their campaign of terror, kidnapping, raping, beating and harassing women in the camps. Everyone was afraid because there was no protection. In that moment of fear I recorded a letter of appeal for help to First Lady Michelle Obama. See link: To Michelle Obama from Wifag Ibrahim Widaa of Darfur https://www.youtube.com/watch?v=FlfyoLEQaKI This international appeal put my life at risk. One day, armed security forces stopped a women's empowerment training I was leading and arrested me. They violently interrogated me, accusing me of providing information to U.S. aid agencies that gave my testimony to the ICC. They questioned me about my involvement in training workshops, asked who my funders were, all the while threatening to kill me. I thought they were going to kill me then and there. I was terrified. Actually, I had indeed provided evidence that was submitted to the ICC. In early 2008 I had met Wanda Atkins at an international symposium on women's roles in resolving the conflict in Darfur in Kampala, Uganda. Wanda worked with International Justice Project (IJP) and took the stories I told about what I had witnessed in Darfur and gave that as evidence to the ICC. Aftermath and Continued Death Threats Three days after the first interrogation I bought a ticket to Khartoum, but I was arrested at the airport. I was detained in the security forces office there and questioned in an intimidating way about where I was going and why. I lied. I said I was going on vacation, when actually I was planning to attend a UNIFEM conference in Khartoum. I was carrying the training manual I edited and used when I trained IDP women to participate in the Doha Peace Conference (described above). The security forces accused me of wanting to go to a training workshop and said they were confiscating my manual. They insisted I could not take my training manual or get on the plane. I insisted it was within my rights to have the manual and fly to Khartoum. A local government official I knew happened to be at the airport, and he saw me detained. He intervened to advocate for me. He convinced them to let us board the plane. I got on the plane for Khartoum with my manual and attended the UNIFEM Conference. After a month, I returned to Nyala from Khartoum. When I finally tried to go back to work, I discovered the security forces had shut down the Haraza office. Soon after this, Janjaweed began following me. This was a very dangerous situation for me. One day they approached me while I was parked in my car. They ordered me out of my car, which I knew meant they were going to kidnap me. I knew what these armed men were capable of. I'd heard about their brutal rapes; I had seen women mutilated by having their throats slit or bones broken. I'd seen women ostracized and suffering with fistulas and psychological trauma. They tried to grab me with their guns pointed at my head, but I rolled the window up and locked my doors, refusing to get out of the car. They could kill me right there, on a street in Nyala, but I wasn't going with them. I saw a man I knew in a nearby park and signaled him to come over. I explained what was going on and asked him to drive my car. He got in and took the wheel. After another attempt by the Janjaweed to grab me, the man drove off and got me out of their reach to safety. At this point, I knew I MUST immediately leave. I left my family, my work and my country to arrive in the United States in June 2011. I now have been granted asylum. At this point it may look like those who are responsible for so much suffering in Darfur are winning: • President Omar Al Bashir remains free even though he has been charged with war crimes, crimes against humanity and genocide by the ICC • Peace talks have not stopped the violence • Hundreds of doctors, human rights and women rights advocates, journalists and others who spoke out for justice or simply told the truth about what's happening in Darfur have been killed, imprisoned or forced into exile I'm quite sad I can't at this time return to Darfur to continue my work with Haraza, yet I cannot let things stand as they are. With the women of Darfur in my heart, I would like to work with the United Nations to continue the trainings I was doing with the women IDP's inside Darfur, but now, perhaps, do it with Darfurian women refugees living in Chad. I would like to expand my understanding of women's roles in the peace building process and be a part of post -conflict reconstruction. NOTE A: A brief video made in Darfur, Sudan about my work with refugee in Darfur . My life in the USA: I arrived to the us in 2012 and started my life in state of new jersey and I astarted my asylem process I guranted asylem in 2013 and was suffering from a sevear depression from torture and punishment that I had when I was arrested in sudan that took for long time to heal until now I use medication for it . in 2017 I thought to continue my education here in the usa I asked about the good school to go and I have chosed iowa to come to attend inorder to go for medical school and achieve my American dream to becoming a doctor I like the quite state of iowa but unfortuinatly I didn't have many American frineds like when I was in new jersey so I didn't ivolove in to many event as before I contunied work in my school ELA to start medical school as I already have hold a BA in public health however I don't know the medical school rquerment in the usa . In later 2017 I knew Magrret when I went to event in Christian church in 42th st cedar rapids and joined them serving food ,cleaning or attend a program I brought food to the church that I made salmon with vegitable that been liked by every one at the event .and the posster apricate that . I made some American frineds in catholic mcauly centaer Anne Digger ,steve and others I laso have engaged with other Islamic center in Cedar rapids to help and joine activities .last January while I was working in hotel Kirkwood there was an event by the United nation -state of iowa and I met Anne Ann Woodward the program manager that she talked to me and I have shared my story with her and she watched my documantry film about my work with women in Darfur during the war she knows my story and later she arranged me to give a speech in their panel in next month May 2022. I also got to know my Neighbor Cara and we have a good relationship as neighbors her sisire and she help me a lot they bring me some furniture and kitchen's tools her mother sent me a gift card from seatel Washington . in kirkwood community collage in 2018 I participate in Norton writer's Prize that I got help from Mr Ryan Dehner my grammar teacher ,and the writing center assistant Kirkwood cedar rapids Ms Janis bultman . I was unlucky to win that prize.put I never give up I keep working for any chance I heard . Why I am applying for Iowa dream , I apply to this scholarship because I have finiacial hardship as I am suffering with depression I felt to pay my rent because I go to school and got sick last february the doctor decide me an operation surgeory for gallstone removal . in addition to I have wrote my book about my story from American dream in Arabic this book has 3 years I still unable to publish it because I contact the publication company the need 24 thousand to be paid if win the scholarship that will help solve lots of problem buy a car because 3 years ago someone gave a car but has a lot of problem . Short term goal : I am enrolled in Kirkwood community collage now about to finished the ELA .after I finish the collage I apply for the medical school in university of Iowa If I got a scholarship because I don't have much money to pay by myself .then I will continue to finish my book and its amazing story of living in two different situation in Africa and USA and publish my book in English so that the American can read my story . My long term goal : is to work 0for women and become a women peace ambassador Activities I feel Qualify is Training : To train young people about empowerment that a unique methods to help them make their life's goal to achieve their dream . Also to integrate the American people and immigrant culture (cross culture exchange ) to make unity among all people residents in Iowa that can be by organizing public event ,meetings or churches and mosques. What is your present knowledge of each advisory board you are interested in?* I know about Human Rights as hard work to reduce the human discrimination and civil rights by providing help through a recommendation to the city counsel for the such discrimination. also to planning programs and activities to eliminate all kind of discrimination. (Race ,Religion ,sex,color,gendder,Age ,disability Identity and marital status. 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, 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 (Optional) 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 40 Country of Origin Sudan Sexual Orientation woman Religion Islam Do you have a disability? No Ethnicity black Race Sudanes Gender identity Female *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/28/2022 First Name* Jahnavi Last Name * Pandya First Name ( Phonetic spelling ) Optional Jan-vi Last Name ( Phonetic spelling ) Optional Home Address* 1015 West Benton Street, Apartment 33 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* 3198559608 Email Address * jahnavi-pandya@uiowa.edu Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 1 year 3 months Occupation: * Doctoral student in Counseling Psychology Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I have worked in various areas in human rights advocacy and justice. As a psychologist in India, I did a lot of work with the marginalized sections of the society including women on the streets, children in an orphanage, in Juvenile Observation Homes. I have gone to schools where children have been denied admission to advocate for their rights and also worked with parents from the lower SES who have been treated wrongfully. As a psychologist in a corporate organization, I helped a group of women who were being sexually harassed not only in therapy but also in the process of advocacy. Currently as a practicum student I provide free services to refugees and immigrants at IC Compassion. I am also a member of the Anti -Racism Committe in the College of Education and am an Advisor at weareSAATH, a new Indian student organization taking the initiative for mental health advocacy among Indian students at the University of Iowa. I have also worked as a volunteer with the Native American population in Cass Lake in August 2022. I strongly believe in community support for human rights advocacy. US being a diverse country and Iowa City too having diverse population, I would like to work with this committee to reach the community in a culturally sensitive way that helps advocate for equity and social justice, keeping in mind several social and cultural barriers, and also work on activities to help create unity in diversity and belonging. Having a background in counseling psychology, I also believe I will be able to use my skills to be a compassionate listener and bring my experiences in the work at this commission. What is your present knowledge of each advisory board you are interested in?* From what I have read and known about the Human Rights Commission, this committee works to educate people on human rights and discrimination while also encouraging ways to support a sense of community, belonging and unity. 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-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 (Optional) 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 25 Country of Origin India Sexual Orientation Heterosexual Religion Hindu Do you have a disability? No Ethnicity Gujarati Race Asian Gender identity Female *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. ra.arr�_ CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 8/30/2022 First Name* Kiran Last Name* Patel First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 817 1/2 N Linn St City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3193256424 Email Address * kiranmariepatel@gmail.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) Do you receive rental assistance? (?) Yes No Do you have expertise in construction?* (?) Yes No Do you have expertise in finance?* (?) Yes No Preference on first choice If multiple boards are being applied for. Human Rights Commission How long have you been a resident of Iowa City? Occupation: * Map Delineator Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male ./ Female Experience and/or activities which you feel qualify you for this position: * I have a long history advocating for human rights issues, most notably voting rights as an organizer for the March On for Voting Rights. Additionally, I know what it's is like not be welcomed in public spaces, and I would like to prevent other people from having similar experiences. What is your present knowledge of each advisory board you are interested in?* I am aware of the work of the advisory boards. 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-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 (Optional) 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 36 Country of Origin USA Sexual Orientation Asexual Religion Atheist Do you have a disability? Ethnicity Indian American Race Multiracial Gender identity Cis Woman *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* f e7if (;;;?k lr (J"`flt 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. ra.arr�_ CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/7/2022 First Name* Mark Last Name* Pries First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Preese Home Address* 1128 Denbigh 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* 319-321-5263 Email Address* pries.mark@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 15 years Occupation: * Pastor, retired Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * 5 years as a Human Rights Commissioner in the City of Dubuque, Iowa (1978-1983); continual training in Human Rights work as a theologian, pastor, and citizen; completing a first term with the IC Human Rights Commission during which time I have received training in implicit bias, critical race theory, E.Q. (emotional intelligence) toward understanding the necessity for D.E.I. (diversity, equity and inclusion) to enrich and hold secure life of every resident. The IC HRC has just begun a 3 year strategic plan "Breaking Bread" in which I had a contributing role and am prepared to invest all the more in the realization of this plan. I am an old (73), white, heterosexual, married, male with a passion for the human rights of every person - a willing and eager voice with time and energy to to serve. What is your present knowledge of each advisory board you are interested in?* I'm completing a first term on the IC Human Rights Commission. My attendance record is near perfect as we navigated our way thru the COVID-19 pandemic. I have led the training sessions for citizens to learn how to apply for Iowa City's annual Human Rights grants and then contributed to the ranking and awarding of these grants; I have served on the Human Rights Award committee this and last year. my relationships with Stefanie Bowers, Equity and Human Rights Director, and commissioners is positive and supportive. 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-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 (Optional) 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 73 Country of Origin United States of America Sexual Orientation Heterosexual Religion Christian Do you have a disability? No Ethnicity German 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/3/2021 First Name* Michael Last Name* Simon First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 706-4 Carriage Hill 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* 520-234-7310 Email Address * mdsimoniv@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? Occupation: * Bus Driver Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I work in public transportation. What is your present knowledge of each advisory board you are interested in?* Entry level 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-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 (Optional) 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 Country of Origin Sexual Orientation Religion Do you have a disability? Ethnicity Race Gender identity *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* KiW;-0,,rnta0. u_c?fteet 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 8/29/2022 First Name* Holly Last Name* Stevenson First Name ( Phonetic spelling ) Optional 3198008421 Last Name ( Phonetic spelling ) Optional Home Address* 4430 E Court St City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3198008421 Email Address * hastevenson@optimaelifeservices.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? Occupation: * Director of Diversity, Equity and Inclusion Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I currently serve as the Director of Diversity, Equity and Inclusion for Optimae LifeServices. We serve over 40 of Iowa counties and I am based out of Iowa City. I have my PhD in Philosophy, focusing on social injustice, from The University of Iowa and I also have my MAs in Philosophy and Gender, Women and Sexuality Studies. I am published on issues pertaining to marginalization and intersectionality and I also offer a unique perspective being from the U.K and also having an invisible disability. What is your present knowledge of each advisory board you are interested in?* At present, I am aware that this board is doing invaluable work to both spread awareness and education to all members of the community regarding their rights but also to promote social justice progress to make Iowa City a city that is advancing DEI initiatives and making them a priority. 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-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 (Optional) 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 27 Country of Origin United Kingdom Sexual Orientation Straight Religion N/A Do you have a disability? Yes Ethnicity Race White Gender identity Female *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* iallf 45r oe 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. zniyhtt CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/4/2021 First Name* Janis Last Name* Taylor First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 201 North 1st Ave., Apt. 105 City* Iowa City State IA Zip Code* 52245-3608 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 5635802682 Email Address * jantaylorj1940@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? Since 1985 Occupation: * Retired Educator and College Professor Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * Volunteer with Inside Out Reentry Community, Free Lunch Program, many years of work with Iowa Valley Habitat for Humanity and service on their board. Study group "Act Justly" researching and studying white supremacy and steps to racial reconciliation at Saint Andrew Presbyterian Church for the past two years. What is your present knowledge of each advisory board you are interested in?* I will admit that I am a novice. I have read through some of the Human Rights Commission web page, some recent agendas and attached documents from grant recipients. I will continue reading and studying those. Of the subcommittees, I would be interested in serving on the Anti -Racism subcommittee, but am willing to work wherever I am needed 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-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 (Optional) 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 81 Country of Origin United States Sexual Orientation Heterosexual Religion Christian -Protestant Do you have a disability? No Ethnicity Swedish -German -British Race white Gender identity female *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 8/30/2022 First Name* Catherine Last Name* Tra n First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 283 Haywood Drive City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 5157328433 Email Address * tran.catherinekim@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 1 year Occupation: * Executive Director, Immigrant Entrepreneurs Summit Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I am the Executive Director for a nonprofit organization that works with immigrant and minority business owners to help educate and advocate for business success. We hold business summits in Eastern Iowa as well as in other parts of the Midwest to bring people together to support and encourage the immigrant entrepreneurial experience. Additionally, I serve as Branch Manager and Marketing Manager at Community CPA, a regional CPA firm that is an immigrant and woman -owned business, and which serves a large immigrant and minority client base. What is your present knowledge of each advisory board you are interested in?* I am interested in the Human Rights Commission. Currently, I know some of the members who were formerly part of the commission, and I know that it advocates for civil rights in Iowa City, as well as make recommendations for 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 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 (Optional) 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 35 Country of Origin USA Sexual Orientation Religion Do you have a disability? Ethnicity Vietnamese Race Gender identity *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/9/2021 First Name* Mitchell Last Name* Wiewel First Name ( Phonetic spelling ) Optional 5414805359 Last Name ( Phonetic spelling ) Optional Home Address* 3216 Shamrock Dr City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 541-480-0746 Email Address * mitchwiewel@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 4 months Occupation: * Marketing Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * Racism has been at the forefront of my mind since high school, where my junior or senior year I was in the principal's office for defending my friend, one of the only Mexican girls in the school after she was insulted and spat on. Before that, I watched a group of kids participate in a weekly racist march down the hallway, well known as "white power Wednesdays". They wore blue jeans and a white t-shirt and a grin as they walked together as a group down the halls each Wednesday. This was Hempstead High School in Dubuque, Iowa, in 2006. Later in life, I married the most beautiful human being, a Mexican girl, who opened my mind to so many new and beautiful experiences and people. I was scared to try chorizo before her. She took me to a drag queen show for my birthday. She introduced me and helped me befriend gay people and convinced me to wear a homemade glitter and rainbow t-shirt for 'Pride'. Now, my children are half -Mexican and when Trump was elected, I was terrified for the direction our country was headed. Most of all, the racial outbursts he was inspiring in elementary schools during his campaign. I watched as minorities were blamed for other people's problems. Throughout his presidency, I've stood by and avoided multiple altercations as white people around me spoke abhorrently about minorities, whom I married, and became friends and family with so many others. I stood by to avoid a fistfight, to avoid losing jobs, and the list goes on - but that is what the Black Lives Matter movement opened my eyes to - the need to stop avoiding conflict and embrace it for anything to ever change. To take a stance and stop being silent and "safely neutral" especially when someone speaks hate in my presence. So what do all of my personal anecdotes have to do with what is happening now? A lifelong observation of xenophobia - a word I heavily researched in college as a Sociology major. There was a lot of racism where I grew up, towards Blacks, Mexicans, Gay people, and anyone different. I've had a lot of time to reflect and analyze everything I experienced. Here's the key: Something happens when you are exposed and not just exposed to but interact and build relationships with people who are different than you. When you meet people from other cultures around the world or people here in the States that live differently than you. Whether they are poor or rich, black or brown, gay or straight. When you get to know them, you realize we are all just humans, we all want the same things in life: equality, love, safety, and opportunity. I want to help educate others and their children. I want people to get to know someone that makes them uncomfortable. To get outside their comfort zone and stop being fearful and speak up. To help create a world of joy for ourselves, our neighbors, and our community. I am invested in becoming engrained in the Iowa City community and part of that includes volunteering for good causes and being actively involved in local politics. What is your present knowledge of each advisory board you are interested in?* I know the position is available and that I would do my best. I understand the layers of government and the role these committees play in the bigger picture, and that we work with the Council and advise but certainly do not have authority. 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-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 (Optional) 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 35 Country of Origin United States Sexual Orientation Heterosexual Religion Catholic Do you have a disability? No Ethnicity White 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. Item Number: 14.d. _'"ewr�� CITY OF IOWA CITY www.icgov.org November 15, 2022 Human Rights Commission - One vacancy to fill an unexpired term, upon appointment - December 31, 2024. (Siri Felker resigned) ATTACHMENTS: Description Vacancy Notice/Coversheet Board Demographics/Attendance Ali, Asma - Application Arnold, Matt - Application Beltre, Ines -Application Burr, Darla - Application Cellman, Christie - Application Channon, Suyun - Application Dedeaux-Norris, T.J. -Application Gilmore Sr., Kim -Application Hagerla, Denise -Application Hall, Ryan -Application Halley, Michael -Application Hawthorne, Thorn - Application Ismail, Ahmed -Application Jennings, Ashley - Application Krebs, Marie - Application Kreger, Grace - Application Kuku, Badri -Application Mohammed, Wifag -Application Pandya, Jahnavi -Application Patel, Kiran -Application Pries, Mark -Application Simon, Michael -Application Stevenson, Holly -Application Taylor, Janis -Application Tran, Catherine - Application Wiewel, Mitchell -Application NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: HUMAN RIGHTS COMMISSION One Vacancy: Unexpired Term Upon Appointment — December 31, 2024 • 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. • The Human Rights Commission meets the third Tuesday of each month at 5:30 p.m. in the Lobby Conference Room at City Hall, 410 E. Washington Street. Iowa City -appointed members of boards and commissions must be at least 18 years of age and live in lowa 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 8, 2022. An application can be completed and submitted on the City of Iowa City website at www.icbov.orq or by contacting the City Clerk's office. Questions about the Iowa City Human Rights Commission should be directed to Stefanie Bowers, Human Rights Coordinator at 356-5022. Board/Commission Application Cover Board/Commission: Human Rights Commission One vacancy to fill an unexpired term. Upon appointment - December 31, 204 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: 11/1/2022 Application Deadline: 11/8/2022 Council Appointment Date: 11/15/2022 Date of Non -Gender Appointment: 1/1/2023 After date above Council may appoint without regard to gender Gender Balance Requirement: 1-Female, 2-Male, 1-None Current Gender Balance: Female: 3 Male: 2 Gender Name and Address Male Ali, Asma 1222 4th Ave Male Arnold, Matt 1830 F St Female Beltre, Ines 984 Westside Drive Female Burr, Darla 784 Mission Point Rd Female Cellman, Christie 128 Arabian Ct Female Channon, Suyun 3335 Limerick Ln Female Dedeaux-Norris, T.J. 332 S Linn St 418 Male Gilmore Sr, Kim 915 Harlocke Street, Unit 12 Female Hagerla, Denise 174 Shrader Rd Male Hall, Ryan 18 Kenneth Dr Male Haney, Michael 310 Finkbine Lane Female Hawthorne, Thorn 327 Highland Drive Male Ismail, Ahmed 2033 Keokuk St Apt 5 Female Jennings, Ashley 742 Perry Ct Female Krebs, Marie 3312 E Washington St Female Kreger, Grace 20 S. Lucas Street, Apartment 0 Male Kuku, Badri 2409 Bartelt Rd. Apt 7B Female mohammed, wifag 740 Mikael st Female Pandya, Jahnavi 1015 West Benton Street, Apartment 33 Female Patel, Kiran 817 1/2 N Linn St Male Pries, Mark 1128 Denbigh Drive Male Simon, Michael 706-4 Carriage Hill Female Stevenson, Holly 4430 E Court St Female Taylor, Janis 201 North lst Ave., Apt. 105 Female Tran, Catherine 283 Haywood Drive Male Wiewel, Mitchell 3216 Shamrock Dr Human Rights Commission Demographic Report Name Term Stop Term Resident Occupation Gender' Age' Country of Sexual Religion' Disability` Ethnicity' Gender Pace' Type Years Origin' Orientation* Identity' Roger Unexpired 4 12/31/2023 22 Years President /CEO Male 45 Demouatic Straight Non. No African Male Lusala Full at MYEP4 Mayor' Republic of Denominalio Youth Congo n empowerment Program) BIJOU Fult 12/31/2023 23 years Transtaloritnterpr Female United States Cllnslian No Female White MALIABO et Kelsey Unexpired 12/31/2023 Over 4 years Program Officer, Female 31 Canada/USA' Heterosexual Protestant No Female Black Paul Mass Violence Christian Shantz and Atrocities Prevention, Stanley Center Sylvia Jogs Full 12/31/2024 2 years Lead. Global Female Partnerships and Fellowships at the Institute of International Educ Doug Unexpired 12/31/2024 Managing Male 44 USA Gay None No Male Kallasch Consultant Vacant Unexpired 12/31/2024 Vacant Full 12/31/2025 Vacant Full 12/31/2025 Vacant Full 12/31/2025 Black/Africa n American Human Rights Commission ATTENDANCE RECORD YEAR 2022 NAME TERM EXP. 1/25 2/22 3/29 4/26 5/24 6/28 7/11 7/26 8/23 9127 10/25 11/22 12/27 Jason Glass 2022 P P P P P - P P P P P Ashley Lindley 2022 P P P P P - P P P P P [Hark Pries 2022 P P P P P - P P P P P Roger Lusala 2023 P P P P P - P P A P Bijou Mallabo 2023 P P P P P - P P P P P Kelsey Paul Shantz 2023 - - - - - P P P P VACANT 2024 P A P P P P P P P - Sylvia ions 2024 P A P P P - A P P P A Doug Kollaseh 2024 - - - - P P KEY: P = Present A — Absent R = Resigned I r t ®t , ■ alls._ M CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240- 1 826 (319) 356-5000 (319) 356-5009 FAX www.icgov.org City Council Agenda — November 15, 2022 — Formal Meeting Information submitted between distribution of packet on Thursday and 4:OOpm on Monday. Late Handout(s): Regular Agenda 14. Council Appointments 14.c & 14.d Human Rights Commission — See revised demographic report. Human Rights Commission Demographic Report Name Term Term Stop Resident Occupation Gender* Age* Country of Sexual Religion* Disability* Ethnicity* Gender Race* Type Num Term Years Origin* Orientation* Identity* Kelsey Unexpired 12/31/2023 Over 4 years Program Female 31 Canada/USA' Heterosexual Protestant No Female Paul Officer, Mass Christian Shantz Violence and Atrocities Prevention, Stanley Center Roger Unexpired + 1 12/31/2023 22 Years President /CEO Male 45 Democratic Straight Non- No African Male Black Lusala Full at MYEP( Republic of Denominatio Mayor Youth Congo n Empowerment Program) BIJOU Full 1 12/31/2023 23 years Translator/Inter Female United States Christian No Female Black/Afric MALIABO pret an American Sylvia Jons Full 1 12/31/2024 2 years Lead, Global Female Partnerships and Fellowships at the Institute of International Educ Doug Unexpired 12/31/2024 Managing Male 44 USA Gay None No Male White Kollasch Consultant Vacant Unexpired 12/31/2024 Vacant Full 12/31/2025 Vacant Full 12/31/2024 Vacant Full 12/31/2024 Please note: The information provided is the information provided on the application at the time of submission. *Information is voluntary Late Handouts Distributed (Date) CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/27/2021 First Name* Asma Last Name* Al i First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 1222 4th Ave City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3195944619 Email Address * asma12610@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 20 Occupation: * Arabic Language teacher, Substitute Teacher and Arabic interpreter -School Dist Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I feel qualified for this position when I was assigned the position of Vice President of the Sudanese Community in Iowa City, Chairman of the Social Committee of the Iowa City Mosque, and also my work in the Ministry of Education in Iowa, Cedar Rapids and Iowa City. All this and that gave me the ability to deal with a number of different peoples of the world and gain many experiences in the field of resolving family disputes without causing harm and creating friendly relations between members of some communities that suffer from the inability to open up to others within the United States of America. I also feel that I am qualified for this position due to the number of courses and studies I have received in the academic field in Sudan and America. What is your present knowledge of each advisory board you are interested in?* None. 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, 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 (Optional) 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 Country of Origin Sexual Orientation Religion Do you have a disability? Ethnicity Race Gender identity *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/1/2021 First Name* Matt Last Name* Arnold First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 1830 F St City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 612-803-5592 Email Address * mrmatthewarnold@yahoo.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 12 years Occupation: * consultant and adjunct lecturer Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * Over the past 18 months I've created and hosted a podcast called the Iowa Idea Podcast which focuses on themes of creativity, persistence, collaboration, and innovation. It is designed to focus on traditionally underrepresented voices. Themes of restorative justice, diversity, and regenerative approaches have been shared. My professional experience has been related to innovation and design, with an emphasis on team dynamics. We know that diverse orgs are more innovative. My interests are in how we can ensure Iowa City is doing its best to provide dignity and opportunity to all citizens. I'm a graduate of The Iowa City Area Business Partnership's Community Leadership Program. Additionally, my wife is a professor in the College of Ed and her work has focused on social justice. For the past year I have served as a volunteer organizer for One Million Cups Iowa City and have seen the power of collaboration to assist minority -owned business... and have seen how much more work there is to do to support Human Rights and equal opportunity in lowa City. I believe this combination of background and interest could help me serve our constituents in this volunteer capacity. What is your present knowledge of each advisory board you are interested in?* I was introduced to the commissions work through a presentation from Stefanie Bowers in the 2019-2020 Community Leadership Program. 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, 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 (Optional) 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 50 Country of Origin United States Sexual Orientation straight, cisgender Religion Do you have a disability? No Ethnicity European American Race White Gender identity Male, cisgender *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 8/30/2022 First Name* Ines Last Name* Beltre First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 984 Westside 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* 787-426-1037 Email Address * beltrei@yahoo.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? around 2.5 years (6 years in Iowa) Occupation: * Employment Manager (HR) Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * Currently part of the Diversity and Inclusion Committee for Johnson County. Also part of LULAC in Iowa City. I try to be on every activity regarding human rights, diversity and inclusion as well as keep up to date with news and changes, participate in symposiums and conferences. What is your present knowledge of each advisory board you are interested in?* it currently has 8 members, the Chair is Jason Glass. I read the minutes to keep tracking what the commission is doing for our 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 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. Do you currently have a conflict of Interest?* No Do you currently serve on another Iowa City board or commission?* No (Optional) 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 35 Country of Origin Dominican Republic Sexual Orientation Religion Do you have a disability? Yes Ethnicity Race Gender identity Female *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* 'd tYen, e:' 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 6/28/2022 First Name* Darla Last Name* Burr First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 784 Mission Point Rd City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 707-290-1984 Email Address * Darlaburr2014@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? One week Occupation: * Transitioning teacher Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * Teacher in a title 1 school for 4 years in CA with extensive experience advocating for students and their families. Living with a chronic illness since birth and I help run several support groups, as well as an ambassador for the Oley Foundation. What is your present knowledge of each advisory board you are interested in?* Human rights are a passion of mine and I would love to be a part of a commission that helps ensure human and civil rights are not violated. To be a part of community and educational programs for human 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 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. Do you currently have a conflict of Interest?* No Do you currently serve on another Iowa City board or commission?* No (Optional) 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 35 Country of Origin United States Sexual Orientation Female Religion Do you have a disability? Ethnicity Race Gender identity *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* titga_ strut. 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/27/2022 First Name* Christie Last Name* Cellman First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 128 Arabian Ct City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3199306177 Email Address * christie-cellman@uiowa.edu Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? Iowa City Occupation: * Graduate Research Assistant and DEI Director at the Daily Iowan Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I am a current MSW candidate, a graduate research assistant at the Law, Health Policy, & Disability Center, the DEI Director at the Daily Iowan, and I am heavily involved in the community - giving several public speeches and rallying for the greater good. Public speeches include a voter inauguration ceremony in 2018 call hosted by the NAACP, and two public speeches regarding the overturning of roe versus wade this year - one in Iowa city and one at the capital and Des Moines. What is your present knowledge of each advisory board you are interested in?* Disseminating information to educate the public on illegal discrimination and civil rights and making recommendations to City Council. 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, 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 (Optional) 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 35 Country of Origin United States Sexual Orientation Pan Religion Atheist Do you have a disability? Yes Ethnicity Race White Gender identity Non -binary *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 8/30/2022 First Name* Suyun Last Name* Channon First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 3335 Limerick Ln 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* 3195308074 Email Address * suyunma@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 15 Occupation: * University staff Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * - Global External Relations Officer, International Programs, The University of Iowa - Co-chair, Iowa City Area Chinese Association - Member, Iowa City Foreign Relations Council - Member, International Task Force, Iowa City Area Development Group What is your present knowledge of each advisory board you are interested in?* I am very familiar with the programs, awards, and funding opportunities provided by the Human Rights Commission. In fact, under my leadership, the local Chinese-American community is actively working with the Human Rights Commission to embrace and further improve diversity, equity, and inclusion in Iowa City and its surrounding area. 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, 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 (Optional) 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 Country of Origin Sexual Orientation Religion Do you have a disability? Ethnicity Race Gender identity *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* fl Gft L-`-/'edarevet 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 8/28/2022 First Name* T.J. Last Name* Dedeaux-Norris First Name ( Phonetic spelling ) Optional Dee Dough Last Name ( Phonetic spelling ) Optional Home Address* 332 S Linn St 418 City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 8184005236 Email Address* tj-dedeaux-norris@uiowa.edu Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 6 years Occupation: * Associate Professor/ Artist Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * T.J. Dedeaux-Norris is a mixed -media artist who employs painting, fiber, performance, video, and music to explore the somatic impacts of racial, gender, and class socialization. In form and content, their work poses a philosophical inquiry into the distinction between Self and Other, with the body as a social microcosm of distinct yet discursive dynamics to observe and question. Everything is both permeable and fractile. Dedeaux-Norris completed their BA at University of California at Los Angeles and their MFA at Yale University. Their work has been presented internationally at the Contemporary Arts Museum Houston, Mission Creek Festival, Nasher Museum of Art, Performa, Prospect New Orleans, Rotterdam Film Festival, The Studio Museum in Harlem, Sundance Film Festival, and The Walker Art Center - among other institutions. Dedeaux- Norris has participated in residencies at Grant Wood Colony, MacDowell, Skowhegan, and Yaddo. They are a 2019-2020 Pollock -Krasner Foundation grantee, a 2022 Iowa Artist Fellow, and a tenured Associate Professor at University of Iowa. What is your present knowledge of each advisory board you are interested in?* I am newly acquainting myself with the HRC and feel that within my art practice and teaching pedagogy that I embody and already practice the ideologies and concerns of the commission. Having lived in Cedar Rapids/Iowa City for the past 6 years, I believe I've gotten great lived experience in understanding the needs and gaps of needed programming and advocacy. I'm also an eager learner. 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, 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 (Optional) 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 43 Country of Origin Guam, USA Sexual Orientation NA Religion Do you have a disability? Ethnicity Black American Race multi raced (black/white/native/creole) Gender identity Fluid she/they pronouns *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* f d'ga'eae4V mat t 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/17/2021 First Name* Kim Last Name* Gilmore Sr First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 915 Harlocke Street, Unit 12 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* 319-981-1553 Email Address * kdavid5@yahoo.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 10/1/2021 Occupation: * VA Human Resource Specialist Employee/Labor Relations Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * The experience and activities that I feel qualify me for a seat on the Human Rights Commission are the following: 1) Avalon Park Local School Council (Chicago, II) - Vice -Chair and Parliamentarian - 1993 to 1996 2) City of Chicago 8th Ward Legislative Liaison for Alderman Lorraine Dixon — 1992 to 1993 3) National Forum of Black Public Administrators Chicago Chapter - Treasurer and Board Member -2000-2007 4) New Mexico Coalition for Literacy Board Member (Albuquerque, NM) -2012 to 2013 5) Salvation Army Corps Certified Disaster Worker (Orlando, FI) — 2017 to 2021 What is your present knowledge of each advisory board you are interested in?* My present knowledge of the Human Rights Commission is that it identifies organizations working to create a positive cultural impact through their activities for grant sponsorship. The Human Rights Commission champions actions that result in a level playing field for all people no matter how old or what color they are, what they believe in, what sex they identify with, where they are from, or whether they are disabled or married. The Human Rights Commission has three subcommittees that focus on housing, equity in health, and anti - racism. I would most effectively serve on the Housing Subcommittee, but I am willing to be placed on any committee. The Human Rights Commission also commissions surveys/studies that identify opportunities for improving the quality of life for disadvantaged Iowa City 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 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 (Optional) 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 58 Country of Origin United States Sexual Orientation Straight Religion Christian Do you have a disability? No Ethnicity African American Race African American 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* r� Cy7TlsIretp, 0.17t. 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. ra.arr�_ CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 6/29/2022 First Name* Denise Last Name* Hagerla First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Hey-girl-uh Home Address* 174 Shrader Rd City* Iowa City State IA Zip Code* 52245-4920 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 7732181287 Email Address* didihag@yahoo.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 7 months Occupation: * Clinical Social Worker Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I've spent much of my 20+ years as a social worker serving marginalized populations and providing education and support to other professionals working with the LGBTQIA+ community. I am always seeking opportunity to create, live, and work in community that strives to uphold the values of diversity, equity, and inclusion. This is a big impetus for my recent move to lowa City. What is your present knowledge of each advisory board you are interested in?* I've been watching the educational initiatives of the Human Rights Commission over the past several months and have been impressed with the level of community engagement and the breadth and scope of ways in which this committee reaches out to community for education and impact. I also have watched several hours of the committee meetings to witness the content and purpose of these meetings. 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-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 (Optional) 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 50 Country of Origin United States Sexual Orientation Lesbian/Queer Religion UUS Do you have a disability? No Ethnicity N/A Race White Gender identity Gender non -conforming *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* PE#I, � f{-Q +C,Q- 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 7/22/2022 First Name* Ryan Last Name* Hall First Name ( Phonetic spelling ) Optional 3192486400 Last Name ( Phonetic spelling ) Optional Home Address* 18 Kenneth Dr City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3158706939 Email Address* rhall@newpi.coop Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Select a Board or Commission you are interested in: * Historic Preservation Commission (HPC) Historic Preservation Commission Category* At -Large Preference on first choice If multiple boards are being applied for. Human Rights Commission How long have you been a resident of Iowa City? 7 years Occupation: * Information Technology and Data Analysis Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below, Male Female Experience and/or activities which you feel qualify you for this position: * > Political Science Honors graduate of the University of Iowa with a focus in bias, protest, and political revolution. Published academically on related topics. > Grew up in a poor single parent household and became a first generation college student. Understands the struggles of navigating our educational system without any prior experience or guidance. > Familiar with boards and their functions through my work with the board at New Pioneer Food Co-op > Very passionate about Iowa City's history and it's relationship with underserved communities. > Appreciative of the inclusivity that Iowa City offers while understanding that our work has just begun What is your present knowledge of each advisory board you are interested in?* > Familiar with the functions of the committees and their relationship with Iowa City as a whole > Understands the limits of the boards as well as their importance > Good sense of board relationships and how to constructively and inclusively navigate topics and build solutions 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-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 (Optional) 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 33 Country of Origin United States Sexual Orientation Heterosexual Religion None Do you have a disability? No Ethnicity Race White Gender identity Cisgender *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* /4&-129 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/6/2022 First Name* Michael Last Name* Halley First Name ( Phonetic spelling ) Optional 641-233-0445 Last Name ( Phonetic spelling ) Optional Ha -lee Home Address* 310 Finkbine Lane City* #2 State IA Zip Code* 52246 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 641-233-0445 Email Address * mhalley25@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? One week Occupation: * Account Manager at Ideal Energy, LLC Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * Served 12-years on Fairfield, Iowa city council and completed the Iowa League of Cities Certified Elected Municipal Official program, so I'm very familiar with city government. More recently I served as an unofficial advisor to the City of Fairfield Diversity, Equity, and Inclusion Committee, though I was not an official member. I've advocated for human rights during my time as an elected official and would like to expand that work here in Iowa City. What is your present knowledge of each advisory board you are interested in?* I read information provided on the city's website, read the most recent meeting minutes, and watched the most recent meeting on Channel 4. I have a general understanding of the commission's responsibilities and activities. 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, 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 (Optional) 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 47 Country of Origin United States Sexual Orientation Heterosexual Religion None Do you have a disability? No Ethnicity White 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* itOottitap 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/4/2022 First Name* Thorn Last Name* Hawthorne First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 327 Highland 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* 8179805820 Email Address * hello@thornhawthorne.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? Occupation: * Communications Specialist Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * As a communications specialist working in the next town over, I serve alongside city council and every board and commission. I've become extremely familiar with everything about the process and would really love to be able to do the same work in Iowa City since I live here. I'm transgender, disabled, and a descendant of refugees, so I'm also particularly well versed in related social justice and human rights issues. What is your present knowledge of each advisory board you are interested in?* I've been interested in and watching public meetings since I moved to Iowa 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, 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 (Optional) 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 26 Country of Origin America Sexual Orientation Queer Religion Do you have a disability? Yes Ethnicity Not Latino Race Middle Eastern / White Gender identity Transgender / Agender *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/5/2022 First Name* Ahmed Last Name* Ismail First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 2033 Keokuk St Apt 5 City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3196210813 Email Address * ahmedi2144@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 17 years Occupation: * Software Engineer Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * After finishing High School, I went on to pursue an industrial engineering degree at ISU. While there I got involved with a nonprofit called the National Society of Black Engineers. I served as the President of the Iowa State Chapter and then went on to serve on the national board, where I helped oversee 300+ collegiate chapters and launch a strategic plan to graduate 10k black engineers annually by 2025. I did this alongside the executive director and strategy consultants. I believe these experiences combined with my ability to advocate make me a great fit for the role. Furthermore, I also started a BLM chapter and have worked with the president of ISU to push for more equitable change within the university. What is your present knowledge of each advisory board you are interested in?* The commission is responsible of doing the following: 1) 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 2) Making recommendations to the City Council for such further legislation concerning discrimination as it may deem necessary and desirable 3) 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) 4) 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. 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-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 (Optional) 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 25 Country of Origin Sudan Sexual Orientation Religion Islam Do you have a disability? No Ethnicity Sudanese Race Black 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. ra.arr�_ CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 5/21/2022 First Name* Ashley Last Name* Jennings First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 742 Perry Ct City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 6414854760 Email Address * ashljennings@gmail.com 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 Select a Board or Commission you are interested in: * Housing and Community Development Commission(HCDC) Do you receive rental assistance? (?) Yes No Do you have expertise in construction?* (9) Yes ,3 No Do you have expertise in finance?* (7) Yes " No Select a Board or Commission you are interested in: * Library, Board of Trustees Select a Board or Commission you are interested in: * Parks and Recreation Commission Preference on first choice If multiple boards are being applied for. Civil Service How long have you been a resident of Iowa City? 6 years Occupation:* Learning Experience Designer Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity' may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I am a former University of Iowa lecturer with an extensive background in service learning and community involvement. I now work for the US Coast Guard's Leadership Development Center as an Instructional Systems Designer, and I strive to promote civic engagement and inclusivity in all I do. What is your present knowledge of each advisory board you are interested in?* I have a surface -level understanding of each of the above, but I'm interested and excited to learn more. 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-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 (Optional) 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 35 Country of Origin United States Sexual Orientation Heterosexual Religion Agnostic Do you have a disability? No Ethnicity Race White Gender identity Female *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 7/5/2022 First Name* Marie Last Name* Krebs First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 3312 E Washington St City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3199361573 Email Address * mariekrebs4@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 26 years Occupation: * Patient Access Specialist Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I am a mixed race woman who has much life experience dealing with racism and sexism. I have made it my life's work to help make change. I have volunteered with DVIP and helped with a women's build for Habitat for Humanity. I was trained and then led Diversity Dialogue Circles with WRAC. What is your present knowledge of each advisory board you are interested in?* I only know what I have read online regarding Human Rights Commission. I understand this to be a group that helps to educate our community on human rights issues and assists members of our community who have/believe to have had human rights violations occur. 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, 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 (Optional) 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 44 Country of Origin United States Sexual Orientation Heterosexual Religion None Do you have a disability? Yes Ethnicity Hispanic Race Japanese, Spanish, German, Apache Gender identity She/her *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* -+Watie LJLfee(' 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/8/2022 First Name* Grace Last Name* Kreger First Name ( Phonetic spelling ) Optional 5157107634 Last Name ( Phonetic spelling ) Optional Home Address* 20 S. Lucas Street, Apartment D City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 5157107634 Email Address* gkreger@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 11 years Occupation: * Program Director Assistant, Reach for Your Potential, Inc. Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I have ten years combined professional experience serving individuals with disabilities and low-income, at -risk youth (MYEP - Direct Support Professional/Program Facilitator, RFYP - Program Director Assistant, NCJC - Youth Counselor). I have extensive professional and volunteer experience working on political campaigns, most recently serving as an elected delegate in 2018 and 2020. I have additional formal volunteer experience with Iowa City Hospice, Iowa Youth Writing Project, and Girls on the Run. As an undergraduate student at the University of Iowa, I studied nonfiction creative writing with a focus on gender studies, social justice, trauma, and empowerment. I am passionate about advocating for and defending the rights of others. What is your present knowledge of each advisory board you are interested in?* The HRC educates the public on discrimination and civil rights via public forums, activities, and programs. The HRC also provides suggestions to City Council regarding legislation concerning discrimination. The HRC meets once a month, and members serve for three years. This is an unpaid, volunteer position. 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, 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 (Optional) 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 31 Country of Origin United States of America Sexual Orientation Bisexual Religion Unitarian Do you have a disability? No Ethnicity Caucasian Race White Gender identity Female *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* Pact KA/la 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. a 1 CITY OF IOWA CITY UNESCO CITY OF LRERATURE Advisory Board/Commission/Committee Application 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: Applicants MUST reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application Which Board or Commission(s) are you interest Which one do you prefer? Applicant Information: First Name* 13 A DR f Last Name* {‹,ti �( u First Name (Phonetic spelling) (Optional) Last Name (Phonetic spelling) ( (Optional) Home Address* 2 L4© 9 e U r4' l.�F i u apt- 71,Ey� City* o W g CAA y State 1 P Zip Code * j_ 24.4 6 Contact phone number* 3 Z at SSS g231 Email Address* load tl KAKu yafoc -co've► 1. Is your home address (listed above) within the corporate limits of Iowa City?* YpSv40 2. How long have you been a resident of Iowa City? /0 -( (,4 i' ' 3. Occupation:* r i_ L De_ I jrlfef 4. Gender* *This question is mandatory in order for the City to comply with the State's gender balance i_e,Guirem6it which treats gender as binary "Gender Identity" may be provided in the demographics section of the applicatt below. r<r" ed in kivh rch<lie Female 5. Experiences and/or activities which you feel qualify you for this position: 6. What is your present knowledge of each advisory board you are interested in? d c� Please contact the city attorney at 319-356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describe some but not ail potential conflicts. Potential Conflict of Interest The Housing and Community Development Commissionmakes recommendations to the City Council regarding the distribution of federal CBDG/HOME fiords. 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. 7. Do you currently have a conflict of interest?* YES I, NO Please identify any potential conflicts between membership on the advisory board an 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 propriet f.: artnee, 5%-Or 'ii ore of corporation's stockholdings). — --- I - _... List potential conflicts of interest* (See above for information regarding conflict of=ittterest4.— Please indicate if there are none. " BUSINESS NAME* BUSINESS ADDRESS* 9odartae, l/Y1►41(Atel 5.3,t4 ' A v..6 to, ► a G I52140 -5_ f 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. S. Do you currently serve on another Iowa City board or commission?* YES NO 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: Demographic Information: (optional) 9. Age 10. Country of OriginSlit 4drtc � A/ at 1I. Sexual. Orientation ti 12. Religion 't k l 13. Do you have a disability? YES NO 1!'' 14. EthnicityA-1ic-ci4 A -VA ect ✓t 15. Race t cJ 16. Gender Identity IcArkLe_ 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, except demographics, 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 (rev. 04/30/21) CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 8/29/2022 First Name* wifag Last Name* mohammed First Name ( Phonetic spelling ) Optional +11929434427 Last Name ( Phonetic spelling ) Optional Home Address* 740 Mikael st City* Iowa city State IA Zip Code* 52446 Is your home address (listed above) within the corporate limits of Iowa City?* No Contact Phone Number* 929-434-4274 Email Address * mohammedwifag@yahoo.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 4 years Occupation: * Nordstrom Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * My Story Introduction Despite tremendous social pressure on women in Sudan to stay silent, I've known since I was a child it was important to break the silence and speak out. It was important to become educated and empowered and then to encourage other women to do the same. I founded Haraza Organization for Peace and Development for Women's Empowerment (HOPD) that put me on the front lines assisting and empowering survivors of genocide in Darfur. Through my organization in Sudan . I trained women internally displaced (IDP) by the violence from 2003 to 2012 to participate in all levels of decision -making, including in the home, school, social, religious and political. Collaborations with international non -governmental organizations (INGO's) like United Nations Fund for Women (UNIFEM) and United Nations Mission in Darfur (UNAMID), the World Food Program WFP and United Nations Children's Fund (UNICEF) allowed me to channel funding to build health clinics, schools and water pumps for desperate villagers, and to provide food, clothing and basic services to women and children in IDP camps. These INGO's and others allowed me to produce a training manual and workshops that prepared IDP women to actively participate in the Abuja and Doha Peace Talks in 2006 and 2010. I was known for my persistence as the "Iron Lady." Sadly, I was forced into exile after armed Sudanese security forces threatened to kill me for speaking out about violence against women as a tool of the genocidal war in Darfur. While attending an international peace conference, I had shared horrible stories of women I met, like the mother and daughter who had been horribly raped and mutilated in front of each other. These stories reached the International Criminal Court (ICC) and became evidence included in the indictment of Sudanese President Omar al Bashir for War Crimes, Crimes Against Humanity and finally, Genocide. Early Life & Education I was born in Nyala, South Darfur, in Sudan on July 21, 1982 into an activist family of politicians committed to freedom. Many of my brothers and sisters worked for justice. Yet, from early on I witnessed discrimination in my family. My father had a high school education, my mother had none, and I could see the difference that made. The boys and men got attention, education, resources and support. Girls, including me, were submitted to female genital mutilation (FGM) and women experienced a lack of appreciation and opportunity. My father wanted me to get married young, but I was inspired by my older sisters who were educated. I insisted on going to school like them. I was so grateful my sisters helped me to get on that track that I knew I eventually wanted to pass it on to others. In 1999 I moved to Khartoum to study at the prestigious Khartoum University. Although I wanted to become a doctor, that path was not open to me because I was a Darfurian woman. I studied and got my BA degree from the College of Public and Environmental Health in 2002. At this time Darfurians were being targeted in Khartoum, so it was impossible for me to get a job. War in Darfur Despite the Darfurians best efforts to get the Government of Sudan (GoS) to provide basic services in areas like roads, electricity, drinking water, education and health, the central government in Khartoum did little to develop Darfur. People who spoke out or organized were imprisoned, tortured, killed and forced into exile. Once the Sudanese Air force started bombing villages, we lived in tear tor our lives. In 2003, a Darturian rebel group struck back, attacking El Fashir airport. They destroyed some of the planes that were used to bomb villages. In response, the government of Sudan initiated a campaign of terror. They increased their bombing of villages, training and arming militias called the Janjaweed. Darfurian men and children were killed; women were brutally raped; crops and stores of food were destroyed, and animals were slaughtered. Survivors fled as their villages burned to the ground, escaping with only those items they could carry on their backs. So many villages were demolished that soon refugees flooded the cities, seeking safety, shelter, food and medical care. Children arrived malnourished and died in their mothers' arms. Those of us who lived in cities faced a wall of discrimination that blocked Darfurians from getting jobs. Darfurian men had no avenues open to them and were channeled into the armed forces or local police forces. The GoS pushed our men to serve in the very group that was destroying us. Men who didn't follow this path became idle and frustrated, the most capable went to college in Khartoum, while others went into exile or joined the rebels. Women and children were left without their men. Amid such suffering, Darfurians became a miserable people. Establishing Haraza Organization for Peace and Development (HOPD) In 2002 I was seeing women and children trying to deal with the outbreak of civil war in Darfur. I decided to found the Haraza Organization for Peace and Development for Women's Empowerment. I named my non- governmental organization (NGO) after a tree called a haraza. This tree is dry in spring and stores water for the dry season. When no other trees have leaves or fruit or provide shade, the haraza offers solace. I formed a board that helped set goals and implement programs to help the victims. Haraza received funding from, and worked with, the international aid agencies listed above and groups from the European Union. Haraza worked in numerous camps; Kalma, Ottach, Derig and Salaam camps. There was so much need. Here are our areas of focus: • Providing for urgent needs: food, shelter, clothing • Capacity building workshops * Health education, HIV prevention and care * Violence Against Women (VAW) and Gender Based Violence (GBV) * Income Generating Activities • Training IDP women to be leaders in their communities * Peace Culture and Peace Building * Psychosocial support for women traumatized from rapes and witnessing the deaths of loved ones * Support for women prisoners • Training IDP women to understand their rights provided for under UNSC Resolution 1325 * Prepare women to participate in peace keeping * Trained IDP women to attend and participate in the Abuja Peace Talks (2006) and the Doha Peace Conference (2011) I collaborated with UNIFEM and made a training manual on Conflict Resolution and Negotiating Skills for Peace Building and Decision Making for IDP Women Leaders in South Darfur. We organized a ten day training to make sure women leaders got what they needed to participate in the ongoing peace talks. They contributed fresh, workable solutions to seemingly intractable struggles. This training was essential to ensure women's involvement in mechanisms that could prevent conflict, stop war and stabilize regions damaged by warfare. The workshop goals were: 1) To build skills for decision -making, leadership, negotiation and conflict resolution, 2) To involve displaced women in the negotiation process side by side with men and 3) To introduce UNSC 1325 and other international protections for women's rights in the context of the war in Darfur. Although the GoS Security forces barred me from attending the peace talks, I trained over 250 women and 50 men; sending thirty IDP women to actively participate in these high level negotiations. The Government Arrests Me For My Work The war in Darfur spread, eventually leaving over 4,000 villages burnt to the ground, over 300,000 people dead and nearly half the population of 6 million internally displaced, living in camps lacking every necessity, including security from attack. In 2008 ICC indicted Omar Al Bashir on War Crimes, Crimes Against Humanity and eventually charged him with the crime of Genocide. The GoS then expelled many of the most effective international aid agencies and began a campaign to find and get rid of anyone suspected of providing evidence to the ICC — either by killing them or forcing them into exile. I 1nrac nna of thnca tarnatari Ac a rnncaniianra of my uinrk in tha ramnc %nrith internatinnal airs ananriac 11nrac harassed, arrested, tortured, given death threats and eventually had to flee for my life. Here's why: With the international aid agencies gone, the Government of Sudan (GoS) soldiers and Janjaweed militias reignited their campaign of terror, kidnapping, raping, beating and harassing women in the camps. Everyone was afraid because there was no protection. In that moment of fear I recorded a letter of appeal for help to First Lady Michelle Obama. See link: To Michelle Obama from Wifag Ibrahim Widaa of Darfur https://www.youtube.com/watch?v=FlfyoLEQaKI This international appeal put my life at risk. One day, armed security forces stopped a women's empowerment training I was leading and arrested me. They violently interrogated me, accusing me of providing information to U.S. aid agencies that gave my testimony to the ICC. They questioned me about my involvement in training workshops, asked who my funders were, all the while threatening to kill me. I thought they were going to kill me then and there. I was terrified. Actually, I had indeed provided evidence that was submitted to the ICC. In early 2008 I had met Wanda Atkins at an international symposium on women's roles in resolving the conflict in Darfur in Kampala, Uganda. Wanda worked with International Justice Project (IJP) and took the stories I told about what I had witnessed in Darfur and gave that as evidence to the ICC. Aftermath and Continued Death Threats Three days after the first interrogation I bought a ticket to Khartoum, but I was arrested at the airport. I was detained in the security forces office there and questioned in an intimidating way about where I was going and why. I lied. I said I was going on vacation, when actually I was planning to attend a UNIFEM conference in Khartoum. I was carrying the training manual I edited and used when I trained IDP women to participate in the Doha Peace Conference (described above). The security forces accused me of wanting to go to a training workshop and said they were confiscating my manual. They insisted I could not take my training manual or get on the plane. I insisted it was within my rights to have the manual and fly to Khartoum. A local government official I knew happened to be at the airport, and he saw me detained. He intervened to advocate for me. He convinced them to let us board the plane. I got on the plane for Khartoum with my manual and attended the UNIFEM Conference. After a month, I returned to Nyala from Khartoum. When I finally tried to go back to work, I discovered the security forces had shut down the Haraza office. Soon after this, Janjaweed began following me. This was a very dangerous situation for me. One day they approached me while I was parked in my car. They ordered me out of my car, which I knew meant they were going to kidnap me. I knew what these armed men were capable of. I'd heard about their brutal rapes; I had seen women mutilated by having their throats slit or bones broken. I'd seen women ostracized and suffering with fistulas and psychological trauma. They tried to grab me with their guns pointed at my head, but I rolled the window up and locked my doors, refusing to get out of the car. They could kill me right there, on a street in Nyala, but I wasn't going with them. I saw a man I knew in a nearby park and signaled him to come over. I explained what was going on and asked him to drive my car. He got in and took the wheel. After another attempt by the Janjaweed to grab me, the man drove off and got me out of their reach to safety. At this point, I knew I MUST immediately leave. I left my family, my work and my country to arrive in the United States in June 2011. I now have been granted asylum. At this point it may look like those who are responsible for so much suffering in Darfur are winning: • President Omar Al Bashir remains free even though he has been charged with war crimes, crimes against humanity and genocide by the ICC • Peace talks have not stopped the violence • Hundreds of doctors, human rights and women rights advocates, journalists and others who spoke out for justice or simply told the truth about what's happening in Darfur have been killed, imprisoned or forced into exile I'm quite sad I can't at this time return to Darfur to continue my work with Haraza, yet I cannot let things stand as they are. With the women of Darfur in my heart, I would like to work with the United Nations to continue the trainings I was doing with the women IDP's inside Darfur, but now, perhaps, do it with Darfurian women refugees living in Chad. I would like to expand my understanding of women's roles in the peace building process and be a part of post -conflict reconstruction. NOTE A: A brief video made in Darfur, Sudan about my work with refugee in Darfur . My life in the USA: I arrived to the us in 2012 and started my life in state of new jersey and I astarted my asylem process I guranted asylem in 2013 and was suffering from a sevear depression from torture and punishment that I had when I was arrested in sudan that took for long time to heal until now I use medication for it . in 2017 I thought to continue my education here in the usa I asked about the good school to go and I have chosed iowa to come to attend inorder to go for medical school and achieve my American dream to becoming a doctor I like the quite state of iowa but unfortuinatly I didn't have many American frineds like when I was in new jersey so I didn't ivolove in to many event as before I contunied work in my school ELA to start medical school as I already have hold a BA in public health however I don't know the medical school rquerment in the usa . In later 2017 I knew Magrret when I went to event in Christian church in 42th st cedar rapids and joined them serving food ,cleaning or attend a program I brought food to the church that I made salmon with vegitable that been liked by every one at the event .and the posster apricate that . I made some American frineds in catholic mcauly centaer Anne Digger ,steve and others I laso have engaged with other Islamic center in Cedar rapids to help and joine activities .last January while I was working in hotel Kirkwood there was an event by the United nation -state of iowa and I met Anne Ann Woodward the program manager that she talked to me and I have shared my story with her and she watched my documantry film about my work with women in Darfur during the war she knows my story and later she arranged me to give a speech in their panel in next month May 2022. I also got to know my Neighbor Cara and we have a good relationship as neighbors her sisire and she help me a lot they bring me some furniture and kitchen's tools her mother sent me a gift card from seatel Washington . in kirkwood community collage in 2018 I participate in Norton writer's Prize that I got help from Mr Ryan Dehner my grammar teacher ,and the writing center assistant Kirkwood cedar rapids Ms Janis bultman . I was unlucky to win that prize.put I never give up I keep working for any chance I heard . Why I am applying for Iowa dream , I apply to this scholarship because I have finiacial hardship as I am suffering with depression I felt to pay my rent because I go to school and got sick last february the doctor decide me an operation surgeory for gallstone removal . in addition to I have wrote my book about my story from American dream in Arabic this book has 3 years I still unable to publish it because I contact the publication company the need 24 thousand to be paid if win the scholarship that will help solve lots of problem buy a car because 3 years ago someone gave a car but has a lot of problem . Short term goal : I am enrolled in Kirkwood community collage now about to finished the ELA .after I finish the collage I apply for the medical school in university of Iowa If I got a scholarship because I don't have much money to pay by myself .then I will continue to finish my book and its amazing story of living in two different situation in Africa and USA and publish my book in English so that the American can read my story . My long term goal : is to work 0for women and become a women peace ambassador Activities I feel Qualify is Training : To train young people about empowerment that a unique methods to help them make their life's goal to achieve their dream . Also to integrate the American people and immigrant culture (cross culture exchange ) to make unity among all people residents in Iowa that can be by organizing public event ,meetings or churches and mosques. What is your present knowledge of each advisory board you are interested in?* I know about Human Rights as hard work to reduce the human discrimination and civil rights by providing help through a recommendation to the city counsel for the such discrimination. also to planning programs and activities to eliminate all kind of discrimination. (Race ,Religion ,sex,color,gendder,Age ,disability Identity and marital status. 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, 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 (Optional) 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 40 Country of Origin Sudan Sexual Orientation woman Religion Islam Do you have a disability? No Ethnicity black Race Sudanes Gender identity Female *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/28/2022 First Name* Jahnavi Last Name * Pandya First Name ( Phonetic spelling ) Optional Jan-vi Last Name ( Phonetic spelling ) Optional Home Address* 1015 West Benton Street, Apartment 33 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* 3198559608 Email Address * jahnavi-pandya@uiowa.edu Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 1 year 3 months Occupation: * Doctoral student in Counseling Psychology Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I have worked in various areas in human rights advocacy and justice. As a psychologist in India, I did a lot of work with the marginalized sections of the society including women on the streets, children in an orphanage, in Juvenile Observation Homes. I have gone to schools where children have been denied admission to advocate for their rights and also worked with parents from the lower SES who have been treated wrongfully. As a psychologist in a corporate organization, I helped a group of women who were being sexually harassed not only in therapy but also in the process of advocacy. Currently as a practicum student I provide free services to refugees and immigrants at IC Compassion. I am also a member of the Anti -Racism Committe in the College of Education and am an Advisor at weareSAATH, a new Indian student organization taking the initiative for mental health advocacy among Indian students at the University of Iowa. I have also worked as a volunteer with the Native American population in Cass Lake in August 2022. I strongly believe in community support for human rights advocacy. US being a diverse country and Iowa City too having diverse population, I would like to work with this committee to reach the community in a culturally sensitive way that helps advocate for equity and social justice, keeping in mind several social and cultural barriers, and also work on activities to help create unity in diversity and belonging. Having a background in counseling psychology, I also believe I will be able to use my skills to be a compassionate listener and bring my experiences in the work at this commission. What is your present knowledge of each advisory board you are interested in?* From what I have read and known about the Human Rights Commission, this committee works to educate people on human rights and discrimination while also encouraging ways to support a sense of community, belonging and unity. 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-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 (Optional) 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 25 Country of Origin India Sexual Orientation Heterosexual Religion Hindu Do you have a disability? No Ethnicity Gujarati Race Asian Gender identity Female *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. ra.arr�_ CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 8/30/2022 First Name* Kiran Last Name* Patel First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 817 1/2 N Linn St City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3193256424 Email Address * kiranmariepatel@gmail.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) Do you receive rental assistance? (?) Yes No Do you have expertise in construction?* (?) Yes No Do you have expertise in finance?* (?) Yes No Preference on first choice If multiple boards are being applied for. Human Rights Commission How long have you been a resident of Iowa City? Occupation: * Map Delineator Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male ./ Female Experience and/or activities which you feel qualify you for this position: * I have a long history advocating for human rights issues, most notably voting rights as an organizer for the March On for Voting Rights. Additionally, I know what it's is like not be welcomed in public spaces, and I would like to prevent other people from having similar experiences. What is your present knowledge of each advisory board you are interested in?* I am aware of the work of the advisory boards. 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-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 (Optional) 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 36 Country of Origin USA Sexual Orientation Asexual Religion Atheist Do you have a disability? Ethnicity Indian American Race Multiracial Gender identity Cis Woman *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* f e7if (;;;?k lr (J"`flt 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. ra.arr�_ CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/7/2022 First Name* Mark Last Name* Pries First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Preese Home Address* 1128 Denbigh 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* 319-321-5263 Email Address* pries.mark@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 15 years Occupation: * Pastor, retired Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * 5 years as a Human Rights Commissioner in the City of Dubuque, Iowa (1978-1983); continual training in Human Rights work as a theologian, pastor, and citizen; completing a first term with the IC Human Rights Commission during which time I have received training in implicit bias, critical race theory, E.Q. (emotional intelligence) toward understanding the necessity for D.E.I. (diversity, equity and inclusion) to enrich and hold secure life of every resident. The IC HRC has just begun a 3 year strategic plan "Breaking Bread" in which I had a contributing role and am prepared to invest all the more in the realization of this plan. I am an old (73), white, heterosexual, married, male with a passion for the human rights of every person - a willing and eager voice with time and energy to to serve. What is your present knowledge of each advisory board you are interested in?* I'm completing a first term on the IC Human Rights Commission. My attendance record is near perfect as we navigated our way thru the COVID-19 pandemic. I have led the training sessions for citizens to learn how to apply for Iowa City's annual Human Rights grants and then contributed to the ranking and awarding of these grants; I have served on the Human Rights Award committee this and last year. my relationships with Stefanie Bowers, Equity and Human Rights Director, and commissioners is positive and supportive. 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-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 (Optional) 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 73 Country of Origin United States of America Sexual Orientation Heterosexual Religion Christian Do you have a disability? No Ethnicity German 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/3/2021 First Name* Michael Last Name* Simon First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 706-4 Carriage Hill 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* 520-234-7310 Email Address * mdsimoniv@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? Occupation: * Bus Driver Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I work in public transportation. What is your present knowledge of each advisory board you are interested in?* Entry level 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-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 (Optional) 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 Country of Origin Sexual Orientation Religion Do you have a disability? Ethnicity Race Gender identity *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* KiW;-0,,rnta0. u_c?fteet 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 8/29/2022 First Name* Holly Last Name* Stevenson First Name ( Phonetic spelling ) Optional 3198008421 Last Name ( Phonetic spelling ) Optional Home Address* 4430 E Court St City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3198008421 Email Address * hastevenson@optimaelifeservices.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? Occupation: * Director of Diversity, Equity and Inclusion Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I currently serve as the Director of Diversity, Equity and Inclusion for Optimae LifeServices. We serve over 40 of Iowa counties and I am based out of Iowa City. I have my PhD in Philosophy, focusing on social injustice, from The University of Iowa and I also have my MAs in Philosophy and Gender, Women and Sexuality Studies. I am published on issues pertaining to marginalization and intersectionality and I also offer a unique perspective being from the U.K and also having an invisible disability. What is your present knowledge of each advisory board you are interested in?* At present, I am aware that this board is doing invaluable work to both spread awareness and education to all members of the community regarding their rights but also to promote social justice progress to make Iowa City a city that is advancing DEI initiatives and making them a priority. 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-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 (Optional) 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 27 Country of Origin United Kingdom Sexual Orientation Straight Religion N/A Do you have a disability? Yes Ethnicity Race White Gender identity Female *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* iallf 45r oe 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. zniyhtt CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/4/2021 First Name* Janis Last Name* Taylor First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 201 North 1st Ave., Apt. 105 City* Iowa City State IA Zip Code* 52245-3608 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 5635802682 Email Address * jantaylorj1940@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? Since 1985 Occupation: * Retired Educator and College Professor Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * Volunteer with Inside Out Reentry Community, Free Lunch Program, many years of work with Iowa Valley Habitat for Humanity and service on their board. Study group "Act Justly" researching and studying white supremacy and steps to racial reconciliation at Saint Andrew Presbyterian Church for the past two years. What is your present knowledge of each advisory board you are interested in?* I will admit that I am a novice. I have read through some of the Human Rights Commission web page, some recent agendas and attached documents from grant recipients. I will continue reading and studying those. Of the subcommittees, I would be interested in serving on the Anti -Racism subcommittee, but am willing to work wherever I am needed 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-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 (Optional) 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 81 Country of Origin United States Sexual Orientation Heterosexual Religion Christian -Protestant Do you have a disability? No Ethnicity Swedish -German -British Race white Gender identity female *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 8/30/2022 First Name* Catherine Last Name* Tra n First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 283 Haywood Drive City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 5157328433 Email Address * tran.catherinekim@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 1 year Occupation: * Executive Director, Immigrant Entrepreneurs Summit Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I am the Executive Director for a nonprofit organization that works with immigrant and minority business owners to help educate and advocate for business success. We hold business summits in Eastern Iowa as well as in other parts of the Midwest to bring people together to support and encourage the immigrant entrepreneurial experience. Additionally, I serve as Branch Manager and Marketing Manager at Community CPA, a regional CPA firm that is an immigrant and woman -owned business, and which serves a large immigrant and minority client base. What is your present knowledge of each advisory board you are interested in?* I am interested in the Human Rights Commission. Currently, I know some of the members who were formerly part of the commission, and I know that it advocates for civil rights in Iowa City, as well as make recommendations for 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 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 (Optional) 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 35 Country of Origin USA Sexual Orientation Religion Do you have a disability? Ethnicity Vietnamese Race Gender identity *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/9/2021 First Name* Mitchell Last Name* Wiewel First Name ( Phonetic spelling ) Optional 5414805359 Last Name ( Phonetic spelling ) Optional Home Address* 3216 Shamrock Dr City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 541-480-0746 Email Address * mitchwiewel@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Human Rights Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 4 months Occupation: * Marketing Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * Racism has been at the forefront of my mind since high school, where my junior or senior year I was in the principal's office for defending my friend, one of the only Mexican girls in the school after she was insulted and spat on. Before that, I watched a group of kids participate in a weekly racist march down the hallway, well known as "white power Wednesdays". They wore blue jeans and a white t-shirt and a grin as they walked together as a group down the halls each Wednesday. This was Hempstead High School in Dubuque, Iowa, in 2006. Later in life, I married the most beautiful human being, a Mexican girl, who opened my mind to so many new and beautiful experiences and people. I was scared to try chorizo before her. She took me to a drag queen show for my birthday. She introduced me and helped me befriend gay people and convinced me to wear a homemade glitter and rainbow t-shirt for 'Pride'. Now, my children are half -Mexican and when Trump was elected, I was terrified for the direction our country was headed. Most of all, the racial outbursts he was inspiring in elementary schools during his campaign. I watched as minorities were blamed for other people's problems. Throughout his presidency, I've stood by and avoided multiple altercations as white people around me spoke abhorrently about minorities, whom I married, and became friends and family with so many others. I stood by to avoid a fistfight, to avoid losing jobs, and the list goes on - but that is what the Black Lives Matter movement opened my eyes to - the need to stop avoiding conflict and embrace it for anything to ever change. To take a stance and stop being silent and "safely neutral" especially when someone speaks hate in my presence. So what do all of my personal anecdotes have to do with what is happening now? A lifelong observation of xenophobia - a word I heavily researched in college as a Sociology major. There was a lot of racism where I grew up, towards Blacks, Mexicans, Gay people, and anyone different. I've had a lot of time to reflect and analyze everything I experienced. Here's the key: Something happens when you are exposed and not just exposed to but interact and build relationships with people who are different than you. When you meet people from other cultures around the world or people here in the States that live differently than you. Whether they are poor or rich, black or brown, gay or straight. When you get to know them, you realize we are all just humans, we all want the same things in life: equality, love, safety, and opportunity. I want to help educate others and their children. I want people to get to know someone that makes them uncomfortable. To get outside their comfort zone and stop being fearful and speak up. To help create a world of joy for ourselves, our neighbors, and our community. I am invested in becoming engrained in the Iowa City community and part of that includes volunteering for good causes and being actively involved in local politics. What is your present knowledge of each advisory board you are interested in?* I know the position is available and that I would do my best. I understand the layers of government and the role these committees play in the bigger picture, and that we work with the Council and advise but certainly do not have authority. 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-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 (Optional) 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 35 Country of Origin United States Sexual Orientation Heterosexual Religion Catholic Do you have a disability? No Ethnicity White 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. Item Number: 14.e. ..71441 CITY OF IOWA CITY www.icgov.org November 15, 2022 Parks & Recreation Commission - Two vacancies to fill four year terms, January 1, 2023 - December 31, 2026. (Terms expire for April Schmidt and Brianna Wills. ATTACHMENTS: Description Vacancy Notice/Coversheet Board Demographics/Attendance Bird, Stephen -Application Broege, Aaron - Application Crain, Carin - Application DeGraw, Sharon -Application Eckhardt, Alan -Application Jennings, Ashley - Application Koczara, Camilla - Application Lingo, Mitchell -Application McPherson, Rachel -Application Mellecker, Susan - Application Mixon, Doloris - Application Schmidt, April - Application NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: PARKS AND RECREATION COMMISSION Two Vacancies: Four -Year Term January 1, 2023 — December 31, 2026 • 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 meets the second Wednesday of each month at 5:00 p.m. 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 8, 2022. An application can be completed and submitted on the City of Iowa City website at www.icgov.orq or by contacting the City Clerk's office. Questions about the Iowa City Parks and Recreation Commission should be directed to Juli Seydell- Johnson, Parks & Recreation Director at 356-5104, Board/Commission Application Cover Board/Commission: Parks and Recreation Commission Two vacancies to fill a four-year term January 1, 2023 - December 31, 2026 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: 10/3/2022 Application Deadline: 11/8/2022 Council Appointment Date: 11/15/2022 Date of Non -Gender Appointment: 1/1/2023 After date above Council may appoint without regard to gender Gender Balance Requirement: 1-Female 1-None Current Gender Balance: Female: 3 Male: 4 Gender Name and Address Male Bird, Stephen 359 Magowan Ave Male Broege, Aaron 919 S. Scott Boulevard Female Crain, Carin 742 South 7th Avenue Female DeGraw, Sharon 519 Brown St. Male Eckhardt, Alan 233 Colchester Drive Female Jennings, Ashley 742 Perry Ct Female Koczara, Camilla 508 Kimball Rd Male Lingo, Mitchell (Mitch) 302 Morningside Drive Female McPherson, Rachel 711 Rundell Street Female Mellecker, Susan 1918 Ridgeway Drive Female SCHMIDT, APRIL 478 Charlotte Lane Female MIXON, DOLORIS 310 Foster Rd. #203 Parks and Recreation Commission Demographic Report Name Term Term ;Stop Term Resident Occupati Gender' Age' Country of Sexual Type Number 'Years on Origin` Orientation' Melissa Full Serenda 0oniface Full Penandjo Lemoupa Alex Full 1 Hachtman Christopher Full Odinet Mssie Forbes Full 1 Connie Moore Unexpired Brian Morelli Full Vacant Vacant Full Full ' 12/31/2023:15years Program Female 42 USA Hetero Specialist II al ACT, Inc. 12/31/2023.3months NIA Mate 22 Cameroon Heterosexual Catholic Religion' Disability' Ethnicity' Gender Race* identity' 12/31/2024 11 years 12/31/20245 months! 12/3i/2025 30 years 12/31/202511n total 40 years 12/31/2025 Since2003 12/31/2025 12/31/2025 Marketing Male ,40 United Stales Manage r taw Male 35 USA gay nia professor at Ulowa Non•Profit Female 51 United States heterosexual Christian manageme, nt Physical Female 50 US straight therapist Marketing Male Commmunlc rations No No No No No posh/Greek/Oa Female White rmart Bamileke Male Black African French, ds male while English/Scottish/ Irish caucas!an female white thelher While PARKS AND RECREATION COMMISSION October 12, 2022 Page 8 of 8 PARKS ANII RECREATION COMMISSION ATTENDANCE RECORD NAME TERM EXPIRE S t-, N r" ,-( N a *-1 — ry 1" el ev ~ '-' 02/09/22 03/09/22 04/13/22 05/23/22 N e`v a N N a N N a N `1 o r+ Steve Bird 12/31/21 X X NM * * * * * * * * * Missie Forbes 12/31/25 * * * X NM X X O/E X X X X Brian Morelli 12/31/25 * * * X NM O/E X X X O/E X X Alex Hachtman 12/31/24 X X NM X NM X X X X X X X Connie Moore 12/31/25 * * * * * * * * *X X X Christopher Odinet 12/31/24 X X NM X NM X OLE X O/E X O/E O/E Boniface Penandja Lemoupa 12/31/23 0 0 NM X NM X 0 O/E 0 O/E O/E 0 Ben Russell 12/31 /21 X X NM * * * * * * * * * April Schmidt 12/31/22 0 O/E NM O/E NM O/E X X X O/E X X Melissa Serenda 12/31/23 X X NM X NM X X X X X X X Angie Smith 12/31/21 X X NM * * * * * * * * * Brianna Wills 12/31/22 O/E O/E NM O/E NM X X X X X X X Michelle Wiegand 12/31/25 * * * X NM X O/E * * * * KEY: X = Present 0 = Absent O/E = Absent/Excused LQ = No meeting due to Incl. of quorum * = Not a member uow NM = No meeting CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/17/2021 First Name* Stephen Last Name* Bird First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 359 Magowan Ave 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* 2064194583 Email Address * smbird1l @yahoo.com Boards & Commissions Select a Board or Commission you are interested in: * Parks and Recreation Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? Occupation: * Manager Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * Currently serving as a Parks Commission member first term is up, two of years as chair. What is your present knowledge of each advisory board you are interested in?* Would like to serve another term, my knowledge of the departments operations will assist me being a active participant on 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 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?* Yes Board current serving on* Parks and Recreation Commission (Optional) 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 Country of Origin Sexual Orientation Religion Do you have a disability? Ethnicity Race Gender identity *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_57reen4eietry' 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 5/21/2022 First Name* Aaron Last Name* Broege First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 919 S. Scott Boulevard City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 2624223353 Email Address * aaronjbroege@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Parks and Recreation Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 2 years Occupation: * Property Manager - Barker Apartments Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * - B.A. in Sports Administration/Recreation (Loras College) - Two years of County Parks Maintenance experience (Waukesha County, WI) - One year of supervisory experience in Public Park Development (City of Dubuque) - Case study experience: knowledge of researching, planning, presenting, and implementing What is your present knowledge of each advisory board you are interested in?* I understand that the Parks and Recreation Commission is tasked with the improvement of parks, playgrounds, and Iowa City facilities. To do so, the Commission must review rules and regulations, as well as research and propose new ideas to promote the development of all City spaces. 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-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 (Optional) 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 26 Country of Origin USA Sexual Orientation Straight Religion Christian Do you have a disability? No Ethnicity German/Italian 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* *tat, dioeIt 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/8/2022 First Name* Carin Last Name * Crain First Name ( Phonetic spelling ) Optional Karen Last Name ( Phonetic spelling ) Optional Crane Home Address* 742 South 7th Avenue City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3194717507 Email Address * carinnylacrain@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Parks and Recreation Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 15 years Occupation: * Associate Dean at the University of Iowa College of Law Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I am a lifelong parks and recreation user, I am also an attorney and senior administrator. What is your present knowledge of each advisory board you are interested in?* I understand that the parks and recreation commission will focus on community needs, and that commissioners must have knowledge of the operating policies and issues relevant to municipal government. I also understand that the city council is ultimately responsible for the conduct of local government and that not all of the parks and recreation commissions' recommendations will be approved. Finally, I understand that commissioners must devote time and energy to understanding the issues before them and taking input from interested members of the public. 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, 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 (Optional) 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 60 Country of Origin United States Sexual Orientation Heterosexual Religion Catholic Do you have a disability? No Ethnicity Black and White (Biracial) Race African American Gender identity Female *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* £e7--tram Qt tarot 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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 11/8/2022 First Name* Sharon Last Name* DeGraw First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 519 Brown Street City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-936-0021 Email Address * sharondegraw@yahoo.com Boards & Commissions Select a Board or Commission you are interested in: * Parks and Recreation Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 22 years Occupation: * book designer, letterpress printer Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * My family and I use and appreciate Iowa City parks and recreation on a weekly basis. For the past 15 years, my children and I have visited most of the City's park playgrounds. It started with us looking for the best playgrounds with baby swings and toddler play equipment to visiting as many playgrounds as we could find to accommodate imaginative play for kids between the ages of 6 to 12. Now that my kids are teens, we use the tennis courts, take walks in Hickory Hill Park, visit the pool, use the basketball courts and baseball fields. I tend to be observant in how spaces are used in the parks I go to. In 2019, I served on a Playground Design Committee at Lincoln Elementary School. What is your present knowledge of each advisory board you are interested in?* My knowledge of the Parks & Rec Commission is basic. I have previously served on Iowa City's Historic Preservation Commission (I have an understanding of what's involved in being a commissioner) 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, 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 (Optional) 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 55 Country of Origin USA Sexual Orientation Religion Do you have a disability? No Ethnicity caucasian Race white Gender identity she *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/28/2022 First Name* Alan Last Name* Eckhardt First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 233 Colchester Drive City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3196213562 Email Address * 2dogspubiowacity@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Parks and Recreation Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 20 years Occupation: * Business Owner Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I currently serve on the board of Chomp Delivery and Little Hawks Baseball Club. I have 5 years of board experience in different fields between profit and nonprofit entities. My children have utilized the park and recreation offerings for years and I'd love to help shape the future of this department to improve how it serves the city. What is your present knowledge of each advisory board you are interested in?* I'm aware this board is helping to shape the 10 year master plan for park and recreation currently being created. 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, 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 (Optional) 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 43 Country of Origin USA Sexual Orientation Religion Do you have a disability? No Ethnicity Race White Gender identity *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. ra.arr�_ CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 5/21/2022 First Name* Ashley Last Name* Jennings First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 742 Perry Ct City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 6414854760 Email Address * ashljennings@gmail.com 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 Select a Board or Commission you are interested in: * Housing and Community Development Commission(HCDC) Do you receive rental assistance? (?) Yes No Do you have expertise in construction?* (9) Yes ,3 No Do you have expertise in finance?* (7) Yes " No Select a Board or Commission you are interested in: * Library, Board of Trustees Select a Board or Commission you are interested in: * Parks and Recreation Commission Preference on first choice If multiple boards are being applied for. Civil Service How long have you been a resident of Iowa City? 6 years Occupation:* Learning Experience Designer Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity' may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I am a former University of Iowa lecturer with an extensive background in service learning and community involvement. I now work for the US Coast Guard's Leadership Development Center as an Instructional Systems Designer, and I strive to promote civic engagement and inclusivity in all I do. What is your present knowledge of each advisory board you are interested in?* I have a surface -level understanding of each of the above, but I'm interested and excited to learn more. 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-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 (Optional) 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 35 Country of Origin United States Sexual Orientation Heterosexual Religion Agnostic Do you have a disability? No Ethnicity Race White Gender identity Female *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 8/16/2022 First Name* Camilla Last Name* Koczara First Name ( Phonetic spelling ) Optional Camilla Last Name ( Phonetic spelling ) Optional Koczara Home Address* 508 Kimball Rd City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 4255050403 Email Address * girlindk@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Parks and Recreation Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 3 years Occupation: * Medical student Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I am an avid cyclist and commute to the hospital to work every day. I feel that I could excellently comment on Iowa City's trails and their accessibility to commuters. I also understand the importance of work life balance and strive for that for all Iowa City citizens via cultural and outdoor activities. What is your present knowledge of each advisory board you are interested in?* I am aware of the activities the board has been involved in. 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, 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 (Optional) 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 25 Country of Origin United States Sexual Orientation Straight Religion Agnostic Do you have a disability? No Ethnicity European Race White Gender identity Female *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 7/3/2022 First Name* Mitchell (Mitch) Last Name* Lingo First Name ( Phonetic spelling ) Optional like you have an itch but with a Mah Last Name ( Phonetic spelling ) Optional Bingo but with an L Home Address* 302 Morningside Drive City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-329-5720 Email Address * mitchlingo@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Parks and Recreation Commission Preference on first choice If multiple boards are being applied for. Park and Recreation Commission How long have you been a resident of Iowa City? 8 Years Occupation: * Research Scientist with the Iowa College Student Aid Commission Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * My experience surrounds marrying into a family that has three generations living within Iowa City. When I came to the city, I began by using the bike trails around town. As I grew into the father of an active three -year -old and a 6-month-old, I find myself busy at the various parks and pools throughout Iowa City on a weekly basis. During the first two summers of the Pandemic, Glendale park became our little oasis near our house on Morningside. Our winter evenings are dominated by going to the pools at Mercer or Lee. Even though we look forward to both of our daughters utilizing the youth programs as they get older, I have a 10 and eight -year -old niece and nephew who get a fair understanding of their needs and wants in the community. Finally, I have a 68 and 79-year-old mother- and father-in-law that utilize the various senior offerings in the community. Living near multiple generations in the community keeps me an understanding of the various needs of many different generational perspectives. What is your present knowledge of each advisory board you are interested in?* I grew up with an uncle that was second in command of the parks and rec department in Plano, Texas. Talking to him throughout my life gave me a fair idea of the coming and goings of the parks and recreation department. I understand the committee's job is primarily as an advisory role to the City Council. As unelected advisors, we are another layer to provide advice and ideas on how to improve and sustain the parks and recreation department. At the end of the day, we may have specific thoughts but the end decision on any policy surrounding the parks and recreation ultimately rests on the City Council. 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-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 (Optional) 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 38 Country of Origin Iowa, USA Sexual Orientation Hetero Religion Christian Do you have a disability? No Ethnicity White Race White Gender identity Cis *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. CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/27/2022 First Name* Rachel Last Name* McPherson First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 711 Runde!! Street City* Iowa City State IA Zip Code* 52240 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-359-0776 Email Address * rachelmcpherson@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Parks and Recreation Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? Since 2015. But I kinda grew up here too Occupation: * part-time English teacher Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I think my background as an educator teaching a variety of students could help me for this position. I have taught ESL in trailer courts, tutored writing with incarcerated students at Oakdale Prison, and taught English in Spain for 7+ years. I have experience trying to understand how a variety of people best learn, and I think this has helped to make me an empathetic, respectful and thoughtful --for the most part --person. I grew up in Iowa City and so I do care deeply about what it grows into. (The one downfall of this is that I may be reluctant to change. But I suspect serving on this board would help me to expand my thinking in this way.) My student teaching experience was in an underserved classroom at City High. The students were from the south side of Chicago, the Congo, Guatemala, and Mexico. As a member of Parks and Rec, I would love to imagine with fellow board members how we might initiate more community activities which facilitate inclusion of these underserved populations into "main stream" Iowa City. What is your present knowledge of each advisory board you are interested in?* Pretty sure that members of the board of Parks and Recreation watch that TV sitcom Parks And Rec. and quiz each other on it, right? :) Just kidding, of course. : ) My present knowledge of the Parks and Rec. advisory board is not extensive, unfortunately. I know that we would meet as a board to discuss imaginative solutions for meeting the needs of our community members' parks, pools, and cultural facilities. For Wednesday's public meetings, I imagine we would listen attentively to community members' concerns, take notes, and brainstorm and research possible solutions. 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-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 (Optional) 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 43 Country of Origin United States Sexual Orientation heterosexual Religion Episcopalian Do you have a disability? No Ethnicity Race Black (and white) Gender identity female *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. ra.arr�_ CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 6/22/2022 First Name* Susan Last Name* Mellecker First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 1918 Ridgeway Drive City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3195418497 Email Address * susan.mellecker@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Parks and Recreation Commission Preference on first choice If multiple boards are being applied for. Parks and Recreation Commission How long have you been a resident of Iowa City? 63 years Occupation: * Former sales and account manager, now part time ICCSD Gender* "This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity' may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I am a (born and bred resident of Iowa City and have raised my family here. I have a lifelong commitment to fitness and I applaud the City by having such great facilities, parks and bike trails (not to mention community gardens!). I've participated in the City's neighborhood association and attend the Summer of the Arts and Music in the Park activities, to name a few. Iowa City is a great community and our parks and rec programs greatly contribute to this culture. I worked as a remote employee in a global technology organization for the majority of my career until an early retirement, then two years for TRAIL of Johnson County, a local non-profit housed at the Senior Center. I have keen communication, customer service and organizational skills. I am analytical and detail oriented and have also supplemented my professional career with non-profit volunteer opportunities within the Iowa City community. I care about the process, integrity and transparency of our city government. I would welcome the opportunity to serve on the Parks and Rec commission in order to give back to the community that I love. What is your present knowledge of each advisory board you are interested in?* I am aware that the Parks and Rec Commission is an advisory role to the City Council, as are all of the local commissions. I've attended several meetings this year. 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, 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 (Optional) 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 Country of Origin Sexual Orientation Religion Do you have a disability? Ethnicity Race Gender identity *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. , rw®,mom CITY OF IOWA CITY UNESCO CRY OK LITERATURE Advisory Board/Commission/Committee ApplicaO L D This application is a public document and as such can be reproduced and dis the public. This application will be considered for twelve months only and a considered for any vacancy during that time. City Clerk NOTE Applicants MUST reside in Iowa City and be 18 years of age unless specific qualifications area4d'Gwa 1. Date of Application i OV, ! . Which Board or Commission(s) are you interested in Which one do you prefer? Applicant Infor•matiIOn: First Name* D (-s) yktS. First Name (Phonetic spelling) Last Name (Phonetic spelling) w5 1(." * R LEFT 1N\ �'tjYVyndS14 Last Name* xon (Optional) a h (Optional) Home Address* 1 \ f OSker . 4jc?13 City* . - C. State — Zip Code * ° 7 Contact phone number Email Address* r(1‘1 X O i-A 0 l or ,s@ G r1 C" 1. is your home address (listed above) within the corporate limits of Iowa City?* YES NO 2. How long have you been a resident of Iowa City? 3 --if yrs., Off 4. 3. Occupation:* m a-Chi-4'J; 4. Gender* Fa- kThis question is mandatory in order for the City to comply with the State's gender balance requirement which treats gender as binary "Gender Identity' may be provided in the demographics section of the application below. Male [Female 5. Experiences and/or activities which you feel qualify you for this position: d -Awe P• ceA, ..u�t-J ' �` Y 4ifL{ C •/4Tw- ceivw.(. C-Gi4 , F'YJlTL.1i "CG�Cfi'• CM-iI,' n-r- t.41Te ri ��'%..5 - 6. What is your present knowledge of each advisory board you are interested in? Gt0-44,11-1 • Please contact the city attorney at 319-356-5030 to discuss questions or concerns regarding a potential-- conflict of interest. The following describe some but not all potential conflicts. I ,} Potential Conflict of Interest NOV 0 >j 202z The Housing and Community Development Commission makes recommendations to thc(qtyr it regarding the distribution of federal CBDGIHOIvIE funds. The general rule is that no perizaglJoil6eikVa or have exercised any functions or responsibilities with respect to federally funded activities, or wh'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 sane 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, 7. Do you currently have a conflict of interest?* YES NC3f 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). List potential conflicts of interest* (See above for information regarding conflict of interest) Please indicate if there are none. BUSINESS NAME* BUSINESS ADDRESS* -4\dc 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. 8. Do you currently serve on another Iowa City board or commission?* YES r. • 1 *T9 F-h The City Council values all types of diversity on its boards and commissions. Your responses on LI,iti page provide valuable information to the Council in achieving that goal. NOV 0672 In order to ensure that the board and commission is representative of the community and the groups(s� City Clerk Iowa City, Iowa which it serves, please provide your information for the following: Demographic llrtformation: (optional) 9. Age C/1 10. Country of Origin V! N 11. Sexual Orientation 12. Religic 13. Do you have a disability? YES . f NO 14. Ethnicity 15. Race Oa -Gil 16. Gender Identity t -ex-e- Note: The Hunan 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 Applica 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. Contact information is attached. (rev. 04/30/21) CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/29/2022 First Name* APRIL Last Name* SCHMIDT First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 478 Charlotte Lane City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 9529059679 Email Address * aprillynnschmidt@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Parks and Recreation Commission Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 11 years Occupation: * Retired Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I have served two years on Parks and Recreation Commission (Jan 2019-Dec 2022). As a Veterans Affairs Rehabilitation Counselor I followed policies, rules and regulations. I also managed finances utilized to provide necessary equipment to live independently.I served as a Union Steward impacting the implementation of changes in office policy. I currently serve, and have, as the Treasurer and Vice President of Cardigan Park Condominium Home Owners Association (HOA). As such approving and declining payment of charges necessary to run the HOA. Also, as a Board Member I take part in making change to HOA declarations and by- laws. Lastly, I currently serve on the Veterans Engagement Panel (VEP) at the Iowa City Veterans Affairs (VA) Medical Center. I take part in responding to and impacting how VA researchers conduct their research to the different populations within the VA, the questions they ask, and the venue by which they use to conduct their surveys. Currently, within the VEP I am part of a nationwide team discussing the impact of race and ethnicity on VA Research. What is your present knowledge of each advisory board you are interested in?* The importance of serving as part of a team to develop and maintain safe and a broad array of recreational spaces and activities with the community. Being aware of policies and regulations so that recommendations for change can be made regarding the above stated. Working with the community, even through adversity with humility and respect. I have also been on the receiving end of being a person in the community given the option to render input as to how the green space in front of my home would be developed. 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-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 (Optional) 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 49 Country of Origin United States Sexual Orientation heterosexual Religion Latter Day Saint Do you have a disability? Yes Ethnicity Latter Day Saint, White, Miami Indian Race German, Irish, Miami Indian, + Gender identity Female *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* er! c5rxrr r6;er 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. Item Number: 14.f. CITY of IOWA CITY www.icgov.org November 15, 2022 Public Art Advisory Committee - One vacancy to fill a three-year term. January 1, 2023 - December 31, 2025 (Term expires for Andrea Truitt). ATTACHMENTS: Description Vacancy Notice/Coversheet Board Demographics/Attendance Sullivan, Nate - Application Truitt, Andrea - Application NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMITTEE: PUBLIC ART ADVISORY COMMITTEE One Vacancy: Three -Year Term January 1, 2023 — December 31, 2025 At -Large • Duties of the Public Art Advisory Committee include: developing by-laws and the Iowa City Public Art Program; • administering the Public Art Program by determining the placement of public art to be used in a specific project, and the artist to be engaged; procedures for art, the type of • 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. • The Public Art Advisory Committee meets the first Thursday of each month at 5:30 p.m. 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 8, 2022. An application can be completed and submitted on the City of Iowa City website at www.icgov.oro or by contacting the City Clerk's office. Questions about the Iowa City Public Art Advisory Committee should be directed to Marcia Bollinger, Neighborhood Outreach Coordinator at 319- 356-5248 or wford(ciowa-city.org Board/Commission Application Cover Board/Commission: Public Art Advisory Committee - At -Large One vacancy to fill a three-year term. January 1, 2023 - December 31, 2025. 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: 10/3/2022 Application Deadline: 11/8/2022 Council Appointment Date: 11/15/2022 Date of Non -Gender Appointment: 1/1/2023 After date above Council may appoint without regard to gender Gender Balance Requirement: Current Gender Balance: 1 Female Female: 2 Male: 4 Gender Name and Address Male Sullivan, Nate 1849 B St Female Truit, Andrea 815 N Johnson St Public Art Advisory Committee Demographic Report Name Category Term Term (Stop Term 'Resident Occupation !Gender* Age" Country Sexual iReligion* !Disability* Ethnicity* Gender Race' Type Number Years of iOrientationl Identity" Origin* :* 'Dominic IAt-Large .Full 1 6/3012023'2years Public Maie 27 United Gay!Homosex NonAlllICat No Italian/Germ Cis- While -Dongilli i Humanities/Re States uar holic an American gendered (Caucasian) search/Gradual Male e Student Jenny At -Large Unexpired 12/3112023155 years Research Female 55 US S7atght None No Not -hispanic Female White Granger Assodete/Pnnt maker 'Anita Jung Art or Design Unexpired 1 6/30/2023 17 years Faculty • Female 60 United No Celtic l White Professional University of Slates Iowa 1 !Steven Art or Design Full 2 12131120234.5years Architect Mate 38 United Straight Christian No Iowan Mate white ?Miller Professional States Edward Art or Design Full 2 12/3112024 34 years Freelance Male Boyken Professional artist Jeremy Art or Design Unexpired 12/3112025:13 years Looking fora Male 45 USA Gay No hemim White Endsley Professional + Full lob aim Vacant ARarge Full 1213112025- Please note: The information provided is the information provided on the application at the time of submission. * Information is voluntary Approved, p.4 Public Art Advisory Committee Mtg, 10/13/22 Public Art Advisory Committee Attendance Record 2022 Name Term Expires 10/7/21 11/4/21 1/6/22 2/3/22 3/3/22 5/5/22 6/2/22 7/7/22 8/4/22 918/22 10/13/22 Ron Knoche X X X X X X" X X X X X* Juli Seydell- Johnson X X X X X X X X X* X X Steve Miller 12/31/23 X X X X X X 0/E 0/E X X X Eddie Boyken 12/31/24 X X X X X X X 0/E X X X Andrea Truitt 12/31/22 0/E X X X X X X X X X X Dominic Dongilll 12/31/23 X 0/E 0/E X X X X X X 0/E X Anita Jung 6/30/23 --- — --- --- -- X 0/E X X 0/E 0/E Jenny Gringer 12/31/23 -- --- --- --- --- — -- --- — X 0/E Jeremy Endsley 12/31/22 --- —_ _._ ___ — _ --- — — X X Jan Finlay- son 12/31/23 0/E 0/E X 0/E 0/E -- — -- --- --- --- Nancy Puring- ton 12/31/22 X X 0/E 0/E 0/E — --- -- --- --- --- Sandy Steil 12/31/23 X 0/E 0 0/E 0/E -- -- --- --- --- --- Key: X = Present 0 = Absent 0/E = Absent/Excused = Not a member ra.arr�_ CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/13/2022 First Name* Nate Last Name* Sullivan First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 1849 B St City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 5159711325 Email Address * nate.j.sullivan@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Public Art Advisory Committee Public Art Advisory Committee Category* At -Large Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 27 years Occupation: * Ecommerce Copywriter Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * I served on the board of directors for Dreamwell Theatre for 4 years, including 1 year as the vice president and 2 years as their president. During that time, I oversaw the group's 20 year anniversary celebration and a transition to a new performance space following the Unitarian Universalist Society's move. What is your present knowledge of each advisory board you are interested in?* It's my understanding that the PAAC oversees public art projects such as the sculpture showcase, public murals and similar projects intended to showcase the beauty and creativity of Iowa City. I am applying to join the commission because I would like to advocate for an expansion of that mission to include the performing arts as well. 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-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 (Optional) 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 35 Country of Origin United States of America Sexual Orientation Bisexual Religion Atheist Do you have a disability? No Ethnicity White 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* Q,te,c_crlrtir 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. ra.arr�_ CITY OF IOWA CITY UNESCO CITY OF LITERATURE 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. If appointed to a Board/Commission, all other applications will be removed from consideration. NOTE: Applicants must reside in Iowa City and be 18 years of age unless specific qualifications are stated. Date of Application 10/23/2022 First Name* Andrea Last Name* Truitt First Name ( Phonetic spelling ) Optional Last Name ( Phonetic spelling ) Optional Home Address* 815 N. Johnson St. City* Iowa City State IA Zip Code* 52245 Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-359-8388 Email Address * andrea.m.truitt@gmail.com Boards & Commissions Select a Board or Commission you are interested in: * Public Art Advisory Committee Public Art Advisory Committee Category* At -Large Preference on first choice If multiple boards are being applied for. How long have you been a resident of Iowa City? 8 years Occupation: * Director of Engagement, Summer of the Arts Gender* *This question is mandatory in order for the City to comply with the States gender balance requirement, which treats gender as binary. "Gender Identity" may be provided in the Demographics sectionof the application below. Male Female Experience and/or activities which you feel qualify you for this position: * My educational- and work backgrounds, in addition to my art writing and experience as a current member of the Public Arts Advisory Committee (PAAC) make me qualified to continue serving on the committee as at at -large member. By training, I am an historian of American art and architecture, focusing on vernacular architecture and material culture. I am fortunate to work in arts administration as the Director of Engagement at Summer of the Arts, a nonprofit organization that produces both large-scale music and arts festivals and smaller neighborhood music events across Iowa City. All of our programming is free of charge and thus accessible to all community members. Similarly, the art projects supported by PAAC provide funding for different types of art installations, sculptures, murals, and performances that are publicly accessible and free of charge. I also write about visual art in Iowa City and Cedar Rapids for Little Village Magazine. My goal is to spotlight and celebrate art in our community in order to encouraging the community to view different types of art and demystify the process of engaging with visual art. I like to actively engage with the local art community in multiple ways, because I am passionate about the arts. Access to art of all mediums is vital to community wellbeing, not a privilege, and public art is one key component to access. What is your present knowledge of each advisory board you are interested in?* The Public Art Advisory Committee oversees the City's Public Art Program and advises the City on potential projects/needs. The program provides grants and project opportunities to artists of all media, in order to build upon Iowa City's reputation as an artistic center and to enhance the cultural resources that the city has, bringing art to the community at large, and acknowledging that Iowa City itself can be interpreted in different ways for different groups. There are many exciting projects in process for the committee, and we have recently changed our matching grant program, increasing our grant amounts while also having one round of grants. This should lead to more variety in the scale of projects. Another success of the committee has been the installation of temporary sculpture pads in various parks around town, which allow for a rotating exhibition of sculptures by regional artists. 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-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 (Optional) 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 38 Country of Origin USA Sexual Orientation Mostly heterosexual, maybe a whiff of queerness Religion NA Do you have a disability? No Ethnicity Race White Gender identity Woman *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. Item Number: CITY OE IOWA CITY www.icgov.org November 15, 2022 Senior Center Commission - One vacancy to fill an unexpired term. Upon appointment - December 31, 2023. (Linda Vogel resigned). Correspondence included in Council packet. Applications must be received by 5:00 P.M., Tuesday, January 3, 2023. ATTACHMENTS: Description Linda Vogel Resignation Tammy Neumann From: Sent: To: Cc: Subject: Kristin Kromray Thursday, November 10, 2022 9:03 AM Tammy Neumann LaTasha DeLoach; Kellie Fruehling FW: Senior Center Commission Meeting Tammy, Please see the email below from Linda Vogel resigning from the commission at the end of this year. Thank you, Kristin From: Linda <Igvogel1728@gmail.com> Sent: Thursday, November 10, 2022 5:03 AM To: Kristin Kromray <KKromray@iowa-city.org>; LaTasha DeLoach <Ideloach@iowa-city.org> Subject: Re: Senior Center Commission Meeting I will not be able to attend. Also as stated at last meeting I will be unable to be on commission starting Jan 1, 2023. On Fri, Nov 4, 2022 at 2:00 PM Kristin Kromray <KKromrav@iowa-citv.org> wrote: Hi All, Attached is the packet for the Thursday, November 17th Senior Center Commission meeting. If you are unable to attend the meeting please let LaTasha know. Thanks, Kristin Kristin Kromray Operations Assistant IOWA CITY SENIORp_319-3555221 CENTER 28 South Linn Street Iowa City, IA 52240 icgov.orJjsenior