HomeMy WebLinkAbout1997-12-16 AppointmentNOTICE
THE CITY COUNCIL OF IOWA
CONSIDERING APPOINTMENT
FOLLOWING COMMISSION:
CITY IS
TO THE
AIRPORT COMMISSION
One vacancy - Unexpired Term
December 16, 1997 - March 1, 2003
Duties: To exercise all the powers granted to
cities and towns under Chapter 330 of the Code
of Iowa, except the power to sell said airport. To
annually certify the amount of taxes within the
limitations of the Statutes of the State of Iowa to
be levied for Airport purposes. All funds derived
from taxation or otherwise for airport purposes
shall be under the full and absolute control of the
Airport Commission, deposited with the City
Treasurer, and disbursed only on the written
warrants or order of the Airport Commission.
Iowa City-appointed members of boards and
commissions must be eligible electors of the City
of Iowa City. The Airport Commission meets the
second Thursday of each month at 5:45 p.m.
This appointment will be made at the
December 16, 1997, meeting of the City Council
at 7:00 p.m. in the Council Chambers. The City
of Iowa City encourages diversity in the
appointment of citizens to boards and
commissions. Persons interested in being
considered for this position should contact the
City Clerk at the Civic Center, 410 E.
Washington Street. Application forms are
available from the Clerk's Office upon request.
Males: 4
Females: 0
AIRPORT COMMISSION
One Vacancy Unexpired Term
December 16, 1997 March 1, 2003
Brian Sponcil
523 S. Lucas
Mark A. Anderson
202 Linden Court
Norm Osland
201 First Avenue Apt. 201
Thomas J. Bender
1145 Duck Creek Drive
AIRI~RT COMMISSION
One ~a~ancy Unexpired Term
December16, 1997
Brian Sponc~'l
523 S. Lucas\
Mark A. Anderin
202 Linden Couf~
Norm Osland
201 First Avenu
March 1, 2003
Males: 4
Females: 0
CITY OF IOWA CITY
ADVISORY BOARD/COMMISSION
A PLICATION FORM
Individuals serving on Boards/Commissions play an important role in advising the Council on rrTa~ters of interest
to our community and its future. Applicants must reside in Iowa City.
After a vacancy has been announced, the Council reviews all applications during the work session. The
appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers.
PLEASE USE A BLACK INK PEN. Return the application to City Clerk, 410 E. Washington St., Iowa City,
Iowa.
THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE
PUBLIC. THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY
CONSIDERED FOR ANY VACANCY DURING THAT TIME.
ADVISORY BOARD/COMMISSION NAME /b~dz-~oP-,,T
NAME ~.,~-.~ ~.~c,~. HOME ADDRESS
Is your home address (listed above) within the corporate limits of Iowa City?
OCCUPATI O N ~-~r~,~/,a~,~o~Y'Sr' EMPLOYER
PHONE NUMBER: HOME 53? -~'~! BUSINESS
TERM
7/' Yes
No
EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? /.-t,,~,T'r~. /*¢/,.. ~ ~
~~,~ ~
WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR
SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY
PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY.
AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF
AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE.
IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE
AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE.
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~- YES NO
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? YES '/~ NO
(It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.)
cclerk\bdcomaPD,pro August 1996
CITY OF IOWA CITY
ADVISORY BOARD/COMMISSION
A PLICATION FORM '
Individuals serving on Boards/Commissions play an important role in advising the Coun~on matters*~f interest
to our community and its future. Applicants must reside in Iowa City. ~-~ .....
After a vacancy has been announced, the Council reviews all applications during the worl~ session. The
appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers.
PLEASE USE A BLACK INK PEN. Return the application to City Clerk, 410 E. Washington St., Iowa City,
Iowa.
THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE
PUBLIC. THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY
CONSIDERED FOR ANY VACANCY DURING THAT TIME.
ADVISORY BOARD/COMMISSION NAME AII~PD~Z,T C,oM/V~t.c,~toN TERMN~c,H
NAME /~/~^12-14, A.~NOF-,~ON ~ AIA HOME ADDRESS ~.~, L, IWID~INi
Is your home address (listed above) within the corporate limits of Iowa City? v/ Yes ~ No
OCCUPATION AI2-C,~[-~F_,C,I' EMPLOYER 9FH¥~-I~ATT!:-~¥,
PHONE NUMBER: HOME ~.c~,~. BUSINESS
EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR
APPLYING)? -['Hc~ Nm~MI~ OF FUTURE- IOEcI$1~N$ 'l-RAT WI~ /',,/~:~) TO ~E. /VtA~OE.
SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY
PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY.
AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF
AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE.
IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE
AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE.
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? vx' YES
NO
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? v/' YES ~NO
IC)E. 51G~I~ ~EVlr-,'4/ C, OA~tll'T'F-E - FIL, LINC~ U,N&;XlOlEEto TEYL/~ 'I'FfA1~ 15 tDoNE IhJ ~JLIL.'f J,t
(It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.)
ccl,,k\bdcomapp.l~O posslTto~ o~/ T/~5_~ At¥?_l~evLT" CeAAARiSSiON :~ V~/IL, L I~-E51GN I=l~oA~ THE August1996
~£C-0~-97 13,3S ~ROM,CiC~ o~ I0~ CITY ID,3193SG~89 ~AC~ I
CITY OF IOWA CITY
ADVISORY BOARD/COMMISSION
I 'PLICATION FORM
Individuals serving on Boards/Commissions play an important role in advising the Counc~l.'m .a~. rsof;interest
to our communitv and its future. Applicants must reside in Iowa City.
After a vacancy has been announced, the Council reviews all applications during the work~ession. The
appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers.
PLEASE USE A BLACK INK PEN. Return the application to City Clerk, 410 E. Washington St., Iowa City,
Iowa.
THIS APPLICATION IS A PUBUC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE
PUBLIC. THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY
CONSIDERED FOR ANY VACANCY DURING THAT TIME.
Is your home address [listed above) within the corporate limits of Iowa City? ~es ~ No
PHONE NUMBER: HOME .~ - ~/~ ~ .. BUSINESS ~- m 5 ~m
WHAT ,$ YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR
SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY
PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY.
HFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY, OTHER TYPES OF
AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE.
IF YOU ARE UNCERTAIN WHETHER OR NOT ~, POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE
AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE.
IF '3U ARE NOT SELECTED, DO YOU WANT TO I~E NOTIFIED? X_YES ..NO
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CI !'Y BOARD OR COMMISSION? .... YES ~'.. NO
(It has been Council policy not to permit an individual to serve On two Boards or Commissions at the same time.)
=cla~\b~cam~013.!~ro AUgUS~ 1 9~ 6
NORMAN A. OSLAND
307 E. 14th Terrace · Cameron, Missouri 64429
(816) 632-3288
OFFERING
The experience and acumen of a communications industry professional with excellent
management, financial, budget, personnel and communication skills and a proven track record
of success in a variety of increasingly responsible positions. Dynamic, loyal, progressive with
proven personal and professional ethics and standards.
Administration
SUMMARY OF QUALIFICATIONS
Intimate knowledge of the matrix which defines how an organization functions and
succeeds...Supervision of business affairs...implementation of business office practice
development...implementation of procedures and supervision of all business office
employees...Business office evaluations...Bottom line responsibilities.
Experience managing revenue accounting, customer billing and special studies in budget, finance
and toll separation... Legal matter coordination... Developed, implemented and chaired Employee
Advisory Board...Reviewed and monitored advertising programs...Company franchise
responsibilities...Oversaw property transactions-purchases and sales... Public
relations...Represented companies as spokesperson to various civic clubs, chambers and other
groups...Chaired Consumer Advisory Board.
Regulatory Excellent nonpartisian working relationship with Nebraska Public Service Commission and
related areas...Worked monitoring day-to-day regulatory activities...Advising top management
on political and timing feasibilities for rate case introduction...Corporate representative to
governmental bodies answering significant consumer complaints...Experience with mandated
documentation.
Quality
Assurance
Worked with implementation of Quality Circle program...Quality Customer Service
responsibility in multi-state area...Quality and constant improvement programs in various areas.
PROFESSIONAL EXPERIENCE
9/94 - Present OSLAND BROADCASTING COMPANY · Cameron, Missouri
Owner-Manager
· Overall Owner-Manager of radio stations I~MRN AM 1360 / KNOZ FM 100.1.
· In April 1995, put KNOZ FM 100.1, a 50,000 watt FM station, on the air.
2/85 - 9/94 NEBRASKA TELEPHONE ASSOCIATION. Lincoln, Nebraska
President
· Established and maintained nonpartisan working relationship with Nebraska Public Service
Commission, PSC staff, legislators and appropriate governmental agencies in the best
interests of the organization and in accordance with established policies.
· Maintained relationships and attended appropriate meetings of national organizations and
associations.
· Worked with Association or member legal counsel to promote Association objectives at
Nebraska Public Service Commission, Nebraska Legislature, other regulatory agencies and
in the courts.
· Represented Association in legislative and regulatory hearings on matters of industry-wide
consensus, preparing and offering testimony where appropriate.
NORMAN A. OSLAND Page two
10/83 - 2/85
8/77 - 10/83
6/74 - 8/77
1/70 - 6/74
1/69 - 1/70
11/66 - 1/69
9/57 - 11/66
EDUCATION
COMMUNITY
CONTINENTIAL TELEPHONE OF NEBRASKA AND COLORADO
State Manager
CONTINENTAL TEI.EPHONE OF IOWA. Knoxville, Iowa
Division Public Affairs Manager
CONTINENTAL TELEPHONE OF KANSAS, NEBRASKA AND COLORADO
Vice President/Business Relations
CONTINENTAL TELEPHONE' MIDWEST DIVISION. Wentzville, Missouri
Manager/Inter-Company and Regulatory Affairs
General Commercial Supervisor
State Commercial Supervisor
GENERAL TELEPHONE MIDWEST. Grinnell, Iowa
Accounting Management Positions
AMERICAN INSTITUTE OF BUSINESS · Accounting and business studies
DALE CARNEGIE SPEAKING COURSE' Graduate
Toll Separations Seminar
USITA Public Relations Seminar
Management by Objectives/Appraisals Seminar
Supervisory Leadership Seminar
Initial and Advanced Management Training
Various other business-related schools and seminars
Continuous involvement in seminars and training courses
Member: Cameron Chamber of Commerce and Board of Directors, Cameron Rotary,
Cameron Sertoma and Cameron Economic Development Board
NEBRASKA FEDERATION OF BUSINESS ASSOCIATIONS
Past Member of the Board and Past President
· NEBRASKA SOCIETY OF ASSOCIATION EXECUTIVES
Past Member of the Board and Past President
· KNOXVILLE IOWA INDUSTRIAL DEVELOPMENT CORPORATION
Past President
Past Member: Junior Achievement Board of Directors, various Chamber of Commerce and
Rotary Clubs
Past Board Member
Various Health and Educational Institutions
Past Member
Church Council, Jaycees
DEC-12-1999 16:59 INS. F~OC. [IF IC.
;1"1~ OF IOWA crrY
· ,DVISORY BOARD/COMMISSION
" PPLICATION FORM
319 331~ 4016 P.~ I~.
tndividuals sewing o- Boards/Commission, Ny an im~.,nt role in adding ~e Coun~l~'m~rs o~teres~
our c~muni~ and ~s f~ure. ~plican~ mu~ reside in Iowa City. ::.~ ....
AHer · vacancy ~s ~en an~unced, ~ Count{ reviews all a~lic~s dufi~ T~>w~'~s~on. The
;D~intmem is made at the ~ f;rmal ~1 toeing..A~inm~ sewe as u~ volunica.
~$E USE A B~CK INK PEN. n~ the application to City Clerk, 410 E. Washi.on St., Iowa C~.
ow8.
tHIS APPUCATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE
:~UBLIC. THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY
;ON51DERED FOR ANY VACANCY DURING THAT TIME.
Is your home address (list~ ~ove) wit~n ~ ~rp~em iim~s of Iowa CiW? ~ Yes
PHONE NUMBER; HOME 3] q" ~.l' ~-/q~.. BUSINESS 3¢/-$.~_ ..t-~'-/.~
EXPERIENCE AND/OR A~IVITIES WHl~ YOU F~E QUALI~ YOU FOR THIS POSITION:
WHAT IS YOUR PRESENT KNOWI FDGE OF THIS ADVISORY
WHAT CONTRIBUTIONS DO. YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE RF.~SON FOR
..z- ,.,,j., $e,~ - ,,,-...-, ,./ -~, ,-o,.-,,,,.~ .-,/% ,~ .d..,,.,' ,,,/...*,,. ,,,,&, ~o..,-_
.~t_ .,;,,t.,,,,=f. .2' /o,,, ~'../,',t,.,, .,,d ,..j,~ xl. ex,.L.,.~, o/,'d..,.,
.Z' ,,,., ,, /e.,-, //,I~,,. ..
DEC-12-1997 17:00 INS. RSSOC. OF IC. 319 338 4016 P.iB3
sPECIFIC ATI'EN1'ION SHOULD BE DIRECTED TO A POSSIBLE CONFUCT OF INTEREST, PI.F. ASE UST ANY
'RESENT AFFILIATIONS YOU HAVE WITH ~ENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY.
~FFILIATION MEANS BEING A ItOARD IIi~MBER OR EMPLOYEE OF THE AGENCY, OTHER TYPES OF
~FFIUATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE.
.= YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAl. CONFLICT OF INTEREST EXISTS, PLEASE UST THE
~GENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE.
F YOU ARE NOT SELECTED, DO YOU WANT TO BI~ NOT|Fii;D7 ~YES
)(' NO
)O YOU CURRENTLY SERVE ON ~NOTHER IOWA CITY BOARD OR COMMISSION? _ YES )~ NO
It h,; ileln Coun=il I~1icy not to permit ~ individual' ~;o serve on two Eards ~ Commissions at the some timcJ
~ .... ~ August 1996
TOTRL P. 03
NOTICE
THE CITY COUNCIL OF IOWA CITY IS
CONSIDERING AN APPOINTMENT TO THE
FOLLOWING BOARD:
BOARD OF ADJUSTMENT
One vacancy - Five-Year Term
January 1, 1998 - January 1,2003
Duties: In appropriate cases and subject to
appropriate conditions and safeguards, the
Board may make special exceptions to the terms
of the Zoning Chapter in harmony with the
general purpose and intent of the ordinance and
in accordance with general or specific rules
contained therein. The Board may grant
variances to the Zoning Chapter only in the case
of "unnecessary hardship." The hardship must
be substantial, serious, real, and of compelling
force, as distinguished from reasons of
convenience, maximization of profit or caprice.
The Board may also hear and decide appeals
where it is alleged there is an error in any order,
requirement, decision, or determination made by
a City official in the enforcement of the Zoning
Chapter.
Iowa City appointed members of boards and
commissions must be eligible electors of the City
of Iowa City. The Board meets the second
Wednesday of each month at 4:30 p.m.
This appointment will be made at the
December 16, 1997, meeting of the City Council
at 7:00 p.m. in the Council Chambers. The City
of Iowa City encourages diversity in the
appointment of citizens to boards and
commissions. Persons interested in being
considered for this position should contact the
City Clerk at the Civic Center, 410 E.
Washington Street. Application forms are
available from the Clerk's Office upon request.
12/11/97
Males: 2
Females: 2
December 9, 1997
Defer to December 16, 1997
BOARD OF ADJUSTMENT
One vacancy - Five -Year Term
January 1, 1998 January 1, 2003
T.J. Brandt
1912 Rochester Court
Edward (Ned) W. Wood
1016 E. College Street
Males: 2
Females: 2
December 9, 1997
Defer to December 16, 1997
BOARD OF ADJUSTMENT
One vacancy Five -Year Term
January 1, 1998 - January 1, 2003
T.J. Brandt
1912 Rochester Court
/
/
D£C-09-87 10,03 FROM,City oF I0WA CITY
ID,3183S~S008
CITY OF IOWA CITY
ADVISORY BOARD/COMMISSION
I ~PLICATION FORM
/?, b.
Indlvid~mls servin0 nn Bnard,~tCommissions play an important role in advising the ¢9undl on motters 9f inwrg~t
to our community and its future. Applicants must reside in Iowa City.
After a vacancy has been announced, the Council reviews all applications during the work session. The
appointment is made at the next formal Council meeting. Appointees serve as unpaid volunteers.
PLEASE USE A BLACK INK PEN. Return the application to City Clerk, 410 E. Washington St., Iowa City,
Iowa.
THIS APPLICATION I$ A PUBLIC .DOCUMENT AND AS SU~.H CAN BE REPRODUCED AND DISTRIBUTED FOR THE
PUBLIC. THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY
CONSIDERED FOR ANY VACANCY DURING THAT TIME.
NAME ~-. ~(~¢~ ' HOME ADDRESS
19 your home addregs (Ilsrod abovo) within the corporate limits of Iowa City7 ~ Yes No
PHONE UUUa~R: HOM~ ~57-~'?¢ eUS~.ESS
E~EHIEN~E ANU/U~ ACI'IVITIE$ WHI'CH YOU FEEL QUALIFY YOU FOR THIS PO31TION.
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR
D~C-08-87 10,04 ~ROM,City o£ I0WA CITY ID,3183686008 PAG~ 3
SPECIFIC ATTENTION SHOULD BE DIR!~CTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY
PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY.
AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY. OTHER TYPES OF
AFFII IATI(]N MU,~T BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE.
IF YOU ARE UNCERTAIN WHI- I HI=H OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LiST THE
AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE.
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~YES /NO
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION?
~YES yY~_..NO
(It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.)
cc~rl~d~o~ a13 p.13~O
August 1996
CITY OF IOWA CITY
ADVISORY BOARD/COMMISSION
APPLICATION FORM
Individuals serving on Boards/Commissions play an important role in advising the Cour{ciI on matte,~of interest
to our community and its future. Applicants must reside in Iowa City. c.~-
After a vacancy has been announced, the Council reviews all applications during :t.13~ w~ session. The
appointment is made at the next formal Council meeting. Appointees serve as unpaid ~blunte~_~s.
PLEASE USE A BLACK INK PEN. Return the application to City Clerk, 410 E. Washington St., Iowa City,
Iowa.
THIS APPLICATION IS a PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE
PUBLIC. THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY
CONSIDERED FOR ANY VACANCY DURING THAT TIME.
Is your home address (listed above) within the corporate limits of Iowa City? ¢ Yes ~ No
PHONE NUMBER: HOME 5 [~ ~46- I~%q BUSINESS
EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIs ADvIsORY BOARD (OR sTATE REASON FOR
SPECIFIC ATTENTION SHOULD BE DIRECTED TO A POSSIBLE CONFLICT OF INTEREST. PLEASE LIST ANY
PRESENT AFFILIATIONS YOU HAVE WITH AGENCIES WHICH MAY APPLY FOR FUNDING FROM THE CITY.
AFFILIATION MEANS BEING A BOARD MEMBER OR EMPLOYEE OF THE AGENCY, OTHER TYPES OF
AFFILIATION MUST BE EXAMINED ON A CASE-BY-CASE BASIS BY THE CITY ATTORNEY'S OFFICE.
IF YOU ARE UNCERTAIN WHETHER OR NOT A POTENTIAL CONFLICT OF INTEREST EXISTS, PLEASE LIST THE
AGENCY AND THEN CONTACT THE CITY ATTORNEY'S OFFICE.
¥~0~
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? v/ YES NO
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? YES ~' NO
(It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.l
cclerk/bdcomapp.p¢o
August 1996