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HomeMy WebLinkAbout2005-05-03 Appointments NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: HOUSING & COMMUNITY DEVELOPMENT COMMISSION One Vacancy - Unexpired Term September 1,2006 Duties of the Housing and Community Development Commission include assessing and reviewing policies and planning documents related to the provision of housing, jobs, and services for Iow- and moderate-income residents; reviewing policies and programs of the Public Housing Authority and Community Development Division and make recommendations regarding the same to the City Council; reviewing and making recommendations to the City Council regarding the use of public funds to meet the needs of Iow- and moderate-income residents; housing policies and programs, and seeking public participation in assessing needs and identifying strategies to meet these needs; recommending to the City Council from time-to-time amendments, supplements, changes, and modifications to the Iowa City Housing Code. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. When possible, Council will appoint persons with expertise in construction and/or finance, a person receiving rental assistance, and a member of the Local Homeless Coordinating Board. The Housing and Community Development Commission will have monthly meetings. Applications must be received by 5:00 p.m., Wednesday, April 27, 2005. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www. icgov.org. Questions about the Iowa City Housing and Community Development Commission should be directed to Steve Long, Community Development Planner at 356-5250. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 5 Females: 3 Council Announcement Date: March 22, 2005 Application Deadline: Wednesday, 5:00 p.m., April 27, 2005 Council Appointment Date: May 3, 2005 HOUSING & COMMUNITY DEVELOPMENT COMMISSION One Vacancy - Unexpired Term Ending September 1, 2006 Erin Barnes resigned Michael Larson [] 625 Scott Park Drive Kelly Mellecker [] 618 Fairchild Street Cherie Cool [] (Not an lC Resident) 615 4th Ave #2 Thomas Niblock [] 821 Melrose Avenue Tyler Mackie [] 100 Currier #N311 Timothy Sexton [] 5 Woolf Ave #3 Amie Kelley [] 2402 Bartelt Rd #2a Michael Shaw [] 2470 Lakeside Dr #11 [] Denotes applicant completed the Confidential page of the application. Housing & Community Development Commission Attendance Record 2005 TelTn Name - -Expire~ 0t/20 O2/1'/ 03/10 03/17 00/00 OO/00- 00/00 00/00' 00/00 00/00 00/00 00/00: Jerry Anthony 09/01/05 X X X X Erin Barnes 09/01/06 X X X X "' Lori Bears 09/01/07 X X X X Mark Edwards 09/01/05 X O/E X O William Greazel 09/01/06 O/E X O X Matthew Hayek 09/01/07 X X X X Rita Marcus 09/01/06 O/E X X X .... Brian Richman 09/01/07 X X X O/E Jayne Sandier 09/01/05 O/E X X X Key: X = Present 0 = Absent O/E = Absent/Excused NM = No Meeting ..... Not a Member CITY OF IOWA CITY ADVISORY BOARD/COMMISSION PPLICATION FORM Individuals serving on Boards/Commissions play an important role in ad~ih~0 .the C°url~ii 0"~h'matters 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. PL£A$£ U$£ A BL~CK INK P£N. Return the application to City Clerk, 410 E. Washington St., Iowa City, Iow& THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME ~o~/~/_.,/hob L~Z/~uc~lrY' Z)~t/~_z~,~-~ul- TERM NAME ~t~ ~ HOME ADDRESS ~ ~c~ Is your home address (listed above) within the ~rporate limits of Iowa Ci~? ~ Yes __ No How long have you been a resident of Iowa Ci~? ~2 ~ ~CCUPATION ~¢(.}(,~ ~~ EMPLOYER PHONE NUMBER: HOME ~Jq--35~-~l~ BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: P~r WHAT IS YOUR PRESENT KNOWLEDGE Of THIS ADVISORY BOARD? /l{¥ ~l,~[u~u~,~(,~ I$ lf~l Rs/} ~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. HCDC Application (1) February 2005 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ~- ~ I~P?Z~/~(~ ~a¢_. P4(~ ~<~,~,~gO ~ ~ ~c,~o ~,~ ~z~ ~ A POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached. If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? '~ YES NO DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? YE8 × NO (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. II II If you fail to answer all the questions, Council will not consider your application. HCDC Application (2) February 2005 BOARD, COMMISSION, & COMMITTEES ~ ~,) BUSINESS LISTING { ~:,',...-~ CITY OFIOWA CITY Name of City Board/Commission ~OUg~(, ~ ~/~/.~N,~ ~I/~,PIH~'I- Date Name /~'~(~//~E/_ /~12~'0~j List all businesses in which you or your spouse/domestic partner have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature ,~~ ~--.~ Address Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. HCDC Application (3) February 2005 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective February 11, 2005 Household 30% Median Income 50% Median 60% Median 80% Median Income Median Size (Poverty Level) Income Income (low income) Income 1 $15,250 $25,400 $30,500 $40,600 $50,800 2 17,400 29,000 34,800 46,400 58,000 3 19,600 32,650 39,200 52,200 65,300 4 21,800 36,300 43,600 58,000 72,600 5 23,500 39,200 47,000 62,650 78,400 6 25,250 42,100 50,500 67,300 84,200 7 27,000 45,000 54,000 71,900 90,000 8 28,750 47,900 57,500 76,550 95,800 ATTACHMENT TO APPLICATION FOR THE HOUSING AND COMMUNITY DEVELOPMENT COMMISSION IN ORDER TO ENSURE THAT THE HOUSING AND COMMUNITY DEVELOPMENT COMMISSION IS REPRESENTATIVE OF THE COMMUNITY AND THE GROUP(S) WHICH IT SERVES, AS REQUIRED BY THE U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT, PLEASE INDICATE IF YOU ARE A MEMBER OF ANY OF THE FOLLOWING CATEGORIES: Senior Citizen (62 or older) Handicapped or Disabled Person of Color Receive Rental Housing Assistance Lower Income (see table) Member of the Local Homeless Coordinating Board Your response is voluntary, and you may wish instead to elaborate on or indicate areas in which you can make a special contribution to the Commission in another section of this form. When possible, Council will appoint a person or persons with expertise in construction and/or finance, a person receiving rental assistance, and a person from the Local Homeless Coordinating Board. If you have expertise in construction or finance, please describe your experience and/or training. (20o~ O~ (2-~DF4~.,m'to~ ~IV4L Or~t ~-~ ?7' HGDG Application (5) February 2005 cITY oF IOWA CITY ",DVISORY BOARD/COMMISSION APPLICATION FORM Individuals serving on Boards/Commissions play an important role in advising the Council on matters 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, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. HOME ADDRESS (Z)~ ~:~'f'C-.~1~,14 SJYYe. z~ Is your home address (listed above) within lhe corporate limits of Iowa Ci~? ~ Yes No How long have you been a resident of owa C ~? ~ ~ (~ ~ ~r{~ ~[~ r~+) HOM US,N SS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. HCDC Application (1) February 2005 V¥ ¢IAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ~ O~ POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. In padicular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is ~-" 'ched. If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. 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 t~ permit an individual to serve on two Boards or Commissions at the same time.) II Misrepresentations on this application will constitute just cause for removal of an appointee. IIf you fail to answer all the questions, Council will not consider your application. General Application (2) February 2005 Kelly Mellecker Housing and Community Development Commission Application Term Ending 9/1/06 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I have been an Iowa City/Coralville resident my entire life, so I have witnessed the major changes our community has undergone in the past, and I feel I am familiar with the many different fomes which affect development in Iowa City. Through the university, I have been involved in activities that deal with human rights and social inequality issues. I'd like to see, and become more involved with, how the city deals with these issues in our community. I also have experience--both academic and professional--in law and business, and feel that my understanding of the regulations and economic factors affecting housing and development would be especially applicable to this position. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD: I have thoroughly researched the board's duties and responsibilities through the Iowa City government webpage, and read past minutes to get a feel for the board's day to day business. WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING): I have been able to see the University's effect on our community, both as a citizen, former employee and a student, giving me a unique perspective among both longtime citizens and students. This perspective has allowed me to see issues of housing and development from many sides, and realize that there is never one easy answer to difficult questions such as downtown commercial development or tenant/landlord regulation issues. Growing up in Coralville has also allowed me to gauge the benefits and detriments of both Iowa City and Coralville's attitudes towards development. Overall, I believe I would bring a balanced and open-minded perspective to the commission. BOARD, COMMISSION, & COMMITTEES ~ BUSINESS LISTING . CITY OF 10 WA CITY Board/Commission 3"1~t~\ {~ .... Name ¢~,~t4 ~~ List all businesses in which you or your spouse/domestic partner have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS flO~. NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature ~ ./ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. General App!ication (3) February 2005 CITY OF IOWA CITY ,DVISORY BOARD/COMMISSION APPLICATION FORM Individuals serving on Boards/Commissions play an important role in advising the Council on matters 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, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME ~r~O~'~tqO,~--~1~f~mLLfll~-~'t-i, I'~rJ'). TERM (~U~Y(~"- ~--~ NAME 0.~.¥i~- L. ~DoL HOME ADDRESS a(~.~ Ztr'-q'lAv'~.'l:~ Is your home address (listed above) within the corporate limits of Iowa City? Yes ,,,/ NO.~ How long have you been a resident of Iowa City? .~_ ~r& _ ~ '-~CCUPATION ~LrCt~t[¢O~C~; {~,~[-~rt¥~ EMPLOYER -T__,P---,O-.~J~'3,.~ PHONE NUMBER: HOME BUSINESS ~: ~_!~ -'' .. EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: "'/ ""J ' '~ .', .Z ' WHA~ ~s YOUR PRESENT ~NOW~ED~E OF T,~S ^DWSORY BOARD? ~ ~-~~. ~[~-~L~ l,c I Misrepresentations on this application will constitute just cause for removal of an appointee. I If you fail to answer all the questions, Council will not consider your application. HCDC Application (1) February 2005 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ~i'iL~d.~--~0 3¢h~E ~(::~S~ 't POTENTIAL CONFLICTS OF INTEREST %O[~&'O~ '1 q %~ ~ ~6 ~~ - ?leaso identi~ any potontial conflicts be~een membership on tho adviso~ board and your personal interests, includin~ financial interests and your 0uties to an omployor. In pa~icular, ff you aro applyino to bo a mombor of a board or commission which makos recommondations to the Council about tho allocation of City fun0s, ploase list any present affiliations you have with a~encies that apply for fun0in~ from the Ci~. "Affiliation" includes bein~ a board member or employoe of the a~ency. Othor ~pes of affiliations must bo examinod on a case by caso basis by the City A~ornoy's office. You should also know that Soction 302.5 of the Code of Iowa ~enerally prohibits, with ce~ain impodant excoptions, a membor of a city Board or Commission from havin~ an interest a~achod. If you are uncedain whethor a potontial conflict of interest exists or havo quostions about Soction 302.5 of the Code of Iowa, please contact the City A~orney's office at 356-5030. 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.) Misrepresentations on this application will constitute just cause for removal of an appointee. if you fail to answer all the questions, Council will not consider your application. HCDC Application (2) February 2005 CITY OFIOWA CITY Name of City Board/Commission -~'~5 ~\~ ~t"~V~-d"'~ ~'¢e.~q)V'r~_'~ Date Name List all businesses in which you or your spouse/domestic partner have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS '~c,~ ~ NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature ?../?,U'Lc~. _~. ~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. HCDC Application (3) February 2005 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective February 11, 2005 Household 30% Median Income 50% Median 60% Median 80% Median Income Median Size (Poverty Level) Income Income (low income) Income 1 $15,250 $25,400 $30,500 $40,600 $50,800 2 17,400 29,000 34,800 46,400 58,000 3 19,600 32,650 39,200 52,200 65,300 4 21,800 36,300 43,600 58,000 72,600 5 23,500 39,200 47,000 62,650 78,400 6 25,250 42,100 50,500 67,300 84,200 7 27,000 45,000 54,000 71,900 90,000 8 28,750 47,900 57,500 76,550 95,800 ATTACHMENT TO APPLICATION FOR THE HOUSING AND COMMUNITY DEVELOPMENT COMMISSION IN ORDER TO ENSURE THAT THE HOUSING AND COMMUNITY DEVELOPMENT COMMISSION IS REPRESENTATIVE OF THE COMMUNITY AND THE GROUP(S) WHICH IT SERVES, AS REQUIRED BY THE U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT, PLEASE INDICATE IF YOU ARE A MEMBER OF ANY OF THE FOLLOWING CATEGORIES: Senior Citizen (62 or older) Handicapped or Disabled Person of Color ~ Receive Rental Housing Assistance ~ Lower Income (see table) Member of the Local Homeless Coordinating Board Your response is voluntary, and you may wish instead to elaborate on or indicate areas in which you can make a special contribution to the Commission in another section of this form. When possible, Council will appoint a person or persons with expertise in construction and/or finance, a person receiving rental assistance, and a person from the Local Homeless Coordinating Board. If you have expertise in construction or finance, please describe your experience and/or training. HCDC Application (5) February 2005 Cherie L. Cool P.O. Box 5424, Coralville, IA 52241, (319) 936-3913 OBJECTIVE More than 10 years' successful experience in customer service and support with recognized strengths in account maintenance, problem-solving and trouble-shooting, and planning/implementing proactive procedures and systems to avoid problems in the first place. EMPLOYMENT 2004 to 2005 Para educator, Iowa City Community School District )~ Teacher Assistant, specializing with Learning Disabled and Behavior Disorder students at City High School 2003 to 2004 Stylist, JC Penney, Coralville, IA )~ Provided beauty services for customers. )~ Analyzed hair to ascertain condition and recommended treatments. > Handled direct customer service and sales with personal communication skills. 2003 Sales Associate, Dillards, Coralville, IA )~ Quickly and effectively solved customer challenges. )~ Maintained quality control, constantly seeking new way~.to customer service. 2002 to 2003 Cosmetology Student, La' James College, Iowa City, IA Studied hair, make up, and skin care. Hair: cuts, styles, perms, conditioning, etc Skin care: facials, makeup, aromatherapy, and waxing. Trained in wide range of product lines and applications. 2000 to 2002 Volunteer Center Manager, Eastern Mennonite Missions, Salunga, )~ Operated and managed retreat center. )' Bi-lingual high school English instructor. Manager, Director of Johnson County Dairy Promotion Board 5 years Childcare Provider, 1997 to 2000 Personal Home Daycare, Kalona, IA. Provided care for children of various ages including meal preparation, naps, and educational activities. EDUCATION 2003 Cosmetology, La' James College of Hairstyling, Iowa City, IA Chosen as Valedictorian of December 2003 class 0.) Marian Karr From: Cherie Cool [Cool. Cherie@iccsd.k12.ia.us] ent: Thursday, April 07, 2005 10:29 AM ~ o: council@iowa-city.org Attn: Steve Long Housing and Community Development Commission Honorable City Council Members, My name is Ms. Cherie L. Cool. I received notice of the available position for the Housing and Community Development Commission advisory board via email account. I work full time for the Iowa City Community School District as a para educator and teacher assistant at City High School. I currently serve as a member of the Program Coordinating Commitee for the Iowa City Housing Authority. I am involved in training with the Institute of Socio-economic Development, Cedar Rapids. Presently you will receive application and my resume. I have more then fifteen years experience actively pursuing creative avenues for effective problem solving. Every week day I work with children of struggling families in our community. I am highly motivated to be a part of the solutions for the future of our great city. I am a mother of three children and I sympathize with low income families because I have experienced the journey, trying to survive and afford housing with the low wages in this current economy. With humility and disapointment I have participated in programs with Human Services to survive. I dream and plan for liberation and self-sufficiency from these supports. · t is a priveledge to serve as a vol.unteer and to advise our Council on matters of interest for a better tomorrow in our community. I hope you will consider me for the Housing and Community Development Commission. Contact me with questions. Respectfully, Ms. Cherie L. Cool 615 4th Ave. #2 Coralville, Ia. 52241 (319)338-7011 (319)936-3913 cool.cherie@iccsd.kl2.ia.us coolmfm@msn.com References: Mary Copper Program Coordinator Iowa City Housing Authority (319)887-6061 Mary-Copper@iowa-city.org Liz Noyes Friend and salon client 319)354-9534 CITY OF IOWA CITY ADVISORY BOARD/COMMISSION .-tPPLICATION FORM CiT OF Iow^ ClT Individuals serving on Boards/Commissions play an important role in advising the Council on matters 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. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). 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, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME Housing and Community Development TERM 09/01/03-09/01/06 NAME Thomas Andrew Niblock HOME ADDRESS 821 Melrose Avenue (starting May 14th, 2005) ZIP 52246 Is your home address (listed above) within the corporate limits of Iowa City? ~ Yes ~F~ No How long have you been a resident of Iowa City? 13 Years (2 in college, 11 previous) ~i: '~CCUPATION Undergraduate Student EMPLOYER The University of iowa PHONE NUMBER: HOME (515) 290-0987 BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ~' I have served as a senator in the University of Iowa Student Government since February 2004, winning the prestigious "Award of Senatorial Excellence" in April 2005 for my work ethic and dedication. I was selected for a leadership position within my senate and continue to stay actively involved by mentoring the incoming senate executive and facilitating the transition between executive administrations. Through Student Government, I have also served on a variety of committees to fund student groups, advise the Iowa Memorial Union's upcoming renovations, increase the student body's role in the "Year of Civic Engagement", and develop a long-run organizational strategic plan. Next year, I am in charge of planning the Association of Big Ten Conference Schools Winter Retreat, a weekend professional development conference for the student governments of the Big Ten Universities. In high school, I was employed for two years by the Nevada Community Resource Center, a local non-profit organization that provides after-school and summer activities to underprivileged youth in the community. During my time at the Nevada Community Resource Center, I constructed a lending library database for the Center and helped teach numerous classes in partnership with the Nevada Community School District and ISU Extension Services. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? The Housing and Community Development Commission is an advisory board to the City Council that makes policy recommendations concerning Iow-to-moderate income housing and development issues. Its major functions include the distribution of housing vouchers to Iow income residents and allocation of grant money from the US Department of Housing and Urban Development to community development projects, subject to the oversight authority of the City Council. I! Misrepresentations on this application will constitute just cause for removal of an appointee. I~ II If you fail to answer all the questions, Council may not consider your application. HCDC Application February 2005 Page 1 of 8 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ~ am applying for the vacancy on the Housing and Community Development Commission because want to start bridging the ~ap between the University of Iowa student body and the Iowa City community. Housing is a natural starting point for students ~nd residents to find common ground and expand the progress we make in tenant-landlord and Iow-income housing relations to other areas of common interest. My experience with the University of Iowa Student Government has taught me the key to mediating disputes between groups as interdependent as the students and residents lies in the importance of greater civic engagement, and having an experienced, trustworthy student like myself on the Housing and Community Development ~,ommission will hel begin that process It is imperative for the Housing and Community Deve opment Comm ssion to include p · Jiverse interests and constituencies to properly address issues that reflect the priorities of the community as a whole. Through ny Student Government experience, I have worked extensively with budgeting mandatory student fee money in a process remarkably similar to the Commission's disbursement of HUD funds and reviewed Student Government's fiscal policies in a similar fashion as the Commission's review of the policies and programs of the Public Housing Authority and Community Development Division. Based on my previous employment with the Nevada Community Resource Center I would contribute an extensive knowledge of non-profit organizations and effective management practices that would aid in the review function of the Commission. 80% of the community development projects funded by the Housing and Community Development Commission's grant money are within a half mile of The University of iowa campus. To better facilitate the distribution of those projects, I bring unique experiences and a passion for making Iowa City a better place that only a student of my capacity could provide. POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies 'at apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 7). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of iowa, please contact the City Attorney's office at 356-5030. ~:: : ; IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~-~YES F'~NO DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~-'-IYES ~-~ NO (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) If you fail to answer all the questions, Council may not consider your application. II HCDC Application February 2005 Page 2 of 8 BOARD, COMMISSION, & COMMITTEES ,...._.~ ~ BUSINESS LISTING CITY OF IOWA CITY Name of City Board/Commission Housing and Community Development Date 04/27/2005 Name Thomas Andrew Niblock Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 7). List all businesses in which you or your spouse/domestic partner have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS None None NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature ~/~ ~. Address 821 Melrose Avenue (starting May 14th, 2005) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. HCDC Application February 2005 Page 3 of 8 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective February 11, 2005 Household 30% Median Income 50% Median 60% Median 80% Median Income Median Size (Poverty Level) Income Income (Iow income) Income 1 $15,250 925,400 930,500 940,600 950,800 2 17,400 29,000 34,800 46,400 58,000 3 19,600 32,650 39,200 52,200 65,300 4 21,800 36,300 43,600 58,000 72,600 5 23,500 39,200 47,000 62,650 78,400 6 25,250 42,100 50,500 67,300 84,200 7 27,000 45,000 54,000 71,900 90,000 8 28,750 47,900 57,500 76,550 95,800 ATTACHMENT TO APPLICATION FOR THE HOUSING AND COMMUNITY DEVELOPMENT COMMISSION IN ORDER TO ENSURE THAT THE HOUSING AND COMMUNITY DEVELOPMENT COMMISSION IS REPRESENTATIVE OF THE COMMUNITY AND THE GROUP(S) WHICH IT SERVES, AS REQUIRED BY THE U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT, PLEASE INDICATE IF YOU ARE A MEMBER OF ANY OF THE FOLLOWING CATEGORIES: Senior Citizen (62 or older) Handicapped or Disabled. [~] Person of Color [~] Receive Rental Housing Assistance Lower Income (see table) Member of the Local Ho_re. ~less? Coordinating Board :J?--: Your response is voluntary, and you may wish instead to elaborate on or indicate areas in which you can make a special contribution to the Commission in another section of this form. When possible, Council will appoint a person or persons with expertise in construction and/or finance, a person receiving rental assistance, and a person from the Local Homeless Coordinating Board. If you have expertise in construction or finance, please describe your experience and/or training. I am majoring in Economics in the College of Business and will take the introductory financial management course offered in Ihe College of Business next fall. I have already taken undergraduate coursework in economics, accounting, and business law. scoring an "A" or better in every class. I have a great deal of experience on the practical side of financial planning Ihrough my work on three student government committees devoted to the financing of student organizations. Through my work on these committees. I have gained invaluable experience in the budgeting of non-profit organizations and oversight [inancial review processes that would make me an excellent addition to the Housing and Community Development Commission. HCDC Application February 2005 page 4 of 8 CITY OF IOWA CITY ADVISORY BOARD/COMMISSION .APPLICATION FORM Individuals serving on Boards/Commissions play an important role in advising the Council on matters 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 dudng 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, towa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Is your ho~ address (list~ a~ve) within the ~rate limits of Iowa Ci~? H~ long have you ~en a resident of Iowa Ci~? ~ ~A~ ~UPA~ ~t{ ~ ~ ~,~ EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION.-_ WHAT IS YOUR PRESENT KNOWLEDGE OF 'THIS ADVISORY BOARD? IMisrepresentations on Ibis application will constitute just cause for removal of an appoints_... If you fail to answer all lhe questions, Council will not consider your application. HCDC Application (1) February 2005 VVHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ,'~,,_ ~ .,,~ ~ Fe-cV.-~ POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with certain impodant exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached. If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attomey's office at 356-5030. ?~ '~ . IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? X 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.) Misrepresentations on Ibis application will constitute just cause for removal of an appointee. I I If you fail to answer all Ihe questions, Council will not consider your application. HCDC Application (2) February 2005 BOARD, COMMISSION, & COMMITTEES /~~ BUSINESS LISTING ~~ CITY OF I0 W~! CITY Board/CommissionName°fCity HouS:,(3~ o..~g, ~ow~,~,~,.~¥~ ~,~v~l=~¢~-.'t- Date q/2~-/o~- Name ~~ G. ~~ ~ all ~n~ in ~ y~ ~ y~r ~~ ~ ~ve ~ ~ip i~ (~ e~, ~ pm~r, ~, 5% ~ ~ ~ ~~'s ~i~). P~ ind~ ff ~m ~ ~. I BUSINESS NAME BUSINESS ADDRESS NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Address loc> Misrepresentations on Ibis application will constitute just cause for removal of an appointee. If you fail to answer all lhe queslJons, Council will not consider your application. HCDC Application (3) February 2005 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective February 11, 2005 Household 30% Median Income 50% Median 60% Median 80% Median Income Median Size (Poverty Level) Income Income (iow income) Income 1 $15,250 $25,400 $30,500 $40,600 $50,800 2 17,400 29,000 34,800 46,400 58,000 3 19,600 32,650 39,200 52,200 65,300 4 21,800 36,300 43,600 58,000 72,600 5 23,500 39,200 47,000 62,650 78,400 6 25,250 42,100 50,500 67,300 84,200 7 27,000 45,000 54,000 71,900 90,000 8 28,750 47,900 57,500 76,550 95,800 ATTACHMENT TO APPLICATION FOR THE HOUSING AND COMMUNITY DEVELOPMENT COMMISSION 1N ORDER TO ENSURE THAT THE HOUSING AND COMMUNITY DEVELOPMENT COMMISSION IS REPRESENTATIVE OF THE COMMUNITY AND THE GROUP(S) WHICH IT SERVES, AS REQUIRED BY THE U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT, PLEASE INDICATE IF YOU ARE A MEMBER OF ANY OF THE FOLLOWING CATEGORIES: Senior Citizen (~ Handicapped or Disabled (' ) Person of ColorX..~~/ Receive Rental Housing Assistance Lower Income (see table) Member of the Local Homeless Coordinating Board Your response is vohmtarv, and yon may wish instead to elaborale on or indicate areas in which you can make a special conln'bution to the Commi~ion in another section oflhi~ form. When possible, Council will appoint a person or persons with expertise in construction and/or finance, a person receiving rental assistance, and a person from the Local Homeless Coordinating Board. If you have expertise in construction or finance, please describe your experience and/or training. HCDC Application (5) February 2005 Tyler G. Mackie April 25, 2005 Contact Information ~ Residence Hall Address: 100 Currier #N311, Iowa City, IA 52242 ~?: ;L~ Family Address: 1873 Gatemont Drive, Chesterfield, MO 63017 ~-' ..... ~ Residence Hall Phone: (319) 353-0462 - :...~ Family Phone: (636) 256-0415 Cell Phone: (314) 397-6323 i -~ As it concerns my residence: ~-¢ r-~ I have been a full-time student at the University of Iowa for two years, and have resided in the university residence halls. My family lives in St. Louis, from which I travel to and from for the summer. For the 2005-2006 school years, I will be living in off-campus housing in Iowa City. *I am a registered voter in Johnson County.* Experiences and/or activities, which you feel qualify you for this position: · Through involvement in University of Iowa Student Government, I have gained experience working with committees on a wide variety of subjects namely Academic Affairs, Budgeting and Allocating, and Recycling. · I have become familiar with the process of allocating public funds while participating on a United Way Allocations Panel as well as University of Iowa's Budgeting and Allocating Committee. · Lastly, I have a developed a breadth of knowledge for community development. While attending high school in St. Louis, my involvement in the Focus St. Louis Youth Leadership Program broadened my understanding of the many different facets that contribute to succinct community planning. What is your present knowledge of this advisory board? The HCDC is responsible for assessing community development and housing policies, and actively soliciting response from the community on the aforementioned policies. Additionally, the commission reviews funding requests from homing related organizations. After review, the committee makes funding recommendations to the City Council as well as amendments and changes to Housing Community Development policies. What contributions do you feel you can make to this advisory board? As a student who has greatly benefited from various leadership and civic engagement opportunities, I feel I can bring experience as well as personality to this committee. Additionally, I will contribute to the diversity of the committee by providing a student voice. (Continued) Experience in finance: As previously indicated, I have experience on committees and boards, which are responsible for the allocation of public and private monies. As far as specific experience in finance, I am a pseudo-business major. I am majoring in Political Science as well as pursuing a certificate in Entrepreneurial Studies. I have taken courses in Financial Accounting. Tyler Godding Mackie Permanent Home Address College Address 1873 Gatemont Drive 100 Currier #N311 Chesterfield, MO 63017 Iowa City, IA 52242 Phone: (636) 256-0415 Phone: (319) 353-0462 tyler-mackie@uiowa.edu EDUCATION B.A. Political Science, Entrepreneurial Certificate Anticipated May 2007 The University of Iowa, Iowa City, IA Chaminade College Preparatory School, St. Louis, Graduated Spring 2003. GPA 3.68 EXPERIENCE Associate April 2001 - present Panera Bread/St. Louis Bread Company · Responsible for food preparation and sales Barista Summer of 2004 Starbuck's Coffee · Committed to serving customers' coffee needs · Devoted to providing patrons with a welcoming atmosphere Senator April 2004- present The University of Iowa Student Government · Currently working on a comprehensive residence hall recycling program · Serve on Academic Affairs Committee · Serve on Student Allocating and Budgeting Committee Member Freshman School Year Hawkeyes for Israel (affiliated with American Israel Public Affairs Committee) · Responsible for the organization of the Second Annual Campus Leaders Dinner · Attended various conferences · Lobbied Congressmen LEADERSHIP Focus St. Louis Youth Leadership Program September 2001-May 2002 National Youth Leadership Forum - Defense, Intelligence and Diplomacy Fall 2003 United Way Allocations Panel (St. Louis, MO), Member August 2002 - April 2003 University Democrats, University of Iowa, Member References Available Upon Request CITY OF IOWA CITY i , ADVISORY BOARD/COMMISSION APPLICATION FORM CITY OF IOWA CITY Individuals serving on Boards/Commissions play an important role in advising the Council on matters 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. This form may be filled out manually (please use a black ink pen), typewritten, or electronically (PDF). 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, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME ¥.~t,~, ~ ,~¢~, (-cwc~/w,Jr~ '~--/~'¢~/,~'TERM ~ ~ ~'~ - ~.J.~C~ NAME '~o'-~ ~~ HOME ADDRESS ~ '~ ~ ~ ~ ZIP ~ P Is your home address (listed above} within the corporate limits of Iowa City? ~ Yes ~ No How long have you been a resident of IoWa City? ~ ~ ~ ~ OCCUPATION ~~ ~. ~t.~.~//5~o~EMPLOYER ~'~¢,~r~.~ o~ ~ PHONE NUMBER: HOME ~t'~CZ~- O'~D~{ BUSINESS ~%~5~ ~- ~[2~, EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? If you fail to answer all the questions, Council may not consider gout application. HCDC Application February 2005 Page 1 of 8 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies *hat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. ,)ther types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 7). If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030 .... : 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.) [ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. HCDC Application February 2005 Page 2 of 8 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective Februa~ 11, 2005 Household 30% Median Income 50% Median 60% Median 80% Median Income Median Size (Pove~y Level) Income Income (Iow income) Income I 815,250 825,400 830,500 840,600 $50,800 2 17,400 29,000 34,800 46,400 58,000 3 19,600 32,650 39,200 52,200 65,300 4 21,800 36,300 43,600 58,000 72,600 5 23,500 39,200 47,000 62,650 78,400 6 25,250 42,100 50,500 67,300 84,200 7 27,000 45,000 54,000 71,900 90,000 8 28,750 47,900 57,500 76,550 95,800 ATTACHMENT TO APPLICATION FOR THE HOUSING AND COMMUNITY DEVELOPMENT COMMISSION IN ORDER TO ENSURE THAT THE HOUSING AND COMMUNITY DEVELOPMENT COMMISSION IS REPRESENTATIVE OF THE COMMUNITY AND THE GROUP(S) WHICH IT SERVES, AS REQUIRED BY THE U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT, PLEASE INDICATE IF YOU ARE A MEMBER OF ANY OF THE FOLLOWING CATEGORIES: ~ Senior Citizen (62 or older) ~ Handicapped or Disabled ~ Person of Color [----] Receive Rental Housing Assistance  Lower Income (see table) [~1 Member of the Local Homeless I I Coordinating Board Your response is voluntary, and you may wish instead to elaborate on or indicate areas in which you can make a special contribution to the Commission in another section of this form. When possible, Council will appoint a person or persons with expertise in construction and/or finance, a person receiving rental assistance, and a person from the Local Homeless Coordinating Board. If you have expertise in construction or finance, please describe your experience and/or training. HCDC Application ~' c~ February 2005 page 4 of 8 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING CITY OF IOWA CiTY Name of City ---~ · ~//~ Board/Commission ~'\~'~'~'~ ~:*-~'~'~ ~.¢~-~ ~2~V~.~ Date ~//~ Name ~ ~ ~-~ Section 362.5 of the Code of Iowa generally prohibits, with certain impo~ant exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 7). List all businesses in which you or your spouse/domestic pa~ner have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there a~e none. BUSINESS NA~E BUSINESS ADDRESS NOTE: A new form must be completed if the above information changes or an ownership interest is acquired ip,~n additional business. Signature Address '1 Misrepresentations on this application will constitute just cause for removal of an appointee. II If you fail to answer all the questions, Council may not consider your application. HCDC Application February 2005 Page 3 of 8 CITY OF IOWA CITY ADVISORY BOARD/COIVIMISSlON APPLICATION FORM Individuals serving on Boards/Commissions play an impodant role in advising the Council on matters 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, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME ¢-¢()u~Em4 , C~mmu~i~r~ ¢~vcl~¢~4grcg_ TERM Is your home address (listed above) within the corporate limits of Iowa Ci~? ~ Yes <iBc How long have you been a resident of Iowa Ci~? /~ ~ ~¢~ :: ~-' ~:~' -Tq [ }NE NUMBER: HOME ~ ¢~ ~ ~/-.¢~ BUSINESS ,..~' ~]~ ::: ~ . EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ~ WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~/~ ~¢¢ ~ ~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. General Application (1) February 2005 ~, ,.-IAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? / ~/~/ /~'~/'/~/')9~'[~..~ ~'~/-~_/_~2~ ~S~ ~ ~~;~ Please identify any potential conflicts between membership on the advisory board andyour personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee ofthe agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is ~,"'~ched. tf you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. :__~. IF YOU ARE NOT 8ELEGTED, DO YOU WANT TO BE NOTIFIED? ~ YE8 NO DO YOU GURRENTLY SERVE ON ANOTHER IOWA GITY BOARD O~ GOMMISSION? YES ~ NO (It h~s been Goundl polioy not to permit ~n individual to se~e on ~o Boards or Gommissions at the same time.) II Misrepresentations on thiS application will constitute just cause for removal of an appointee. I[ If you fail to answer all the questions, Council will not consider your application. General Application (2) February 2005 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING CITY OF I0 WA CITY Name of City Board/Commission ~/---/-o~5/~z: 4 :di92i')ql~l'?l'~LC.._j '/~)E'U'('/¢/-71¢I.¢i'CC Date '/-/. '~. DS" Name :~.d,,ti¢_., J~?Jj~ 64 J List all businesses in which you or your spouse/domestic partner have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. , General App!ication (3) February 2005 CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM Individuals serving on Boards/Commissions play an important role in advising the Council on matters 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, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME ~.'~lu'~ ~ ~..~'-~"~ ~'~,[~0~,',~+ TERM i - ' NAME /'~,c~ ~,.~u~J HOME ADDRESS Zq-~o L~.e~,'~[~,Pr. Is your home address (listed above) within the corporate limits of Iowa City? X Yes __ No How long have you been a resident of Iowa City? ~ ~ ~x,'-5 OCCUPATION ~,.~,~ '"~,~wrc~ f.~>,.~¢ C~,o,r~,;,.A.~(~ EMPLOYER ~-~d~d~oJ PHONE NUMBER: HOME '~-~.~ BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT IS YOUR PRESENT KNOWLEDGE Of THIS ADVISORY BOARD? Misrepresentations on this application will constitute just cause for removal of an apPointee. If you fail to answer all the questions, Council will not consider your application. HCDC Application' (1) Februa~/2005 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING).'? POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attomey's office. You should also know that Section 362.5 of the Code of 'Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached. If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. 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.) If you fail to answer all the questions, Council will not consider your application. HCDC Application (2) February 2005 BOARD, COMMISSION, & COMMITTEES ~ BUSINESS LISTING CITY OF IOWA CITY Name of City Board/Commission ~ou,~¢v~ a~ (_.~,.~,ta.~,.r~ ~2e..de..l~?,~',~.,'~-I~'' Date List all businesses in which you or your spouse/domestic partner have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. HCDC Application (3) February 2005 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective February 11, 2005 Household 30% Median Income 50% Median 60% Median 80% Median Income Median Size (Poverty Level) Income Income (low income) Income 1 $15,250 $25,400 $30,500 $40,600 $50,800 2 17,400 29,000 34,800 46,400 58,000 3 19,600 32~650 39,200 52,200 65,300 4 21,800 36,300 43,600 58,000 72~600 5 23,500 39,200 47,000 62,650 78,400 6 25,250 42,100 50,500 67,300 84,200 7 27,000 45,000 54,000 71,900 90,000 8 28~750 47~900 57,500 76,550 95,800 ATTACHMENT TO APPLICATION FOR THE HOUSING AND COMMUNITY DEVELOPMENT COMMISSION 1N ORDER TO ENSURE THAT THE HOUS1NG AND COMMUNITY DEVELOPMENT COMMISSION IS REPRESENTATIVE OF THE COMMUNITY AND THE GROUP(S) WHICH IT SERVES, AS REQUIRED BY THE U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT, PLEASE INDICATE IF YOU ARE A MEMBER OF ANY OF THE FOLLOWING CATEGORIES: Senior Citizen (62 or older) Handicapped or Disabled ~( Person of Color Receive Rental Housing - Assistance ~ Lower Income (see table) Member of the Local Homeless Coordinating Board Your response is voluntary, and you may wish instead to elaborate on or indicate areas in which you can make a special contribution to the Commission in another section of this form. When possible, Council will appoint a person or persons with expertise in construction and/or finance, a person receiving rental assistance, and a person from the Local Homeless Coordinating Board. If you have expertise in construction or finance, please describe your experience and/or training. HCDC Application (5) February 2005 CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM ATTACHMENT Housing and Community Development Applicant - Michael Shaw 4:7- Experience and/or activities which you feel qualify you for this position: I have been a member of the Iowa City Housing Authority-Family Self Sufficiency-Planning Coordinating Committee for the past 2 years. I was a Board member of the Domestic Violence Intervention Program. I am currently the Family Resource Center Coordinator at Grant Wood Elementary. My current position as Family Resource Center Coordinator has required me to become intimately involved with housing policy in Iowa City as well as interact with multiple agencies that are connected to housing concerns. What is your present knowledge of this Advisory Board? The Housing and Community Development Commission is an Advisory Board of the City of Iowa City established to assess and review housing and community development policy and programming. This Advisory Board makes recommendations to the City Council and consults with other city entities about the use of public funds for low and moderate income residents. There are nine seats on the Advisory Board with one current vacancy. Board members are appointed by the City Council for 3-year terms. What contributions do you feel you 'can make to this Advisory Board (or state reason for applying)? I am a long time resident and parent in Iowa City. I have owned homes and rented here. I received my Bachelors and Masters degrees in Social Work from The University of Iowa. I have worked and volunteered in this community for close to 2 decades. Iowa City is my home. The South East side of Iowa City is where I live and work. I am invested in strengthening all of our communities. I am committed to supporting the vision of the Advisory Board to create a safe, vibrant and supportive community for low and moderate income families in Iowa City. As a long time advocate and community member I believe I can accurately represent the voices of traditionally underrepresented populations, and support them in advocating for their own interests, in the decision making of the Iowa City Housing and Community Development Commission. Potential conflicts of interest: I am a current member of an Iowa City Housing Authority Committee. Though there is no direct conflict of interest in my role on the Planning Coordinating Committee the appearance of conflict is present as the Housing and Community Development Commission is responsible for reviewing policies and programs of the Public Housing Authority. I am also an employee of the Iowa City Community School District, which has received funding based upon Advisory Board recommendations in the past. Specifically, as the Grant Wood Family Resource Coordinator the Advisory Board decision to fund the Grant Wood Elementary Addition directly impacts my work environment and my programming. NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: PLANNING AND ZONING COMMISSION One Vacancy - Unexpired Term Ending May 1,2006 The duties of the Planning and Zoning Commission members include making (or causing to be made) surveys, studies, maps, plans, or charts of the whole or any portion of the municipality and any land outside which--in the opinion of the Commission--bears relation to a comprehensive plan; also include recommending to the City Council from time-to-time amendments, supplements, changes, and modifications to the Zoning Ordinance. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. This Commission conducts formal meetings the first and third Thursdays of each month at 7:30 p.m. (Informal workshops are held the preceding Mondays at 7:30 p.m.) Applications must be received by 5:00 p.m., Wednesday, April 27, 2005. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. Persons interested in being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Questions about the Iowa City Planning and Zoning Commission should be directed to Robert Miklo, Sr Urban Planner at 356-5240. 3/8/2005 Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step-father, step- mother, step-child, aunt, or uncle. (Resolution 85-354) Males: 4 Females: 2 Council Announcement Date: March 22, 2005 Application Deadline: Wednesday, 5:00 p.m., April 27, 2005 Council Appointment Date: May 3, 2005 PLANNING AND ZONING COMMISSION One vacancy - Unexpired Term Ending May 1, 2006 Benjamin Chait resigned Michael Christians [] 4419 Berkley Lane Carl Hirschman [] 935 E Bloomington St Jeffrey Knox [] 1012 Tower Court Jerry Hansen [] (Currently serving 1st 5-year term) 1239 Burns Avenue Elizabeth Ford [] 10 Forest Gin James Ehrmann [] 630 N Dubuque St Terry Smith [] 2220 Balsam Ct John Anderson [] 111 Authur St N4 Ryan O'Leary [] 1924 Muscatine Ave Edward McEleney [] 717 Arlington Dr [] Denotes applicant completed the Confidential page of the application. Planning and Zoning Commission Minutes March 17, 2005 Page 10 Iowa City Planning & Zoning Commission Attendance Record 2005 FORMAL MEETING Namc Expires 116 1/20 2/3 2f17 3/3 3/17 4/7 4/21 5/5 5/19 612 6/16 7/7 7/21 8/4 8/18 9/1 9/15 10/6 10/20 11/3 11/17 12/I 12/15 D. Anciaux 05;06 X X X X X O'E B. Brooks 05:05 X X X X X X B. Chair 05/06 X O X X O .... A. Frcerks 05/08 X X X X X X J. }lansen 05/05 X X X X X X D. Shannon 0508 X X X O,E (')L! X INFORMAL MEETING D. Anciaux 1}5:06 CW X X O;IL B. Brooks 05'05 (. ' \~. X X X B. Chair 05/06 (_'W X O .... A. Frecrkq 05/{~8 CW X X X J. Hansen ¢505 CW X X O/E E. Koppes 05/07 CW X X X D. Shannon 05/08 CW (),1: {.).'~ X CITY OF IOWA CITY ADVISORY BOARD/COMMISSION 7; APPLICATION FORM "' individuals serving on Boards/Commissions play an important role in advisi~g~',C~)'u-nC On '~ffers of interest to our communi~ and its future. Applicants must reside in Iowa Ci~. 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 se~e as unpaid volunteers. PLEASE USE A B~CK INK PEN. Return the application to Ci~ 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, WITH THE EXCEPTION OF THE ~ST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORYBOARD/COMMISSION NAME ~/o. rl~ld~ -~ ~'on,h5 TERM NAME ~ t (; ~ ¢*~-~ ~ ~t ~, ~ ~.s HOME ADDRESS ~q~ Is your home address (listed above) within the corporate limits of Iowa Ci~? ~es __ No How long have you been a resident of Iowa Ci~? )O ~ ~ ~ OCCUPATION ~c~/k ~5~ EMPLOYER¢¢~m~c,~ 4ONENUMBER: HOME ~1¢- CZ~-~I BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? Misrepresentations on this application will constitute just causo for removal of an appointee. If you fail to answer ali the questions, Council will not consider your application. General Application (1) February 2005 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR POTENTIAL CONFLICTS OF INTEREST 3¢(~ v o~ ~7 '~T o, ppo', ~e m . Please identi~ any potential conflicts be~een membership on the advisow board and your personal interests, including financial interests and your duties to an employer. In padicular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City AEorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with cedain impodant exceptions, a member of a city Board of Commission from having an interest in a ci~ contract. A copy of Section 362.5 is attached. you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. ;:~ 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.) Misrepresentations on this application will constitute just cause for removal of an appointee· If you fail to answer all the questions, Council will not consider your application. General Application (2) February 2005 BOARD, COMMISSION, & COMMITTEES , ~, BUSINESS LISTING i -~... ....... ~,, CITY O£10 Wzt CITY Name of City Board/Commission 9/O o~,'~ ,,"~oC,( ~o,'~ [,~_3 Date ,.~ {-7 [o5 List all businesses in which you or your spouse/domestic partner have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. General Application (3) February 2005 March 7, 2005 Members of the Iowa City Council 410 East Washington Street Iowa City, Iowa 52240 Dear Council Members: Please accept this letter of interest for the current vacancy on the Iowa City Planning and Zoning Commission. In addition, I have submitted an official "Advisory Board/ Commission Application Form" as of today to the City Clerk's office. I have been a resident of Iowa City for 10 months. Prior to establishing residency at 4419 Berkeley Lane in June 2004, I have been a resident of North Liberty, Iowa and Coralville, Iowa. During my tenure in the Johnson County area, I have been employed by both Iowa State Bank and Trust Company and Commercial Federal Bank. In the various capacities in which I have operated at each of these institutions, I have had the opportunity to work individually with many of the fine residents and small business owners of Iowa City. I have also been active in many community activities such as serving as a volunteer classroom instructor for Junior Achievement, coaching little league baseball, and participating in Chamber of Commerce luncheons and business exchanges. With these strong bonds to the community, I feel as though my professional talents of open communication, active listening, and proactive problem solving could be put to good use as a member of the Planning and Zoning Commission. While my familiarity with Planning and Zoning is limited, I assure you that my candidacy provides the Commission with a motivated self-starter eager to address new challenges and accept new responsibilities in an effort to serve the greater good of the Iowa City community. Thank you for your time and consideration. Sincerely, Michael R. Christians 4419 Berkeley Lane Iowa City, Iowa 52245 319.325.1171 CITY OF IOWA CITY ADVISORY BOARD/COMMISSION ' PPLICATION FORM /,~ //-3,~ ~.,,, / Individuals sewing on Boards/Commissions play an impo~ant role in advising the Council on maffers of interest to our~ ~mmuni~ and its ~tum. ~pli~nts must reside in Iowa Ci~.-_ .,' .... has b~n announ~d, the Council revie~ all appli~tions dudng the wo~ se~io,. ~e a~i~ent After a va~ncy is made at the ne~ formal Council meeting. Appointees se~e as unpaid volunteem. PLEASE USE A B~CK INK PEN. Return the appli~tion to Ci~ Clerk, 410 E. Washington St., Iowa Ci~, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE ~ST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ' ADVlSORYBOARD/COMMISSlON NAME ~::::~'~C),i~'~tNO~ ~,ry'~ ~Ih~P-~L. TERM~~D Is your home address (listed above) within the ~rate limi~ of Iowa Ci~? Z Yes ~ No How long have you been a resident of Iowa Ci~ ~ */C ~ c~ f~ OCCUPATION V~ ¢~ ~ 1 ~c~r~ ~ EMPLOYER PHONE NUMBER: HOME ~ '~,-i~70 BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: W.AT ~s vou~ PReSenT ~O~LeD~e O~ TU~S ADWSO~V BOARD* %~eps ~ Misrepresentations on this application will constitute just cause for removal of an appointee, If you fail to answer all the questions, Council will not consider your application. General Application (1) February 2005 'HAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR POTEmlAL CONFLICTS OF INTERES~ t-r - . Please identi~ any potential conflicts be~een membersh~n the adviso~ board and your pemonal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached. If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code ~ Iowa, please contact the City Attorney's office at 356-5030. 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.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. General Application (2) February 2005 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING , ~... __ CiTY OF I0 WA CiTY Name of City . Board/Commission ~)~.OAh~/~ (~, Ust all businesses in ~ich you or your s~us~domostic padnor have an ownomhip interest {[or example, sole prop~etor, padn~r, 5~ or more o[ co~oration's stockholdin~s). ~l~a~ indi~at~ ii th~m am non~. BUSINESS NAME BUSINESS ADDRESS NOTE: A new form must be completed if the above information changes or an ownership interest is acquirp.,d in an additional business .... , Signature//~.,.~*' ~ Address ~, '~-~_ ~ ~'~OC'.N~/N~"~O/N <~'~J~ , you fail to answer all the questions, Council will not consider your application. General Application (3) February 2005 CITY OF IOWA CITY ADVISORY BOARD/COMMISSION PPLICATION FORM Individuals serving on Boards/Commissions play an important role in advising the Council on matters 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, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVlSORYBOARD/COMMISSIONNAME_ ,.,. P!O,V~i~lE.,v~,~ ~')..o~v~_.~ TERM NAME J~r~ ~' ~O~ HOME ADDRESS lO' Is your home address (listed above) within the ~rporate limits of Iowa Ci~? X Yes __ No How Ion9 have you been a resident of Iowa Ci~? ' ~ t ~ I ~ ~ ~ OCCUPATION %~eeck~L~u~Ee P~0~O5,%~ EMPLOYER F..JNE NUMBER: HOME ~'~-~q~ BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POS TON L.~ WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? IMisrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. General Application (1) February 2005 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ~ ~ O,.v%,~ '2..0 v',,,' v", ~ f'o ~f~L~-- ~,,:~ ~%CuO-~ POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is r shed. If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030 IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~x, YES NO DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? YES ~x, NO (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) ~1 Misrepresentations on this application will constitute just cause for removal of an appointee. I If you fail to answer all the questions, Council will not consider application. your General Application (2) February 2005 BOARD, COMMISSION, & COMMITTEES ~~~ BUSINESS LISTING .~ CITY OF IOWA CITY Name of City Board/Commission ¢3 I o,¢,~, ~ I ~'~ w, ~.~ Date ~-:2.~ Name ,.Je__ -(-~(,"~ j I/3r· ~.v~o ~ List all businesses in which you or your spouse/domestic partner have an ownership interest (for example, sole prop.rietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS t',40 ~ ~_ NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature ~~ ~., ~'~ Address I O t ~ '"It'~ ~-~ Y~-A, ~.~ (5 U.J'?~-'~ Misrepresentations on this application will constitute just cause for removal of an appointee. ~f you fail to answer all the questions, Council will not consider your application. General App!ication (3) February 2005 CITY OF IOWA CITY ADVISORY BOARD/COMMISSION P DPLICATION FORM Individuals serving on Boards/Commissions play an impodant role in advising the Council on matters 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, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORYBOARD/COMMISSlONNAME >//~,q/I ,'/7 ~ '~ Z¢,'-~ ~','1~ TERM-,~'/~$- Is your home address (listed above) within the corporate limits of Iowa Ci~? ~ Yes ~'~o How long have you been a resident of Iowa City? ~ ~ .~~ :;~ ::~' -:: OCCUPATION ~,~r~¢ ~~ EMPLOYER ~~, F,-.~NENUMBER: HOME ~/~'~'~~ BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT IS YOUR PReSeNT KNOWLEDGE OF THIS ADVISORY BOARD? ~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. General Application (1) February 2005 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is ~ ;hed. If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. 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.) ~1 Misrepresentations on this application will constitute just cause for removal of an appointee. I I you answer questions, will not consider your application. I If fail to all the Council General Application (2) February 2005 BOARD, COMMISSION, & COMMITTEES ~ BUSINESS LISTING .... CITY OF IOW.4 CITY Name of City Board/Commission /Z~/~,'~,'?;,2 ,~ ,/¢~j -~.~,1 ~ Date List all businesses in which you or your spouse/domestic partner have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stOckholdings). Please indicate if thoro are none. BUSINESS NAME BUSINESS ADDRESS NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature Address ) Misrepresentations on this application will constitute just cause for removal of an appointee. ~f you fail to answer all the questions, Council will not consider your application. General App!ication (3) February 2005 CITY OF IOWA CITY ADVISORY BOARD/COMMISSION / PPLICATION FORM Individuals serving on Boards/Commissions play an important role in advising the Council on matters 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, THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME PlA f~ (f)~ O,~, ~.OIr~ft~ ~ ~ m~S~I~TERM NAME ~~ ~ ~or~ HOME ADDRESS lO ~or~+ Is your home address (listed above) within the ~rporate limits of Iowa City? ¢ Yes ~ No How long have you been a resident of Iowa Ci~? ~ ~ ~ OCCUPATION y~¢~ [~r~ ~'t ~0~) EMPLOYER ~. ~. .ONE NUMBER: HOME ~t~) ~5~-IS~ff BUSINESS ~ EXPERIENCE AND/OR ACTIVITIES WHICH YOu FEEL QUALIFY YOU FOR THIS POSITI~:" J WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~ ~  M isrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. General Application (1) February 2005 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? .~ ~3~(P~JP.. ~AO~P~O~Y~'~: ~X~ ~ ~r~S~ ~ ~es~ POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is ; ched. If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ,,/'YES NO DO YOU CURRENTLY SERVE ON ANOTHER IOWA CI'I'Y BOARD OR COMMISSION? YES (It has been Council policy not to permit an in0ividual to serve on two Boards or Commissions at the same time.) II Misrepresentations on this application will constitute just cause for removal of an appointee. I If fail to answer all the questions, Council will not consider you your application. General Application (2) February 2005 BOARD, COMMISSION, & COMMITTEES ~ BUSINESS LISTING CITY OF I0 WA CITY Name of City Board/Commission ~d,~,v~.~l,~ &¥~ '/..o~,~1~ Date"Co ~lO. rcln '(35 List all businesses in which you or your spouse/domestic partner haVe an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS NOTE: A new form must be completed if the aboVe information changes or an ownership interest is acquired in an additional business. on application constitute just cause for removal of an appointee. Misrepresentations this will if you fail to answer all the questions, Council will not consider your application. General App!ication (3) February 2005 CITY OF IOWA CITY ADVISORY BOARD/COMMISSION .PPLICATION FORM Individuals serving on Boards/Commissions play an important role in advising the Council on matters 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, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME ?/~ ~ ",'~ ~) ,~ ,/ ~.. o-,,~,',~ .~ TERM NAME ~ ~ ~.~.~ HOMEAP~R~SS ~ ~- ~~ ~. Is your home address (listed above) within the corporate limits of Iowa Ci~? ~ Yes ~ No How long have you been a resident of Iowa Ci~? ~ ~ ~ ~ ~ ~ ONE NUMBER: HOME ~b~) ~ff0 ~ ~H7 BUSINESS ~- EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION~ ~s WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? T~'~ ¢~ ~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. General Application (1) February 2005 ,.. tAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO ThiS ADVISORY BOARD (OR STATE REASON FOR POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached. ~u are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. 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.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. General Application (2) February 2005 BOARD, COMMISSION,BuSiNESS & COMMITTEES ,,~~ LISTING , .~.. __ _ C~Tr O~: ~OWA C~Tr Name of City Board/Commission Name .'~-~- ~ List all businesses in which you or your spouse/domestic partner have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature ~.-~ .~ Address ~ ~G /J~-4-~,. ~t,~,,~. ~-~¢-~_¢~L, IMisrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. General Application (3) February 2005 CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM Individuals serving on Boards/Commissions play an important role in advising the Council on matters 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, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME / · ~ ~ ~ cb,'., ~b.,~f),-~ ~ r~.t, ~f'~,,~,.~ TERM . Is your home address (listed above) within the corporate limits of Iowa Ci~? X Yes __ No How long have you been a resident of Iowa Ci~? /~ ~f, .~ OCCUPATION ~p~m~,~-5 ~--~,~ EMPLOYER ~/~p,'~,~ ~~ F..ONE NUMBER: HOME ~]~ - ~- (~!~ BUSINESS .~9-_2~/- ~/~ EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I M isrepresentations on this application will constitute just cause for removal o~ an appointee. If you fail to answer all the quostions, Council will not consider your application. General Application (1) February 2005 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? -~ ~',~¢~,~r~/L/ ~,~A'~,o ~,~ ~ .~/~'Z~,~.~_,,_,..Z>~-,~/~,~L~ ~,~SS,~t POTENTIAL CONFLIOTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of'the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is ~ ched. If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. , · i -. , -' ',_~ /,_ IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ES NO " DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? S (It has been Council policy not to permit an individual to serve on two Boards or Commissions ~Jlhe sa~e time.) Il Misrepresentations on this application will constitute just cause for removal of an appointee. I If you fail to answer all the questions, Council will not consider your application. General Application (2) February 2005 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING CITY OF I0 WA CITY Name of City Board/Commission P]~.,~,,,~ ,r..,7_.~,,.~,',,,,_, ~.~¢~,~,v~.s~,~ Date~_~Z//~2.~~ List all businesses in which you or your spouse/domestic partner have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature /~.¢.//_,&¢ ,~. _~ I Misrepresentations on this application will constitute just cause for removal of an appointee. ii if you fail to answer all the questions, Council will not consider your application. General App!ication (3) February 2005 CITY OF IOWA CITY ADVISORY BOARD/COMMISSION PPLICATION FORM Individuals serving on Boards/Commissions play an important role in advising the Council on matters 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 PI=N. 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, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION NAME ~"~/] ~.//1/~--/-/t,z'~ ~..,z~-/2_.u,~, ~ TERM NAME "~z_JJ -~ ~ ). //~/,~/'.st./~ HOME ADDRESS /~/¢j.,~.~,,,~/,j' ~L, A,/Z.[ IS your home address (listed above) within the corporate limits of Iowa City? ~'~'es __ No ? How long have you been a resident of Iowa City?. )-~- ] ~ 'J ~'~ ~""d~/~C'~ "~'~' OCCUPATION C-//:~-,~'~'~'~--,/~',,.r,.,,.~ EMPLOYER '~"-~'r~,, I-..,.)NE NUMBER: HOME 33 ~ -/_f"$~. BUSINESS L'-"~ ~/~ ,~ EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSIT[~..:.. '...-: ' WHAT ~S YOUR PRESENT KNOWLEDOE OF T~S ADWSORV BOARD~ , Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. General Application (1) February 2005 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? _""'Z'~-~-,* / -'/~,,,'~ 'g"~/""'"~ "'"'~''~ ~ ~ ~ <~J POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the adviso~ board and your personal interests, including financial interests and your duties to an employer. In pa~icular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allo~tion of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "A~liation" includes being a board member or employee of the agency. O~her types of affiliations must be examined on a case by case basis by the City A~orney's office. You should also know that Section 362.5 of the Code of Iowa generally prohibits, with ce~a~Zi~oA~:~t exC~tions, a member of a ci~ Board or Commission from having an interest in a city contract. A copy of'Section ~B2.5 is~ ~ ched. , c.~ .. If you are uncedain whether a potential conflict of interest exists or have questions about Sec~ 362;~f thb Code of Iowa, please contact the City Attorney's o~ce at 356-5030. :~ ' .- IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTiFiED? /YEs NO DO YOU CURRENTLY SERVE ON ANOTHER IOWA C TY 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.) I~ Misrepresentations on this application will constitute just cause for removal of an appointee. I II you questions, Council will not consider your application. I If fail to answer all the General Application (2) February 2005 BOARD, COMMISSION, & COMMITTEES ~ BUSINESS LISTING - CITY OF IOWA CITY Name of City Board/Commission Date List all businesses in which you or your spouse/domestic partner have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS NOTE: A new form must be completed if the aboVe information changes or an ownership interest is acquired in an additional business. Signature I Misrepresentations on this application will constituto just causo for romoval of an appointoo. if you fail to answer all the questions, Council will not consiOer your application. General App!ication (3) February 2005 04/01/2005 FRI 8:58 FA~ 3193565497 IOWA CITY CLERK ~002/008 CiTY OF IOWA CiTY ADVISORY BOARD/COMMISSION APPLICATION FORM Individuals serving on Boards/Commission{ pIay an important role in advising the Council on matters 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 dudng the wbrk session. The appointment is made at the next formal Coundl meeting. Appointees serve as unpaid volunteers. PLEASE USE A BLACK INK PEN. Return the application to City Clerk, 410 E. Washington St., Iowa Cib/, Iowa. THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC; WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATLON WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ADVISORY BOARD/COMMISSION N~E ~*~*~~ Is your home address (listed above) within the ~rpomte limits of Io~ Ci~? ~ Yes ?.~o How long have you been a resident of Iowa Ci~? ~ ~ ~ ~ ~ ~PER1ENGE AND/OR AGTIV[TIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ~ Misrepresentations on this application will ~nstitute just cause for removal of an appointee. ~ If you fail to answer all the questions, Council will not consider your application. 04/01/2005 FRI 8:58 FAX 3193565497 IOWA CITY CLERK 003/008 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ~ J'k~'g_..--(~--~'~ ~,Z~jOC~>~.[.,.p~() ~ ,4,,~p_~./~o__m'~-~ .0)4 '-~,'L~__ POTENTIAL CONFLICTS OF INTEREST Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. In particular, if you are applying to be a member of a board or commission which makes recommendations to the City Council about the allocation of City funds, please list any present affiliations you have with agencies that apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. Other types of affiliations must be examined on a case by case basis by the City Attorney's office. Y should also know that Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a m~mber of a city Board or Commission from'having an interest in a city contract. A copy of Section 362.5 is attached. If you are uncertain whether a potential conflict of interest exists or have questions about Section 362.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~'~"YES NO DO YOU CURRENTLY SERVE ON ~IOTHER IOWA CITY BOARD OR COMMISSION?. ._~ YES NO (It has been Council policy not to permitan individual to serve on two Boards or Commissions at the same time.) If you fail to answer all tho questions, Council will not consider your application. General ADolication 04/01/2005 FRI 8:59 FA~ 3193565497 IOWA CITY CLERK ~004/008 BOARD, COMMISSION, & COMMITTEES ~ BUSINESS LISTING . - CITY OF IOi4/A CITY Name of City , Board/Commission ~[~,r, rt ,.~ -4- ~_,~^'~.~ C~.~.~',s~/~..1 Date List all businesses in which you or your spouse/domestic partner have an ownership interest ([or example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature ,~~-~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application_ ' General ADDlication ~'~'~ CITY OF IOWA CITY ADVISORY BOARD/COMMISSION /' PPLICATION FORM Individuals serving on Boards/Commissions play an import, ant role in advising the Council on matters of interest to our community and its future. Applicants must reside in Iowa City. After a vacancy has bccn 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, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. , '& ADVISORY BOARD/COMMISSION NAME~ [4 ~t~ I t%, , ~.O~1, ~C. I~Wl, 55 1 o,~, TERMs. - I ¢ ~--(~ Is your home address (listed above) within ~the corporate limits of Iowa City?. V/Y~.s No How long have you bccn a resident of lowa City? { d~ ~{~'5 / /}~')l'~,~J "~l~'n . O¢CUPAT,ON ~ ~- I '~'~r ~ 'ONE NUMBER: HOME 3ltl~ ~"~- b_~O BUS,NESS ~l~-~3i- EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT,S YOUR PRESE.T K.O~E~E OF TH,S ADWSORY BOARD? 'T~', ~ ~o~ If you fail to answer all the questions, Goundl will not consider your applimtion. General Application (1) February 2005 AT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ~ ~-~ fii'~-''k F~r'~ ~a~ POTENTaLCONFUCTSOFmTEaEST Please identi~ any potential confli~s be~n membemhip on ~e adviso~ board and your personal interests, including financial inter~ and your duties to an employer. In pa~cular, ~ you are applying to be a meier of a ~ard or commi~ion which makes r~mmendations to me Ci~ Council a~ut me all~tion of Ci~ funds, please list any pr~ent affiliat~ns you have wRh agendes that apply for ~nding kom ~e Ci~. 'Affiliation" includ~ ~ing a board member or employ~ of ~e ~en~. ~her ~p~ of affiliations mu~ be examin~ on a ~ by ~ basis by the Ci~ Aaomey's You should also know ~at S~ion 362.5 of ~e C~e ~ Iowa ge~mlN prohibits, wah ~in im~nt ex~ptions, a meier ~ a d~ ~oard or Commi~ion ~m having an interest in a ci~ ~. A ~py ~ S~on 36Z5 is ou are un~ain ~ether a potential ~nflia of interest exists or have guestions about S~2.5:9f t~ Code u, Iowa, plea~ ~nta~ the Ci~ affomey's ~ at 3~5030. IF YOU ARE NOT 8ELEGTED, DO YOU WANT TO BE NOTIFIED~ ~YE8 NO DO YOU OURRENTLY SERVE ON ANOTHER IOWA Ol~ BOARD OR OOMMI8810N~ YE8 ~NO (It has b~n Ooundl ~li~ n~ to ~ an i~Mdu~l to ~e on ~o Bca~8 or Oommi~on8 M ~e ~me ~me.) IMisrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. General Application (2) February 2005 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING CITY OF I0 Wzt CITY NameofCity g,~ '~O#/'~O/Z~Z4///~;S/g~ Date ~"77"S Board/Commission ~.. I'~ ~. List all businesses in which you or your spouse/domestic pa~ner have an ownership interest (for example, sole proprietor, padner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application. General Application (3) February 2005