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HomeMy WebLinkAbout2005-11-01 Appointment 15a NOTICE ~ THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF ADJUSTMENT One vacancy - Five Year Term January 1, 2006 - January 1,2011 Duties: In appropriate cases and subject to appropriate conditions and safeguards, the Board may make special exceptions to the terms of the Zoning Chapter in harmony with the general purpose and intent of the ordinance and in accordance with general or specific rules contained therein. The Board may grant variances to the Zoning Chapter only in the case of "unnecessary hardship." The hardship must be substantial, serious, real, and of compelling force, as distinguished from reasons of convenience, maximization of profit or caprice. The Board may also hear and decide appeals where it is alleged there is an error in any order, requirement, decision, or determination made by a City official in the enforcement of the Zoning Chapter. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets the second Wednesday of each month at 5:00 p.m. Applications must be received by 5:00 p.m., Wednesday, October 26, 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 Board of Adjustment Commission should be directed to Bob Miklo, Senior Planner at 356-5240. Board of Adjustment Attendance Record 2005 Name Expires 01/12 02/09 03/09 04/13 05/11 06/08 07/13 08/10 09/14 10/12 11/09 12/14 Carol Alexander 01/01/08 X X X NM X X X X X X Ned Wood 01/01/10 .... X X NM X X X O/E X X Karen Leigh 01/01/07 X O/E X NM X X X X X X Vincent Maurer 01/01/06 X O/E X NM X X X X X X Michael Wright 01/01/09 X X X NM X X X X X X Key: X = Present O = Absent O/E = Absent/Excused NM = No Meeting ..... Not a Member 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: 2 Females: 2 Council Announcement Date: September 20, 2005 Application Deadline: Wednesday, 5:00 p.m., October 26, 2005 Council Appointment Date: November 1, 2005 BOARD OF ADJUSTMENT One vacancy - Five Year Term January 1, 2306 - January 1, 2011 Term expires for Vincent Maurer Michelle Shelangouski [] 1126 Village Farm Ct [] Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY I _t ~ 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 Board of Adjustment TERM 01/01/06/-01/01/11 NAME Michelle L. Shelangouski HOME ADDRESS 1126 Village Farm CT Iowa City ZIP 52240 Is your home address (listed above) within the corporate limits of Iowa City? ~-~ Yes ~-1No How long have you been a resident of Iowa City? 5 months OCCUPATION Analyst EMPLOYER MidAmerican EnergyCO P, ,~IE NUMBER: HOME 351-2075 BUSINESS 341-4415 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: Before moving to Iowa City, I was a past Vice-Chairman and member, of the Board of Directors for Bridgeway, Inc., a large non-profit mental health organization serving parts of Iowa, Illinois, and Missouri, headquartered in Galesburg, IL. I also served as a member of the Board for the Colona, Green Rock, Orion (IL) United Way. And was a member of the Advisory Board for the Orion (IL) School District. O "= WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? .o None, other than what I've read on the City's web site. ,j> co |1 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. II General Application February 2005 Page 1 of 7 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? lAs a new resident of Iowa City, I would like to become active in it's government. Being part of a Board, Commission, or C mittee, will allow me that opportunity. In addition, as a member I would play a role in the city government process, and lea, n more about how the city government works. II believe that participation this commission will be a rewarding and challenging experience that will help me to grow as an individual and become a part of the community. 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. O" ~r 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 6). 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 c,q DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? r~YES J-~ NO (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Il ~lisrepresentations on this application will constitute just cause for removal of an appointee. J' II If you fail to answer all the questions, Council may not consider your application. General Application February 2005 Page 2 of 7 BOARD, COMMISSION, & COMMITTEES ~ BUSINESS LISTING CITY OF IOWA CITY Name of City Board/Commission Board of Adjustment Date 10/10/2005 Name Michelle L. Shelangouski 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 6). 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 NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature ~ }'xxJL~ '_~...~v~~~' Address 1126 Village Farm CT Iowa City - qisrepresentations 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. II General Application February 2005 Page 3 of 7 Michelle L. Shelangouski 1126 Village Farm CT Iowa City IA 52240 mlsh¢langouski~midamcrican.com (319) 351-2075 October 10, 2005 City of ]:owa City 410 E Washington ST ]:owa City :IA 52240 RE: Board, Committee, and Commission Vacancies Enclosed are applications for two vacancies, Board of Adjustment and Human Rights Commission. While ]: understand that [ can only be a member of one Board, Committee, or Commission at a time, these two applications are being submitted in hopes that [ am appointed to one of them. ]:t is my desire to be a member of the Board of Adjustment. However, if that is not fulfilled, please consider me for a member of the Human Rights Commission. Thank you very much for your consideration. Sincerely, Michelle L. Shelangouski ~_c~ ~ '-i1.01.05 15b NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: AIRPORT ZONING BOARD OF ADJUSTMENT One vacancy - Unexpired Term Ending December 31, 2006 The powers and duties of the Airport Zoning Board of Adjustment are: 1. To hear and decide appeals where it is alleged there is an error in any order, requirement, decision, or determination made by an administrative official in the enforcement of the Airport Zoning Chapter. 2. To hear and decide special exceptions to the terms of the Airport Zoning Chapter upon which such board is required to pass under the Airport Zoning Chapter. 3. To authorize upon appeal in specific cases such variance from the terms of the Airport Zoning Chapter as will not be contrary to the public interest, where owing to special conditions a literal enforcement of the provisions of the Airport Zoning Chapter will result in unnecessary hardship, and so that the spirit of the Airport Zoning Chapter shall be observed and substantial justice done. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets at the call of the Chairperson. Applications must be received by 5:00 p.m., Wednesday, October 26, 2005. The City 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 Johnson County/Iowa City Airport Zoning Board of Adjustment should be directed to Randy Hartwig, Airport Commission Chair at 337-2101. 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: 3 Females: 0 Council Announcement Date: March 16, 2004; May 4, 2004; June 15, 2004; August 3, 2004; September 14, 2004; November 2, 2004; December 7, 2004; January 18, 2005, March 1,2005; April 5, 2005; May 17, 2005; July 5, 2005; August 16, 2005; September 20, 2005. Application Deadline: Wednesday, 5:00p.m., October 26, 2005 Council Appointment Date: November 1, 2005 AIRPORT ZONING BOARD OF ADJUSTMENT One Vacancy - Unexpired Term Ending December 31, 2006 Carl Williams resigned No Applications as of Wednesday, 5:00p.m.,October 26, 2005. [] Denotes applicant completed the Confidential page of the application. 11-01-05 15¢ NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: AIRPORT ZONING COMMISSION One vaaancy - Six Year Term January 1, 2006 - December 31,2011 Duties of the Airport Zoning Commission are: 1. To recommend amendments to the current Iowa City Airport Zoning regulations, including the repeal thereof. 2. To recommend the adoption of new Airport Zoning regulations. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets as required. Applications must be received by 5:00 p.m., Wednesday, October 26, 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 Airport Zoning Commission should be directed to Randy Hartwig, Airport Commission Chair at 337-2101. 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: 0 Council Announcement Date: September 20, 2005 Application Deadline: Wednesday, 5:00p.m., October 26, 2005 Council Appointment Date: November 1, 2005 AIRPORT ZONING COMMISSION One Vacancy - Six-year Term January 1, 2006 - December 31, 2011 Term expires for Mark Anderson No Applications as of Wednesday, 5:00p.m.,October 26, 2005. [] Denotes applicant completed the Confidential page of the application. 15d NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: ANIMAL CARE AND ADOPTION CENTER ADVISORY BOARD One vacancy - Three Year Term January 1, 2006 - December 31,2008 The Animal Control Advisory Board shall provide such recommendations and advice as are required by the 28E Agreement between the City of Iowa City and the City of Coralville, or as may be requested by the City Council or City Manager of Iowa City or by the City Council or City Administrator of Coralville. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. Applications must be received by 5:00 p.m., Wednesday, October 26, 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 Animal Care and Adoption Center Advisory Board should be directed to Misha Goodman, Animal Services Division Supervisor at 356-5295. 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: 2 Females: 2 Council Announcement Date: September 20, 2005 Application Deadline: Wednesday, 5:00 p.m., October 26, 2005 Council Appointment Date: November 1, 2005 ANIMAL CARE AND ADOPTION CENTER ADVISORY BOARD One vacancy - Three Year Term January 1, 2006 - December 31, 2008 Term expires for Tammara Meester No Applications. as of Wednesday, 5:00p.m.,October 26, 2005. [] Denotes applicant completed the Confidential page of the application. 11-01-05 15e NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF APPEALS One Vacancy - Five Year Term (1) Licensed Electrician January 1, 2006 - December 31,2010 It is the duty of members of the Board of Appeals to hold appeal hearings on matters concerning the Uniform Building Code, Uniform Plumbing Code, National Electric Code, Uniform Mechanical Code, Uniform Fire Code, the Dangerous Building Code, and the Iowa City Housing Code. Members must be qualified by experience and training to pass upon matters pertaining to building construction. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Board meets the first Monday of each month at 4:30 p.m. or at the call of the Building Official. Applications must be received by 5:00 p.m., Wednesday, October 26, 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 regarding the Board of Appeals should be directed to Tim Hennes, Sr Building Inspector at 356-5122. BOARD OF APPEALS 12 MONTH ATTENDANCE RECORD 01/01/05 to CURRENT Meeting Date wayne john Ga~ Haman Anna BUSS steve DOuglas Ti~ Fehr Maas Roffman BUckman DuCharme 1/10/2005 X X X X X O/C OIC 5/2/2005 X X X O/C X X X 5/24/2005 X X X X X X X (X) = Present (0) = Absent (O/C) = AbsenFCalled (Excused) 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: 1 Council Announcement Date: September 20, 2005 Application Deadline: Wednesday, 5:00 p.m., October 26, 2005 Council Appointment Date: November 1, 2005 BOARD OF APPEALS One vacancy - Five Year Term January 1, 2006 - December 31, 2010 (Licensed Electrician) Term expires for C. Wayne Maas C. Wayne Maas [] (Currently serving 2®- 5 yr term) 1122 Hampton Ct Alan Gerard [] 851 Coventry Ct [] Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY ADVISORY BOARD/COMMISSION APPLICATION FORM oF Iow^ 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 ~:~ ~ c'~/' ~-- ~' /Z~~ ~-G (~1 TERM NAME HOME ADDRESS ?/~. /-('_.m~rp~'~ ~"'t~, Z~P Is your home address (listed above) within the corporate limits of Iowa City? I~ Yes D No How long have you been a resident of Iowa City? /-,~ ~ ~--<~ OCCUPATION ~/~/_~t',-/'~<,~ 'EMPLOYER ~..c¢,; ~'~,~ ~/~.c.(-~'c_ PHONE NUMBER: HOME .'~ _77 - ~-~ ?-;~,~.5-'-~ BUSINESS ~/?- ~- ~)/.~ EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY yOu FOR THIS POSITION: WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? --- O~ I! Misrepresentations on this application will constitute just cause for removal of an appointee. II II If you fail to answer all the questions, Council may not consider your application. General Application February 2005 Page 1 of 7 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR ~,PPLYING)? 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 (see page 6). 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. (~~c=' ,F You ARE NOT SELECTED, DO YOU WANT TO BE NOT, F ED? DO YOU CURRENIL¥ SERVE ON ANOIHER IOWA CI1¥ 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. If you fail to answer all the questions, Council may not consider your application. General Application February 2005 Page 2 of 7 BOARD, COMMISSION, & COMMITTEES ~ BUSINESS LISTING CITY OF IOWA CiTY Name of City Board/Commission R6~,t-'~ O~ ~lO~,~rA(] ~' Date Name ~~ ~3~_ ~~ · 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 6). 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 /.~ ~/~~ ~./'~----- -/~-- _ _ Misrepresentati°ns °n this applicati°n will c°nstitute just cause f°r rem°val °f an app°intee' [I If you fail to answer all the questions, Council may not consider your application. General Application February 2005 Page 3 of 7 CITY OF IOWA CITY ADVISORY BOARD/COMIVlI'SSION APPLICATION FOR CITY OF IOWA CI~ 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 Board of Appeals TERM 5 Years NAME Alan W. Gerard HOME ADDRESS 851 Coventry Court ZIP 52245 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? Forty Years OCCUPATION Vice President - Gerard Electric, Inc. EMPLOYER Gerard Electric, Inc. PHONE NUMBER: HOME 319-341-0098 BUSINESS 319-337-(~4 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:c7-<no"~ -Fi ..... · 1. Journeymen Wiremen, US Department of Labor, NATC Since 4/1/93 --~ --< ~ ~ iT1 2. Journeymen Wiremen, Block & Associates, Since 6/11/91 3. Master Electrical License, Block & Associates, Since 1/21/95 4. Certified Electrical Inspector, General, One & Two Family Dwelling and Plan Review, Since 11/16/96 5. NICIT Level II, Fire Alarm Certification, Since 11/22/03 WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? NONE II ~1 Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application February 2005 Page 1 of 7 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR ~,PPLYING)? With my schooling and work experience I feel I would be an valuable asset to the Board of Appeals. 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 (see page 6). 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. -'~,,CD o~ F-- IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED7 ~YES ~NO -- DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~YES ~ NO (It has been Council policy not to permit an ihdividual 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 If you fail to answer all the questions, Council may not consider your application. II General Application February 2005 Page 2 of 7 BOARD, COIVIlVIISSION, & COMMITTEES ~ BUSINESS LISTING CITY OF IOWA CITY Name of City Board/Commission Board of Appeals Date 10/26/05 Name Alan W. Gerard 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 6). 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 Gerard Electric, Inc. P.O. BOx 1301, Iowa City, IA 52244 NOTE: A new form must be completed if the above information changes or an oWnership interest is acquired in an additional business. Signature (~C) 0~.~ ~~xo, ~ _A Address 851 Coventry Court~ Iowa City~ Iowa 52245 Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application February 2005 Page 3 of 7 11-01-05 15f NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: HUMAN RIGHTS COMMISSION Three Vacancies - Three Year Terms January 1, 2006 - January 1, 2009 The duties of the members of the Human Rights commission are to receive and to determine the merits of human rights complaints alleging unfair or discriminatory practices in the area of employment, credit, public accommodation, education, and housing. The Commission shall provide conciliation and the enforcement necessary to further the anti-discriminatory goals of the Human Rights Ordinance and to protect citizens from unfounded charges of discriminatory practices. The Iowa City Human Rights Commission has an obligation to investigate and study the existence, character, cause, and extent of discrimination in Iowa City in order to eliminate discrimination by education, conciliation, and/or enforcement. It is also the duty of the Human Rights Commission to draft revisions to the Human Rights Ordinance if necessary to eliminate prejudice, intolerance, bigotry, and discrimination. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Human Rights Commission meets once a month at 7:00 p.m. Applications must be received by 5:00 p.m., Wednesday, October 26, 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 Human Rights Commission should be directed to Dale Helling, Assistant City Manager at 356-5013. Board or Commission: Human Rights ATTENDANCE RECORD YEAR 2005 (Meeting Date) TERM NAME EXP. 1/25 2/22 3/22 4/26 5/24 6/21 7/26 8/17 8/23 9/27 10/25 11/22 12/27 Lisa Beckman 1/1/07 X X X YA O/E NMNQ X X x X Paul Retish 1/1/07 X X X YA O/E NMNQ X O x O/E Geoff Wilming 1/1/07 X X O/E YA X NMNQ X x O/E Sara Baird 1/1/05 X O/E X YA X NMNQ X X x X David Shorr 1/1/06 × X O/E YA X NMNQ × O/E o/e X James McCue 1/1/06 X X X YA X NMNQ X x X Billie Townsend 1/1/06 X X X YA X NMNQ X o X Bev Witwer 1/1/05 X X X YA O/E NMNQ X x X Scott King 1/1/05 X X X YA X NMNQ X X x X KEY: X = Present NMNQ - No meeting, no quorum O = Absent O/E = Absent/Excused Spouses and relatives of City Council Members and members of comparable County Boards and Cor~missions are not eligible for appointment to City Boards and Commissions. '~'his 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: 3 Females: 3 Council Announcement Date: September 20, 2005 Application Deadline: Wednesday, 5:00 p.m., October 26, 2005 Council Appointment Date: November 1, 2005 HUMAN RIGHTS COMMISSION Three Vacancies - Three Year Terms January 1, 2006 - January 1, 2009 Term expires fo' David Shorr, James McCue, Billie Townsend Sehee Foss [] 319 E Court St #13 Mary Copper [] 2718 Jacque St Michelle Shelangouski [] 1126 Village Farm Ct Martha Lubaroff [] 117 Glenn Dr [] Denotes apr licant completed the Confidential page of the application. CITY OF IOWA CITY I -~ _~..=-~.= ADVISORY BOARD/COMMISSION APPLICATION FORM C~TY 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 ~JI,(J'Ti¢II,1 J~'~ ~?lJ'TII'~'~'/'DYL TERM NAME ~ ~-h~¢ ~1) <~ 5 ' HOME ADDRESS ~1~ E. ~r~ S~ ~ 1~ ZIP Is gout home address {listed above) within tho eorporato limit~ of Iowa Cit~7 es o How long have you been a resident of Iowa City? ~11 I~ ~ = o-~, OCCUPATION ~ W ~~ EMPLOYER ~: PHONE NUMBER: HOME C~II ff~- I~ BUSINESS ~~ EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: II 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. II Human Riohts Commission Application February 2005 Paoe 1 of 8 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ~-I ~v ~ ~. ~. ~,~., ~~ ~~..~ ~. ~,~ 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. Jther 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 S__ection ~k~2.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. o..< 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.) .,sr , . nt tions on t is wi,, o st,t t ,.st ,or r mow, o, n II If you fail to answer all the questions, Council may not consider your application. Il Human Rights Commission Application February 2005 Page 2 of 8 BOARD, COMMISSION, & COMMITTEES ~ BUSINESS LISTING CITY OF IOWA CiTY Name of City Board/Commission HUY}')~Y1 ~l~)q'~$ ~K)mJ~j~}~ Date I0]1/0~ 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 NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature ~'t~ ~ ,, Misrepresentations on this application will constitute just cause for removal of an appointee. 1' If you fail to answer all the questions, Council may not consider your application. II Human Rights Commission 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 $25,400 $30,500 940,600 950,800 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 HUMAN RIGHTS COMMISSION It is the mission of the Iowa City Human Rights Commission to protect residents of the city from discrimination as defined in the Human Rights Ordinancel In order to further this goal, the city strives to ensure that the Human Rights Commission is representative of th~.~ comn~[nity. Therefore, "appointments shall take into consideration men and women of ~;~rious ~[lcial, religious, cultural, social and economic groups in the city." (Ord. 94-3647, 11-8-9~C~ C)~ -'~ --I-I OPTIONAL: ~ :=. J-T1 PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONS W CHOOSING AN APPLICANT. .~- I ¢~hi~ ~_. IGender I Disability I~"zo IInc°me (see table) gt -ea I Race, color I or ethnic group ISexual Orientation I I National origin J---~ Other (Please explain below) Human Rights Commission Application February 2005 page 4 of 8 Marian Karr Crom: Sehee Foss [sehee-foss@uiowa.edu] .~nt: Thursday, October 06, 2005 10:38 PM To: council@iowa-city.org Subject: Human Rights Commission City Council members, My name is Sehee Foss and I am a second year law student here at Iowa and I'm applying for a position with the Human Rights Commission. I wanted to introduce myself and send along my resume (see attached). I am dedicating my career to human rights and hope to further human rights awareness here in Iowa City. I think I would make positive contributions to the commission and hope you will think the same! I would love to meet w/ you all some time and talk about the commission. My email is sehee-foss@uiowa.edu and my phone # is 319- 936-1203. I will also try to get in touch w/ you by phone next week. Sincerely, Sehee Foss Sehee Foss University of Iowa College of Law Sehee E. Foss 319 E. Court St #13 sehee-foss~uiowa.edu Iowa City, IA 52240 (319) 936-1203 Education University of Iowa College of Law Iowa City, IA Juris Doctor anticipated May 2007 Journal of Gender, Race, and dustice Member Willard Boyd Public Service Distinction: Membership pending for highest honors Iowa Campaign for Human Rights, Founder and elected President Iowa Student Bar Association, 1L elected UISG representative, 2L elected representative Asian American Law Students Association, 1L elected representative, elected President C'.., University of Iowa Student Government, elected Professional School Senator Iowa Summer Program in Comparative and International Law American Constitution Society, Programming Chaff Equal Justice Foundation ~ .cp. Organization for Women Law Students & Staff a:" University of Iowa College of Liberal Arts Iowa City, IA Bachelor of Arts in Psychology May 2004 Political Science and SociolOgy minors Women in Politics Kappa Alpha Theta Sorority Asian American Coalition Cheerleader for the U of Iowa Legal Experience Research Assistant to Professor Adrien Wing France & Iowa City Research Assistant May 2005-present Serve as an RA for human rights and critical race issues National Consumers League Washington, DC Intern June 2005-Aug2005 Interned and assisted with ongoing projects and research related to the Child Labor Coalition (CLC) Iowa Coalition Against Domestic Violence Iowa City, IA Legal Services Volunteer Jan 2005-May 2005 Johnson County District Attorney's Office Iowa City, IA Intern Aug 2003-Dec 2003 Researched relevant laws and served as an outreach coordinator for victims of criminal acts Other Experience Iowa GymNest Iowa City, IA Coach Aug 2000-present Supervise, train and develop routines for competitive level gymnasts as their gymnastics coach National Association of Women Gymnastics Judges Iowa City, IA Judge Sept 2002-May 2005 University of Iowa Undergraduate Teaching Assistant Iowa City, IA Teaching Assistant for a psychology class Sept 2002-Dec 2002; Jan 2004-May 2005 University of Iowa Support Services Iowa City, IA Tutor Oct 2003-Dec 2003 Iowa United Nations Association Iowa City, IA Advocate Jan 2003-July 2003 Promoted grass roots participation and advocacy Volunteer University of Iowa Center for Human Rights; Iowa City Human Rights Commission; Johnson County Crisis Center; New Voters Project; Dance Marathon; Iowa City Senior Center; Domestic Violence Intervention Program; Salvation Army; Assoc, of Farmworker OpportuniW Programs; Calvert Group CITY OF IOWA CITY ADVISORY BOARD/COMMISSION · - PPLICATION FORM - OF ! OWA C iTY 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 Human Rights Commission TERM Jan 1, 06 - Jan 1, 09 NAME Mary Copper HOME ADDRESS 2718 Jacque Street Iowa City, Iowa 52246 2~ 5224(~ Is your home address (listed above) within the corporate limits of Iowa City? ~-]Yes ~ o...~ -TI How long have you been a resident of Iowa City? 1979-1984,2001-05, Coralville 96-01 OCCUPATION Self Sufficiency Programs Coordinator RN, LMSW EMPLOYER Iowa City Hous~-~ ~hor~ ~HONE NUMBER: HOME (319) 351-2597 BUSINESS (319) 687-6061 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I currently work for the ICHA as the Family Self Sufficiency Coordinator/Resident Opportunity & Self Sufficiency Coordinator. I represent the ICHA on the Local Homeless Coordinating Board, Johnson County Coalition Against Domestic Violence, Housing Trust Fund of JC Public Relations and Education Committee and lC Chamber CLP Program Committee for Human Services. I am the Iowa City Junior Service League VP of Fund-raising and serve on the JSL community outreach committee that assesses community needs and makes recommendations for donation of funds. In addition to my current work I also have past experience working in the areas of domestic violence/sexual assault, mental health, substance abuse, developmental disabilities and public health nursing. My varied work and volunteer experience has exposed me to a wide range of diverse people who have experienced discrimination of their human rights. I have been in an advocacy role all of my personal and professional life. This position is a natural extension of my life work, paid and unpaid. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? To evaluate the merits of discriminatory claims and determine the validity of those claims to protect those who are discriminated against as well as those who have unfounded claims brought against them. This endeavor would include directing action or enforcement to eliminate discrimination in the areas of employment, credit, public accommodation, education, and housing. Investigate the existence and extent of discrimination in Iowa City and work to eradicate. II 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. Human Rights Commission Application February 2005 Page 1 of 8 WHAT CONTRIBUTIONS DOYOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? I work with families who are struggling to increase personal and financial assets. Because of my work I have first hand knowledge of the barriers faced by these families in their efforts to succeed and I work to address these barriers with implementation of new programs and a proactive approach to leveraging resources to assist the families in their goals. But I have seen many times over the years the role that discrimination plays in the barriers my clients face. I have had clients experience discrimination in housing, employment and credit many times. The discrimination has been based on racial, class, gender and sexual orientation issues. My abilities to be a passionate advocate and disseminator of information for my clients' needs would be skills that would transfer well for me in serving on the Human Rights Commission. I want to do more to further anti-discriminatory goals of the Human Rights Ordinance. In attaining my masters of social work degree I become familiar with [he concepts of "systems change" and "change agent". I am aware that to further eliminate barriers faced by my clients, and others in my community, that more work is necessary to eliminate discriminatory practices. I know that this work not only involves individual action at a micro level as a "change agent", but also at a macro level to create "systems change". I AM a change agent in advocating for the disenfranchised and I work towards system changes to improve the quality of life of for Iowa City citizens in particular. I would like to further utilize my passion for fighting discriminatory practices by serving on the Iowa City Human Rights Commission and help to not only protect our citizens, but also to improve the quality of life inclusively for all citizens in Iowa City. Please identify any potential conflicts between membership on the advisory board and your: ~rso~ intents, including financial interests and your duties to an employer. ~"< I · -- In particular, if you are applying to be a member of a board or commission which makes ~e~c~--i~mellaati(j~to the City Council about the allocation of City funds, please list any present affiliations you"~ wi~;~:ag~i~es · hat apply for funding from the City. "Affiliation" includes being a board member or empl~'~"~ of ~'e agency. ~ther types of affiliations must be examined on a case by case basis by the City Attorne¢~'~ office~N 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. I contacted Eleanor Dilkes in February of 2005 to inquire about the restrictions for a City employee serving on a board/ commission at the municipal level. She informed me that there is no absolute rule against an employee serving on a city board, although, if a city employee applies it is necessary to make sure that there would be no actual or perceived conflict of interest between the employee's position and membership on the board. Although I work in the ICHA, my position is one of an advocate for clients and does not place me in conflict with my employer or clients. I have referred many clients to the Human Rights office since I started employment with the city in July 1999. If YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~-]YES I-----1NO DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~YES J~] 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 If you fail to answer all the questions, Council may not consider your application. II Human Rights Commission Application February 2005 Page 2 of 8 BOARD, COMMISSION, & COMMITTEES .,~_.._-~ BUSINESS LISTING ¢~TY OF IOWA CITY Name of City Board/Commission Human Rights Commission Date 10/05/2005 Name Mary Copper 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 m -o NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. S, na, r Address 2718 Jacque Street Iowa City, Iowa 52246 II 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. II Human Rights Commission 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 $25,400 $30,500 940,600 950,800 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 HUMAN RIGHTS COMMISSION It is the mission of the Iowa City Human Rights Commission to protect residents of the city from discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city strives to ensure that the Human Rights Commission is representative of the community. Therefore, "appointments shall take into consideration men and women of various racial, religious, cultural, social and economic groups in the city." (Ord. 94-3647, 11-8-94) OPTIONAL: PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN CHOOSING AN APPLICANT. Age Ichristian I Religion femalel Gender I J Disability median Income (see table) ICaucasian Race, color or ethnic group 1Sexual Orientation IUScitizen I National origin Other (Please explain below) c-~ Human Rights Commission Application ~ ~ ~ February 2005 page 4 of 8 )~; r~ CITY OF IOWA CITY A ADVISORY BOARD/COMMISSION °PLICATION 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 Human Rights Commission TERM 01/01/06/-01/01/09 NAME Michelle L. Shelangouski HOME ADDRESS 1126 Village Farm CT Iowa City ZIP 52240 Is Your home address (listed above) within the corporate limits of Iowa City? ~-] Yes r~No How long have you been a resident of Iowa City? 5 months OCCUPATION Analyst EMPLOYER MidAmerican EnergyCO PHONE NUMBER: HOME 351-2075 BUSINESS 341-4415 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: Before moving to Iowa City, I was a past Vice-Chairman and member, of the Board of Directors for Bridgeway, Inc., a large non-profit mental health organization serving parts of Iowa, Illinois, and Missouri, headquartered in Gaiesburg~_. I also served as a member of the Board for the Colona, Green Rock, Orion (IL) United Way. And was a rr~ber of ~ Advisory Board for the Orion (IL) School District. ~ c:~ WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD7 None, other than what I've read on the City's web site. IIMisrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application February 2005 Page 1 of 7 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? [,~ new resident of Iowa City, I would like to become active in it's government. Being part of a Board, Commission, or C~,,~mittee, will allow me that opportunity. In addition, as a member I would play a role in the city government process, and learn more about how the city government works. I believe that participation this commission will be a rewarding and challenging experience that will help me to grow as an individual and become a part of the community. 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 thr' apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. O~..~r 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 6). 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? ~-IYES__ NO cn DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? F'~YES I-~ NO lit has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) I Misrepresentati°ns °n this applicati°n will c°nstitute just cause f°r rem°val °f an app°intee' II If you fail to answer all the questions, Council may not consider your application. General Application February 2005 Page 2 of 7 A_ BOARD, COMMISSION, & COMMITTEES ~ BUSINESS LISTING C~TY OF IOWA CITY Name of City Board/Commission Human Rights Commission Date 10/10/2005 Name Michelle L. Shelangouski 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 6). 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 NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature "-1~"~_~-~ _~..~ Address 1126 Village Farm CT Iowa City i'vlisrepresentations 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. General Application February 2005 Page 3 of 7 Michelle L. Shelangouski 1126 Village Farm CT Iowa City IA 52240 mlshelangouski~midamerican.com (319) 351-2075 October 10, 2005 City of Iowa City 410 E Washington ST Iowa City IA 52240 RE: Board, Committee, and Commission Vacancies Enclosed are applications for two vacancies, Board of Adjustrnent and Human Rights Commission. While I understand that I can only be a member of one Board, Committee, or Commission at a time, these two applications are being submitted in hopes that I am appointed to one of them. It is my desire to be a member of the Board of Adjustment. However, if that is not fulfilled, please consider me for a member of the Human Rights Commission. Thank you very much for your consideration. Sincerely, Michelle L. Shelangouski ~C) ~ CITY OF IOWA CITY I .- ADVISORY BOARD/COMMISSION FILED APPLICATION FORM 01~'i' 26 Pt'I L~: 3{~lTY OF IOWA tt bLEn~'x Individuals serving on Boards/Commissions play an impo~ant ,o~']~]~,t~cil 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 ~~O ~1', ~ ~o~,,~ TERM t/i/o~--, NAME ~~ L~~o~ HOME ADDRESS [~ ~~ ~. ZIP 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? ~ ~ ~ ~ PHONE NUMBER: HOME ~-~~ BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: w~T Is You~ ~s~T K~OWk~ OF T~IS ~WSO~Y ~0~ Misrepresentations on this ~pplio~tion will oonstitut~ just oaus~ for r~mov~l of ~n ~ppoint~. If you fail to answer all the questions, Council may not consider your application. Human Rights Commission 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 OONFLIOTS 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 (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.) IMisrepresentations 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. Human Rights Commission Application February 2005 Page 2 of 8 . l- l BOARD, COMMISSION, & COMMITTEES ' ~ BUSINESS LISTING CITY OF IOWA C~TY Board/Commission Name ..//~_..~.~L_ ~/~_ /~.~ 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 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' may not consider your application. Human Rights Commission 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% Me~ia~ 60% Median 80% Median Income Median Size (Poverty Level) Income Income (Iow income) Income I 815,250 825,400 830,500 840,600 850,800 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 HUMAN RIGHTS COMMISSION It is the mission of the Iowa City Human Rights Commission to protect residents of the city from discrimination as defined in the Human Rights Ordinance. In order to fUrther this goal, the city strives to ensure that the Human Rights Commission is representative of the community. Therefore, "appointments shall take into consideration men and women of various racial, religious, cultural, social and economic groups in the city." (Ord. 94-3647, 11-8-94) OPTIONAL: PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN CHOOSING AN APPLICANT. r-~ Age I ~--~.b~ , ~(q I Religion Race, color ~ ~-~/~-,~ ~[)0 IInc°me (see table) I ~)~-¢_-- or ethnic group I q S x a, Orientation ~~ ¢ ~ ~ .ariel origin Other (Please explain below) C~ ~ ~ FI~ -~ ~ I I Human Bights Commission Application ~ [ebruary 2005 pa~e 4 of 8 NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: PARKS AND RECREATION COMMISSION Two Vacancies - Four Year Terms January 1,2006 - January 1,2010 The duties of the members of the Parks and Recreation Commission are to recommend and review policies, rules, regulations, ordinances, and budgets relating to parks, playgrounds, recreation centers, and cultural functions of the City and make such reports to the City Council as the Commission deems in the public interest; to exercise broad responsibility for the development of parks, recreation centers, playgrounds, and cultural facilities to serve the City--including the creation and appointment of advisory · groups to make studies. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Parks and Recreation Commission meets the second Wednesday of each month at 5:00 p.m. Applications must be received by 5:00 p.m., Wednesday, October 26, 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 Parks and Recreation Commission should be directed to Terry Trueblood, Parks & Recreation Director at 356-5110. PARKS AND RECREATION COMMISSION ATTENDANCE RECORD YEAR 2005 TERM NAME EXPIRES 1/12 2/16 3/9 4/13 5/11 6/8 7/13 8/25 9/14 10/12 11/19 12/14 Craig Gustaveson 1/1/07 NM X X X X X X X X Judith Klink 1/1/07 NM X X X X O/E X X X Margaret Loomer 1/1/08 NM X X X X X X X X Ryan O'Leary 1/1/06 NM X X O/E X OrE X O/E O/E Matt Pacha 1/1/05 NM X X O/E X O/E X X X Jerry Raaz 1/1/08 ..... X X X X X X X Phil Reisetter 1/1/09 . NM X X O/E X X X O/E X Sarah Walz 1/1/07 NM X X X X X O/E X X John Westefeld 1/1/06 NM X X X X X X X X KEY: X = Present O = Absent O/E = Absent/Excused NM = No meeting i LQ = No meeting due to ~ack of quorum .... Not a Member 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: 3 Council Announcement Date: September 20, 2005 Application Deadline: Wednesday, 5:00 p.m., October 26, 2005 Council AppOintment Date: November 1, 2005 PARKS AND RECREATION COMMISSION Two Vacancies - Four Year Terms January 1, 2006 - January 1, 2010 Term expires for John Westefeld, Ryan O'Leary John Westefeld [] (Currently serving 1st 4-yr term) 4831 Southchase Ct John Watson [] 1105 Barrin¢on Rd Ryan O'Leary [] (Currently serving unexpired term) 1924 Muscatine Ave [] Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY I -~ ~ ADVISORY BOARD/COIVilVilSSION · 4PPLICATION FORM ow^ 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. Is your home address (listed above) within the corporate limits of Iowa City? ~ Yes ~ No How long have you been aresident of Iowa City? ~,~ (~ / 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 lan appointee. If you fail to answer all the questions, Council may not consider your applic.ati0n ..... General Application February 2005 Page 1 of 7 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 at 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 6). 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? r-~ YES. ~--~NO DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~YES ~ NO ( t has been Councd pohcy]not to permit an ndi o serve on two Boards or Commissions i~t the same time.) II Misrepresentations on this application will constitute iust cause for removal of an appointee. i i If you fail to answer all the questions, Council may not consider your application,,. General Application February 2005 Page 2 of 7 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING CITY OF IOWA CITY Name of City ~)~ ~./ ~'--~-- Board/Commission Date 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 6). 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 own-~r, ship interest is acquired in an additional business. Signature Address I' M~sr~r~s~tati~s~hisa~p~.cat.~.~c~st.t~t~stca~s~f~rr~va~fa~ap~t~.~f fa,I to all tho [ ~ you answer questions, Council may not consider ~our application. General Application Februarg 2005 ~a~e 3 of 7 CITY OF IOWA CITY ADVISORY BOARD/COIVilViI'SSION APPLICATION FORM C~TY OF IOWA C~TY 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. Is your home address (listed above) within the corporate limits of Iowa City? 1~ Yes E~] No HOW long have you been a resident of Iowa City? ~ c1~,~.~ PHONE NUMBER: HOME '~ I,~- ~-~/-f~"~o BUSINESS ~ POSITION: EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY yOu FOR THIS WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? If you fail to answer all the questions, Council may not consider your application. II General Application February 2005 Page 1 of 7 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR ~,PPLYING)? 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. 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 6). 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 T© BE NOTIFIED? "F~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'. General Application February 2005 Page 2 of 7 BOARD, COMMISSION, & COMMITTEES ...,~~ BUSINESS LISTING CITY OF IOWA CITY Name of City ~ ~'~..C~'~ ~ Board/Commission O%~.. '~, L,'- Date {,O~'0¥- Name --~,3~.,,.N B. ~ ~ 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 6). List all businesses in which you or your spouse/domestic pa~ner have an ownership interest (for example, sole proprietor, pa~ner, 5% or more of corporation's st0ckholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS / c-~ /~ ~ __--I := F' NOTE: A new form must be completed if the above information changes or an ownersh~'P'p interest is acquired in an additional business. I Address ~ ~y~~ ~ Misropresentations on this application will constitute just causo for romoval of an appointoo. If you fail to answor all the questions, Council may not consider gout application. General Application Februarg 2005 ~a~e 3 of 7 CITY OF IOWA CITY .~ · ADVISORY BOARD/COMMISSION APPLICATION FORM CITY OF IOWA CITY' Individuals serving on Boards/Commissions play an important role in advising the Council on ma~ters of interest to our community end its future. Applir, ants mus~ reside in Iowa City. After a vacancy has been enr~unced, the Council reviews all applications during the work session. The appointment is made at the ne~<t 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 Cky, 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' 33ME. . ADVISORY BOARD/COMMISSION NAME ~cx.~' ~L5 O,. 0~ "- TERM Is your home 'address (listed above) within the corporate limits of Iowa City? [---1 Yes [---] No I-IoW long have you beeh e.,resident of Iowa Cizy? ' OCCUPATION EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT IS YOUR PRESENT KNOWLEDGE OF THIS A~VlgORY BOARD? m "~ 1,,7 mmm m , rmmm ,, ,m ~ Misrepresentations on this application will constitute just cause for. removal of an appoints. if you fail to answer all the questions, Council I ma~ not consider your application. General Application Fobruary ~00~ Page % ~f 7 10/26/2005 WED 16:24 FAX 3193565497 IOWA CITY CLERK 003/008 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 end your duties to an employer. In particular, if you are applying to be a member of a board or commission wh[ch makes recommendations to thc City Council abou~ the*allocation cf City funds, please I~st any present affiJiations 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 A~orney'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 inter, es.t in a city contract. A'cop¥ of Secti¢:n 362.5 is attache'd {see page 6). If you a[~ uncertain whether a po[enflal conflict of interast exists or have questions about Section 362.15 of the Code of Iowa, please contact the City Attorney's office at 356-5030, DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? r~YES (It has b,~en Council policy not to permi~ an individual to serve on two Boards or Commissions at the same time.) I1 "'" .... Misrepresentations on this application Will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application'. General Application February 2005 Page 2 of 7 31935§5497 iU A BOARD, COMMISSION, & COMMITTEES · BUSINESS LISTING CITY OF lOW^ CITY Name City Board/Comrr~ssion -~:~'~'~ ~ ~ ~ Date Section 362.5 of the Code of iowa generally prohibits, with ce~ain important exceptions, a member of .a cky Board ar Commission free having an in~erest in a city contraot. A copy of Section 362.5 is attached (see page 6). Ust all businesses in which you or your s~ouse/domestic partn~ have an ownership interest (for example, sole propd~or, PeRner, 5% or mom of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS I 0 -< rc ..... NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signsture ~,~~' ........... Misrepresentations on this application will ,on~itute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application February 2005 Page 3 of 7 15h NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMITTEE: PUBLIC ART ADVISORY COMMITTEE Two Vacancies - Three Year Terms January 1,2006 - January 1,2009 Duties of the Public Art Advisory Committee include developing by-laws and procedures for the Iowa City Public Art Program; administering the Public Art Program by determining the placement of public art, the type of art to be used in a specific project, and the artist to be engaged; overseeing the acceptance of gifts of art; overseeing the maintenance and disposition of public art; and overseeing expenditures of the Public Art Program budget. Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Public Art Advisory Committee meets the first Thursday of each month at 3:30 p.m. Applications must be received by 5:00 p.m., Wednesday, October 26, 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 Public Art Advisory Committee should be directed to Karin Franklin, Planning & Community Development Director at 356-5232. NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMITTEE: PUBLIC ART ADVISORY COMMITTEE Art or Design Professional Two Vacancies - Three Year Terms January 1, 2006 - January 1,2009 Duties of the Public Art Advisory Committee include developing by-laws and procedures for the Iowa City Public Art Program; administering the Public Art Program by determining the placement of public art, the type of art to be used in a specific project, and the artist to be engaged; overseeing the acceptance of gifts of art; overseeing the maintenance and disposition of public art; and overseeing expenditures of the Public Art Program budget. Iowa City appointed members of boards and commissions, must be eligible electors of the City of Iowa City. The Public Art Advisory Committee meets the first Thursday of each month at 3:30 p.m. Applications must be received by 5:00 p.m., Wednesday, October 26, 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 Public Art Advisory Committee should be directed to Karin Franklin, Planning & Community Development Director at 356-5232. Public Art Advisory Committee Attendance Record 2005 Term Name Expires 1/06 2/02 3/02 4/07 5/05 7/07 9/01 10/06 '11/03 12/01 0/00 Emily Carter Walsh 01/01/08 CW X O X X X O/E X Charles Felling 01/01/06 CW X X X O/E X X X James Hemsley 01/01/06 CW O/E X X X X O/E X Emily Martin 01/01/08 CW X O/E O/E X O/E X X Mark Seabold 01/01/07 CW X X X X X X X Rick Fosse CW O/E X X X X X X Terry Trueblood CW O/E X X X X X X Key: X = Present O = Absent O/E = Absent/Excused NM = No Meeting CW = Cancelled due to Weather 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: 3 Females: 2 Council Announcement Date: September 20, 2005 Application Deadline: Wednesday, 5:00 p.m., October 26, 2005 Council Appointment Date: November 1,2005 PUBLIC ART ADVISORY COMMITTEE Two Vacancies - Three Year Terms January 1, 2006 - January 1, 2009 Term expires for Charles Felling, James Hemsley Charles Felling [] (Currently serving 1st 3-yr term) 825 South 7th Ave []Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY ADVISORY BOARD/COMIViI'SSION 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. 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? A/~ PHONE NUMBER: HOME ~ I 9 %3 S &9¢ ¢ BUSINESS EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY yOu FOR THIS POSITION: ~ / - ' ' ' ,¢ k. 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 may not consider your application. General Application February 2005 Page 1 of 7 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 attached (see page 6). If you are uncertain whether a potential conflict of interest exists or have questions about Section :~652.5 of the Code of Iowa, please contact the City Attorney's office at 356-5030. O ..~.~ ¢-~ ,4="- IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? I--~yES F-q.o DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? F----lYES F~ NO (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) ' ~IMisrepresentati~ns~nthisappli~ati~nwi'.c~nst~tutejust¢ause~~rrem~va~~fanapp~intee.I If you fail.to answer all the questions, Council may not consider your application. General Application February 2005 Page 2 of 7 BOARD, COMMISSION, & COMMITTEES ~ BUSINESS LISTING C~TY OF IOWA CITY Board/Commission .,, ,A, ~ ~ ! ' .-. 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 6). List all businesses in which you or your spouse/domestic partner have an ownership interest (for example, sole proprietor, pa~ner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS NOTE: A new form must be com.p~ted if the above information changes or an ownership interest ~:i~i~e~ in a~.~i~~ess. Signature ( ~'/"'/~'~ ¥ ('~ 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. General Application February 2005 Page 3 of 7 Page 1 of 1 Marian Karr From: mcfelling [mcfelling@mcleodusa.net] Sent: Monday, October 24, 2005 7:49 PM To: council@iowa-city.org Subject: Request for appointment to Public Art Advisory Committee I have had the opportunity to speak with each of you on past occasions as I worked with the Neighborhood Council and during my current tenure on the Public Arts Advisory Committee. ' The time you spend on city matters is considerable and I will not needlessly take up your time. However if you feel that you should talk with me as you consider my appointment to the Public Arts Advisory Committee please respond to this e- mail and I will contact you at a time convenient to your schedule. Sincerely, Chuck Felling 319-338-6994 10/25/2005 15i NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: SENIOR CENTER COMMISSION Two Vacancies - Three Year Terms January 1,2006 - December 31,2008 The duties of members of the Senior Center Commission are to: 1. Serve in an advisory role to the City Council with regard to needs of the Senior Center. 2. Make recommendations with regard to policies and programs at the Senior Center. 3. Join staff and other interested persons in seeking adequate financial resources for operation of the Senior Center. 4. Encourage full participation by senior citizens in the programs of the Senior Center. 5. Ensure that the Senior Center is effectively integrated into the community and cooperates with organizations with common goals in meeting the needs of senior citizens. 6. Serves in an advocacy role with regard to the needs of senior citizens in Iowa City. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Senior Center Commission meets the third Tuesday of each month at 3:00 p.m. Applications must be received by 5:00 p.m., Wednesday, October 26, 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 Senior Center Commission should be directed to Linda Kopping, Senior Center Coordinator at 356-5225. Senior Center Commission Attendance Record Year 2005 Name Term 1/24 2/15 3/15 4/26 5/18 6/21 7/19 8/16/ 9/27 Expires Lo ri Be nz 12/31/05 O/E X O/E X X X X O/E X Jo Hensch 12/31/06 X X X X X X O/E X X Jay Honohan 12/31/07 X X X X X X X X X Betty Kelly 12/31/07 X O/E O/E X X X O/E X O/E Sarah Maier 12/31/06 X X X X X X X X X Charity Rowley 12/31/05 X X X X X X X X X Nancy 12/31/06 X O/E X X X X O/E O/E X Wombacher Key: × = Present O = Absent O/E= Absent/Excused NM: No meeting -o = Not a member 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: 1 Females: 4 Council Announcement Date: September 20, 2005 Application 9eadline: Wednesday, 5:00 p.m., October 26, 2005 Council Appointment Date: November 1, 2005 SENIOR CENTER COMMISSION Two vacancies - Three Year Terms January 1, 2006 - December 31, 2008 Term expires for Lori Benz, Charity Rowley Brian Kaskie [] (Not a resident of lC) 7 Fairview Knoll David Gould [] 2923 Radcliff Ave [] Denotes applicant completed the Confidential page of the application. Spouses and relatives of City Council Members and members of comparable ty Boards and Commissions are not eligible for appointment to City Boards and remissions. This includes: spouse, child, mother, father, mother- in- law, father- law, brother, sister, brother- in- law, sister- in- law, step step- mother, )-child, aunt, or uncle. (Resolution 85-354) Males: 1 Females: 4 Council Ann( ate: September 20, 2005 Application Deadline: W~ ~esday, 5:00 p.m., October 2005 Council Appointment 1, 2005 SENIOR CENTER COMMISSION Two vacancies - Three Year Terms January 1, 2006 - December 31, 2008 Term expires for Lori Benz, Charity Brian Kaskie [] 7 Fairview Knoll David Gould [] 2923 Radcliff Ave [] Denotes applicant completed the Confidential page of the application. CITY OF IOWA CITY 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 S'~O (' ~1~'~-~.-I'"' TERM ~:~(D~n - HOME ADDRESS ~ FCX, t~'V\~ ~O~ ZIP ~ ~ ~ Is your home address (listed above) within the corporate limits of Ibwa City? ~ Yes ~ No How long have you been a resident of Iowa City? ~ OCCUPATION ~s~Lg~ ~fO~~ f EMPLOYER (3 O¢ { ~ ~ ' PHONE NUMBER: HOME ~7- ~O~ BUSINESS ~ - ~1 ~q EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: 0 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 may not consider your application. General Application February 2005 Page 1 of 7 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. )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 6). 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. General Application February 2005 Page 2 of 7 BOARD, COMMISSION, & COMMITTEES ~ BUSINESS LISTING CITY OF IOWA CITY Name of City Board/Commission $-~.~f'~lL~lf' C~/~'-~' Date ~0 (~-¢.,~{0~ Section 362.5 of the Code of Iowa 0enerally prohibits, with certain important exceptions, a member of a city Board or Commission from havin0 an interest in a city contract. A copy of Section 362.5 is attached (see pa~e 6). 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 Signature is acq~~business. Address '~ ;~_,.41P'3/~ ~ ( t/ Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application February 2005 Page 3 of 7 CITY OF IOWA CITY A ADVISORY BOARD/COMMISSION PPLICATION FORM ow^ 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, 41 0 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 Senior Center Commission TERM 200512006 NAME David L. Gould HOME ADDRESS 2923 Radcliffe Avenue ZIP 52245 Is your home address (listed above) within the corporate limits of Iowa City? E~] Yes E~ No How long have you been a resident of Iowa City? 15 years OCCUPATION Program Associate/Adjunct Instructor EMPLOYER The University of iowa '~ONE NUMBER: HOME 351-0556 BUSINESS 335-3630 EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: In my position as a Pro, ram Associate for the Division of Interdisciplinary Programs, I work specifically with the Leisure Studios and the Aging Studies Programs. A significant portion of the students I interact with do volunteer or service-based learning with seniors in the community. I am also an Adjunct Instructor in the Leisure Studios Pro~ram, with an expedite in Aging and Leisure. 0 '=' WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? .~ ~ ~- I have long relationship with the Senior Center, and subsequently a basic understanding of the Advisor~ard a~its duties. AS a graduate student, I did a practicum at the 8onior Center. As an instructor, I have supervised honor's projects conducted at the Senior Center. Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application February 2005 Page 1 of 7 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? incerely believe in the mission of the Senior Center, and have witnessed first hand the impact it has on the community. I believe the combination of my personal experience with the Center, and knowledge of the field, would make me a value board member. 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. ~3ther 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 6). 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. ~F YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTiFiED? ~¥ES [---"]~0 SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? r--'"~YES r'~ No DO YOU CURRENTLY (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) I M isrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application February 2005 Page 2 of 7 BOARD, COMMISSION, & COMMITTEES ~ BUSINESS LISTING C~TY OF IOWA CITY Name of City Board/Commission Senior Center Commission Date 10/26/2005 Name David L. Gould 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 6). 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 them 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 ~ Z~ .~ Address 2923 Radcliffe Avenue Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application February 2005 Page 3 of 7 Page 1 nc7 Marian Karr ?~-~/' From: Janice Frey [janice-frey@uiowa.edu] Sent: Friday, October 28, 2005 11:00 AM To: council@iowa-city.org Subject: Senior Center Commission dear council Members: I am writing in support of applicant Brian Kaskie. Brian is a member of the UI Center on Aging and a professor in the College of Public Health. Since moving to Johnson County, Brian has been involved in issues related to aging in our community. Brian has shown a willingness to work with community members. Brian brings a wealth of knowledge about and compassion for senior issues. I urge the council to vote for Brian as a member of the senior center commission. I believe that he will serve. ,~ with the best interests of the senior community foremost in his mind He will be a positive force on the senior center commission. Thank you. Janice Frey 922 N. Dodge St., Iowa City, IA 52245 Janice Frey janice-frey@uiowa.edu 319-351-1003 10/28/2005 Marian Karr 16a - From: Sue Dulek -- Sent: Thursday, October 20, 2005 8:45 AM To: Marian Karr Cc: Randy Hartwig (rdhartwig@hartwigmotors.com) Subject: FW: resignation of commission for Iowa City Airport ..... Original Message ..... From: Carl Williams [mailto:CarlWilliams@ruhl-ruhl.com] Sent: Thursday, October 20, 2005 8:41 AM To: Sue-Dulek@iowa-city.org Subject: resignation of commission for Iowa City Airport Hi Sue, Just getting back to you, but please accept this as my formal resignation of my commission to the Iowa City Airport. I have thoroughly enjoyed my time doing this m. Jrk. Please extend my sincere gratitude to all city staff and councilors, for their wonderful support. I hope to serve again! I want to thank you specifically for your help and professionalism! I do not remember you ever missing a meeting or leaving early. I hope that I made a difference too. Carl Williams