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HomeMy WebLinkAbout2010-10-26 Appointment21a NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF ADJUSTMENT One vacancy -Five-Year Term January 1, 2011 -January 1, 2016 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 20, 2010. 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 Sarah Walz, Associate Planner at 356-5239. Spouses and relatives of City Council Members and members of comparable County Boards and certain 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 7, 2010 Application Deadline: Wednesday, 5:00 p.m., October 20, 2010 Council Appointment Date: October 26, 2010 After 12/06/10 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. BOARD OF ADJUSTMENT One Vacancy -Five-Year Term January 1, 2011 -January 1, 2016 (Term expires for LeAnn Tyson) Gender Balance Requirement: None No applications as of Wednesday, 5:00 p.m., October 20, 2010 D Denotes a completed application has been filed. 10-26-10 21b NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF APPEALS One Vacancy -Five-Year Term January 1, 2011 -December 31, 2015 One (1) Licensed Electrician 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 20, 2010. 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. Spouses and relatives of City Council Members and members of comparable County Boards and certain 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: 1 Council Announcement Date: September 7, 2010 Application Deadline: Wednesday, 5:00 p.m., October 20, 2010 Council Appointment Date: October 26, 2010 After 12/06/10 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. BOARD OF APPEALS One Vacancy -Five-Year Term Licensed Electrician January 1, 2011 -December 31, 2015 (Term expires for Matt Neumiller) Gender Balance Requirement: 1 Female No applications as of Wednesday, 5:00 p.m., October 20, 2010 D Denotes a completed application has been filed. 21c NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: HUMAN RIGHTS COMMISSION Three Vacancies -Three-Year Terms January 1, 2011 -January 1, 2014 Duties of the Commission include: 1) disseminating information to educate the public on illegal discrimination and civil rights, such as organizing and facilitating educational public forums that address one or more of the broad range of topics included within the rubric of human rights; 2) making recommendations to the City Council for such further legislation concerning discrimination as it may deem necessary and desirable; 3) cooperating within the limits of any appropriations made for its operation with other agencies or organizations both public and private whose purposes are not inconsistent with those of Title 2 of the City Code (Human Rights Ordinance) and; 4) planning programs and activities designed to eliminate racial, religious, cultural and other intergroup tensions including but not limited to sex, color, creed, disability, gender identity, sexual orientation, marital status, age, and national origin. Iowa City-appointed members of boards and commissions must be eligible electors of the City of Iowa City. The Human Rights Commission meets the third Tuesday of each month at 6:00 p.m. in the Lobby Conference Room at City Hall, 410 E. Washington Street. Applications must be received by 5:00 p.m., Wednesday, October 20, 2010. 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 Stefanie Bowers, Human Rights Coordinator at 356-5022. Human Rights Commission ATTENDANCE RECORD 2010 /MPetina Datel NAME TERM EXP. 1/19 2/16 3/16 4/20 5/18 6/15 7/20 8/17 9/21 10/19 11/16 12/21 Dell Briggs 1/1/11 X X O/E X X X X O/E X O/E Yolanda Spears 1/1/11 X O/E X X O/E O/E X O/E X X Corey Stoglin 1/1/11 O/E O/E X O/E X O/E O/E O/E O/E O/E Dianne Day 1/1/12 X X X O/E X X O/E X X X Wangui Gathua 1/1/12 X O/E O/E X X X X X X O/E Martha Lubaroff 1/1/12 X X X X X O/E X X X X Howard Cowen 1/1113 X X X X O/E X O/E X X X Constance Goeb 1/1/13 X O/E X X X X X X X X Fernando Mena- Carrasco 1/1/13 X X O/E X X X O/E R R R R R Harry Olmstead (8-1-2010) 1/1/13 - - - - - - - X X X KEY: X = Present O = Absent O/E = Absent/Excused NM = No meeting/No Quorum R =Resigned - = Not a Member Spouses and relatives of City Council Members and members of comparable County Boards and certain 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: 4 Council Announcement Date: September 7, 2010 Application Deadline: Wednesday, 5:00 p.m., October 20, 2010 Council Appointment Date: October 26, 2010 After 12/06/10 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. HUMAN RIGHTS COMMISSION Three Vacancies -Three-Year Terms January 1, 2011 -January 1, 2014 (Term expires for Corey Stoglin, Yolanda Spears, Dell Briggs) Gender Balance Requirement: 2 Males (M) (M) Paul Retish D 66 Penfro Dr (F) Diane Finnerty D 728 Dearborn St (F) Marla Bailey ~ 1303 Cedar St (F) Julia Zalenski D 828 Oakcrest St, Apt 4 (F) Chelsea Moore ~ 325 E College St, Apt 1635 (F) Jeannie Burns ~ 1570 S 1St Ave #1 (F) Casey Daley D 1010'/2 E Fairchild (F) Erin Nadolny ~ 1409 '/Z Rochester Ave (F) Linda Starke ~ 73 Brentwood Dr (M) John Phillips, Jr D 16 Penfro Dr (M) Orville Townsend, Sr ~ 713 Whiting Ave (M) David Brown ^D 2621 Walden Rd (F) Kenya Badgett ~ 1929 Lakeside Dr (M) Jay Levenson ~ 835 St Anne's Dr D Denotes a completed application has been filed. City of Iowa City i r 1 Advisory Board/Commission/Committee ~,.;~'~~ /' ~plication Form ~~-~- CITY OF IOWA CITY THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name ~~w~~ ~ ~.. t s• ~-`~5 Term Zd7~" Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME ,.ra ~ ~ . L ~ `~ < ~c a a ~ HOME ADDRESS 8 3 5~ 5-~. ~ncrps ~ ~^, .-~C. , ~~ 6'zz~f-• 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? .may tea, ~ s Gender: Male ~ Female OCCUPATION Co ~ ~ ~,..,1-~~:,..,-i- EMPLOYER 6 ~ f~' PHONE NUMBER: HOME 3f F- 3 s-t-(- !,!G 1-/ BUSINESS ~~ - ,s^4~!- !'~5'~l 2-- EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I "~Id a Master's degree in Counseling/Education. I have 30 years experience counseling people identified with ital illness and substance use issues. This includes work with families and consumers. I have managed quality improvement activities for a number of social service agencies which included reviews of human rights and Coi.~ r~ discrimination issues. I am the founder of an agency in the Boston area which focused on teaching men about the p WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? `r Ew E? ~ c~ a3 t 5 O c` ~ f3 ~'~ cam. t c~- (~ 2 v i ~ .,J `~ ~CJ ~ r~ c. Y C.~ v~ ~.~ `7 s^C~.G ~ t ~ G +2 G"c 5 1 Y" i^ ,Q ! ct, ~ P $~ -~' e ~ ~c. w~. cs, w l`Z ~ ~ G.f 5 i 5 5 Lt C' y i a.2 `~ 1i ~ -~- o ~.~ ~. ~ ~ ` ~ ~ C o Ott ~~ a. ~~ : ~~ WHAT C/ONTRIBUTIONS CA(rN YOU MAKE TO THIS ADVISORYf BOARD (REASON FORAPPLYING)? /' ,6 ~ ! r e v C.. f--G~. ex.. ~h~ vn y 'C 7i `9 E. l' r t? ~i C e fu 6 ~^ Fc r Cc t, ik7 ~ -F Ge /~t° ~~ ~~. '~ -~ r ez...y `~' 1 i` Gr~' w i ~- k trn ~ ~ -~ ~. f li C cam/ -~ k ~` S 5 ~t ~ <; ~ Gy! et. / 2. S ~ ~ ; ~ e, `f y f 2 5 ~ ~ e~ ct ~' fc ems. ~ ~' '~ y,~ ~ ~+ ~ v Ei Y1h e ~~:"I' Y` ,C? C%' i~ E= :,v S Gt U_ rs2. O c~-~'~"e^ c.~-~-~. S 4~v~ ' ~- v !v a /c ~ f r`~l ~ % ~ K ~ •~- e v° ~k i -+~ ~o a.c -~' ~. u ~ ~. ~.~ /~ ! : c t~.••f:.•e ~~ o -~' ~ cc ~ c`- ac r : ~ 4t.~ s ~~' ~ ~.. I0...-~ i ~ ti~ Ca s LIST PO~ENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest /~a ,1 IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ Nc~.-; 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.) ~. _ r~,~ - . _~ Misrepresentations on this application will constitute just cause for removal of a~~appointee. If you fail answer all the questions, Council may not consider your application. v _ v Human Rights Commission Application .. June 2010 Page 2 of 9 ~~~ BOARD, COMMISSION, & COMMITTEES -•~.a:._ BUSINESS LISTING CITY OF IOWA CITY Name of City Board/Commission/Committee N- u- ~^ ~~ ~~ = a ~~f 5 Date ~ ° ~ Z ~~ ~ x~~ ~~ Name 'tea- H ~ ~- ~ ~ .~ v ~ ~+ ~1 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 8). 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 T~ _ ~~ ~~ ~ . ~ ~~ C ~- ~.. ~: ,~ ~ ~ ~ C . ~3 ~ .~C~ ~ •~,, G~ S ~ . .C c. rid s~ r~~ ° ;i ~ . NOTE: Signature A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Address ~~~ ~~{ k1~~.e t ~~ ..~'ow~Cf ~a ~"~1 ~ ZZ ~5" ~~ ~~ Misrepresentations on this application will constitute just cause for removal of an appointee. II 'f you fail to answer all the questions, Council may not consider your application. Human Rights Commission Application June 2010 Page 3 of 8 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective May 14, 2010 Household Size 30% Median Income (Poverty Level) 50% Median Income 60% Median Income 80% Median Income (low income) Median Income 1 $16,350 $27,250 $32,700 $43,600 $54,500 2 18,700 31,150 37,380 49,800 62,300 3 21,050 35,050 42,060 56,050 70,100 4 23,350 38,900 46,680 62,250 77,800 5 25,250 42,050 50,460 67,250 84,100 6 27,100 45,150 54,180 72,250 90,300 7 29,000 48,250 57,900 77,200 96,500 8 30,850 51,350 61,620 82,200 102,700 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 ~ J Gender Income (see table) Sexual Orientation Other (Please explain below) human Rights Commission Application June 2010 page 4 of 9 Religion 3-e~..~is~~ Disability Race, color or ethnic group National origin r -? =' _. __... r,~ -_ .~ - c:~ _ -- ~~ j- City of Iowa City r ~~~~ '~.dvisory BoardlCommissionlCommittee ~ ~"' ~°~ ~. _ ,wrao~~~ Application Form CITY ot~ IowA CITY THES 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. ~~ Advisorv_Board/Commission/Committee Name Human Rights Commission Term' 2011 Youth Advisory Commission (shall not be more than 18 years of age at the time pf ap~l.ication). Name of Iowa City High School or high school equivalent: ~ `;_' __:_, ,, . -, Signature of parent/guardian: ~ -` ~ : ' NAME Kpnya BadgPtt _ HOME ADDRESS ~Q~Q i akQ~i~p r~rivP --, Is your home address (listed above} within the corporate limits of Iowa City? a Yes ~ No How long have you been a resident of Iowa City? 4 vears Gender: Male ~ Female OCCUPATION Flartrlral Ppgineer EMPLOYER Procter and Gamble PHONE NUMBER: HOME 319-621-9146 BUSINESS ~~a ~~a ~~~u rv.1r1'fl!!~tAC A\111Ine AnrnnTi~e ~Alul/`41 vAl I ~FFI nuol IFY YOU FOR THIS POSITION: -~IPCI'CIGIVVGP-~rv/v~~u~~ri~.w ^~.nv^. - - - - -- - JYD Workgroup Member; Community Leadership Program; NCJC Board of Directors (member); FasTrac Program Coordinator; ChHdren of Promise (mentor); University of Iowa Project on Rhetoric of Inquiry (speaker); Military service and business travel allowing me to work with many different individuals. ......,r .~...~„,o noCC•C~IT !lAIAUII ~nrc nC T411C ADVISORY BOARD? WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FCiKAYYL1f tNt7 r As an individual not resigned to being a mere spectator in the community, I seek to lead by affecting change, becoming a visible role model, and advocating for all individuals in Iowa City. I wish to connect a community with a changing demographic to embrace the traditions of Iowa while continuing to transition to a more urban community. LIST POTENTIAL CONFLICTS OF INTEREST: See a e 1 for information re ardin Conflict of Interest NCJC -Board of Directors (member}; FasTrac Program Coordinator Both are unpaid positions .---~, IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? U Yes U No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes QNo 71t has been Council oolicv not to hermit 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. Human Rights Commission Application June 2010 Page 2 of 9 ~- r ®~ ,, „wr®•~ BOARD, COMMISSION, & COMMITTEES -~-~-= BUSINESS LISTING CITY OF IOWA CITY Name of City Board/Commission/Committee Human Rights Commission Name Kenya Badgett 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 $}. List all businesses in which you or your spouse/domestic partner have an ownership interest {for example, sole proprietor, partner, 5% or mare of corporation's stockholdings}. Please indicate if there are none , Signature /~'~~,~~ %1 f. ~' Date 10/18/2010 Address 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. Drive Human Rights Commission Application June 2010 Page 3 of 8 NOTE; Anew form must be completed if the above information changes or an ownership interest is acquired in amadditional business. TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective May 14, 2010 Household Size 30% Median Income (Poverty Level) 50% Median Income 60% Median Income 80% Median Income (low income) Median Income 1 $16,350 $27,250 $32,700 $43,600 $54,500 2 18,700 31,150 37,380 49,800 62,300 3 21,050 35,050 42,060 56,050 70,100 4 23,350 38,900 46,680 62,250 77,800 5 25,250 42,050 50,460 67,250 84,100 6 27,100 45,150 54,180 72,250 90,300 7 29,000 48,250 57,900 77,200 96,500 8 30,850 51,350 61,620 82,200 102,700 ATTACHMENT TO APPLICATION FOR THE HUMAN RIGHTS COMMISSION It is the mission of the Iowa City Human Rights Commission to protect residents of the city from discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city strives to ensure that the Human Rights Commission is representative of the community. Therefore, "appointments shall take into consideration men and women of various racial, religious, cultural, social and economic groups in the city." (Ord. 94-3647, 11-$-94) OPTIONAL: PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN CHOOSING AN APPLICANT. 33 Age . Christian Religion Female Gender Median Income (see table) C heterosexual Sexual Orientation Other (Please explain below) none -1 Disability Black ~ Race, color or ethnic group USA National origin `-._, _ _ , ,., Veteran ~ : ~ ` ~' ., ~~ riuman Rights Commission Application June 2010 page 4 of 9 10/20/2010 09:48 FAX 319 688 1049 CITY HIGH SCHOOL @1001 ~~ x ~ ~~ ~~lR~- Gity of Iowa City i r ~~.:,®~ Advisory Board/Commission/Committee ~,~~"'~ r;~.~ ~ppl~cation Form ~-~-- CITY OF IOWA CITY THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Human Rights Commission Term 2011,2013 Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME David D. BCown HOME ADDRESS 2621 Walden Road 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? 1993 Gender: Male ~ Female OCCUPATION Snarial Fri~~catnr- city Hiah Schocl EMPLOYER Iowa City Community School District PHONE NUMBER: HOME 319-621-9186 BUSINESS s14-Fgs_~oan EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: Representative for City High for Multicultural Gender Fair for ICCSD, Special Education Teacher Advocate. Both ositions have allowed me the opportunity to advocate for marginalized populations and create dialogue amongst my ./ork and community. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? Very little outside of the fact that I receive information on public awareness of issues relating to Human Rights. WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLYINC-? A perspective and insight, my graduate work has been dedicated to gaining greater understanding for_-marginalized groups and create dialogue to expand the consciousness of Iowa City residents. ~~_; LIST POTENTIAL CONFLICTS OF INTEREST: See a e 1 for information re ardin Conflictof Inter~s~ -' __ -- ~None, outside of ICCSD interests with youth. ~, _ ,.. _ IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes a No 'f 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. ',man Rights Commission Application ,.une 2010 Page 2 of 9 10/20/2010 09:48 FAX a19 688 1049 CITY HIGH SCHOOL BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Human Rights Commission Name David B. Brown ~l002 „III~,~~ `~~~ '~~ ,~...._ CITY OF IOWA CITY Date 1 oi2oi2o10 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 8). 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 Law Offices of Natalie Cronk (wife) 702 S. Gilbert Street, Suite 111, Iowa City, Iq. 52240 -, _ -~ .. .. ,~ i-,.l -. NOTE: Anew form must be completed if the above information changes or an ownership interest is acquired in an additional business. Sig ure ~~ Walden Road, Iowa City, IA. 52246 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, ,man Rights Commission Application June 2010 Page 3 of 8 10/20/2010 09:49 FAX 319 688 1049 CITY HIGH SCHOOL TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective May 14, 2010 X003 Household Size 30% Median Income (Poverty Level) 50°1o Median Income 60% Median Income 80% Median Income (low income) Median Income 1 $16,350 $27,250 $32,700 $43,600 $54,500 18,700 31,150 37,380. 49,800 62,300 3 21,050 35,050 42,060 56,050 70,100 4 23,350 38,900 46,680 62,250 77,800 5 25,250 42,050 50,460 67,250 84,100 6 27,100 45,150 54,180 72,250 90, 300 7 29,000 48,250 57,900 77,200 96,500 8 30,850 51,350 61,620 82,200 102,700 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. 39 Age Male Gender 69000 Income (see table) Heterosexual Sexual Orientation Other (Please explain below) Protestant Rel ig i4 n none Disability African-American Race, Color or ethnic group United States of America National origin ~~ ~- - ~. .. ~~,, Human Rights Commission Application ie 2010 ~::: , page 4 of 9 .__ • . City of Iowa City r 1'~~~®~r Advisory Board/Commission/Committee ~,~`~~ ~" Application Form "`~"- CITY OF IOWA CITY THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. ~u .m.covt. ' Advisory Board/Commission/Committee Name ~~-R.~~~~5 ~.J~tn,ryt,l ~SCCSYL Term Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME ORy ~ ~~~ ~ •T~1'~~~-+~~-' HOME ADDRESS 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,?~ [t-~-a~.. ~((ZS • Gender: Male © Female OCCUPATION ~ ~.c~c~o n.- c' Vau~~'tan4P KbiG~-EMPLOYER s~~ ~7. ~. ~a - P-'zft2~-~ PHONE NUMBER: HOME ~..t~~ 35~{•-5~ / 5 BUSINESS 17Q..-~~~~~ EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: Scsw a• C ~t ~ 'C_ss rn h.. u~~'i•i {+-~ 5~c~ ( ~AS~'rc~' C~4-,•-,S. t~ .. ~e~ a~a,..51'`~ ~ , ~bwo l D+b-fv c ~..t' ~ u,-~ (~ ~ L' a n-. r++. • tte c -- C h.s.; .t,. ~ s~j~ ~!-e<, S~.d 1 ~-~- l Drs-{~r~ c-f{z`y`~ -~.y..cy C~.o /~n vyb ~ ~'~ ~, - C tw i t2 a7 Vcc . (Q,t,H, p~ Cf-~.a, sc"t~. Cons vrol E~ 1z ~ ~'~"' ~~' `i K-S • ~oc.,,,s~,~ l'~la.<.. l~ Gllc-c -v. n.cl ~w+-~ Di K.ec-~aa -'S Pc R C 63 oc..~rS `~ 1 rec.. c~ +n~unr +c vn++o DCCCCAIT 1[AIf11A/I FnrF [1F THIS ~f'fVIS~RY BOARD? vvnr~+ w +vv~~~ ~~~.,.~~.. 1 - ---- ~.G ,~ 1 2,trs,$ C o ~'+~. p ~ s ~ L ~L.~-~.~ C t 1'c Z e K_f' t ~ ~ C.C] 1-+. 0. -~.~~-'1~1-'a"'o.-ta-~l MAKE TO THIS ADVISORY ~ (~ ,,,~..~..~.-t--e....s c c.~-~~ ~. ~e.~.t -ens-csz~ i..,... -1-~- ~-= --~, ~ A~ ~ ~ .e,~,s c't-~ , ~' ~-Q.~,.,.~.~. ~ o-~..(~.a... a~..-- rte- v. ~j°~..v.-~c~~t-- ~-o,.~a-9- 1~-n--Q..~..Q#-. `5t -(mac, __ LIST POTENTIAL CONFLICTS OF See page 1 for Information -- c~ , ~dh'e - , 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. ran Rights Commission Application June 2010 Page 2 of 9 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Name __ ~i~®~' ~tll~~~ ` MIS®~~IL CITY OF IOWA CITY 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 8). 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 / ohm ~, r F.Vm, .. _., ~ ~.) ~_. .. l__ ~...' __. ~' NOTE: Anew form must be completed if the above information changes or an ownership interest is acquired in an additional business. U Signature Address ~[~ ~ h(~ ~ 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. .man Rights Commission Application June 2010 Page 3 of 8 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective May 14, 2010 Household Size 30% Median Income (Poverty Level) 50% Median Income 60% Median Income 80% Median Income (low income) Median Income 1 $16,350 $27,250 $32,700 $43,600 $54,500 2 18, 700 31,150 37, 380 49, 800 62, 300 3 21,050 35,050 42,060 56,050 70,100 4 23,350 38,900 46,680 62,250 77,800 5 25,250 42,050 50,460 67,250 84,100 6 27,100 45,150 54,180 72,250 90,300 7 29,000 48,250 57,900 77,200 96,500 8 30, 850 51,350 61,620 82,200 102, 700 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. (p~ Age ~~~~~ ~ Religion ~~ Gender Income (see table} Sexual Orientation Other (Please explain below) Disability Race, color r` or ethnic group National origin `' . _ ~:-, ~,.f ..._, ~.~ ,: Human Rights Commission Application - _ - - - le 2010 page 4 of 9 ~~ ~- .,, City of Iowa City ~ ~ 1 ~~~~. ® ~ Advisory Board/Commission/Committee ~,~'~~ 4pplication Form '~-"- CITY OF IOWA CITY THIS APPLICATION IS A PUBLIG 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/Committee Name Human Rights Commission Term 3 vears Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME ~nhn R philllnc_ .Ir. _ HOME ADDRESS 1F, Pc.+frn Dri~~ . 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? 3 years Gender: Male ~ Female OCCUPATION Qppratinnc Il~anagar EMPLOYER Rockwell Collins PHONE NUMBER: HOME 319-431-1678 BUSINESS ~1a_~a~_1a1n ~vo~o~~nir~c nnintnQ er_•riviT~F~ WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: -Ar V ~ \~4.~ Y V V /~~ ~V• V • ~ rev • Member of Rockwell Collins Corporate Diversity Advisory Council for 3 years. Diversity & Inclusion Dialogue trained `~cilitator -Certification, Real Colors trained facilitator -Certification, Leadership Coaching Certification' un ^ wT ~c. vr\~ ~n onrccn~T 1lAIn~AII Cnr_~ nG TFIIC ~r1VIRORY BOARD? --, "" WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLYINGI? Can contribute to the planning and execution of diversity and inclusion related programming, dialogues and/or training. LIST POTENTIAL CONFLICTS OF INTEREST• See page 1 for information regarding Conflict of Interest __ None. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? U Yes U No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes ~No llt 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. Oman Rights Commission Application June 2010 Page 2 of 9 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING Name of City BOard/COmmISSIOTI/COfnrlfllttee Human Rights Commission Name John R. Phillips, Jr. I r ~~®~~ "m~'" ~ -.~a...~ CITY OF IOWA CITY Date 10/19/2010 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 8). List all businesses in which you or your spouseJdomestic 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 r-, ` ~..~ . ~::_...: .. .._ ..._Yi •. ....• .~ ti~ "I _-- NOTE: Anew form must be completed is acquired ' addition Signature ~~ Address 16 Penf Drive, Iowa City, IA 52246 information changes or an ownership interest 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. Duman Rights Commission Application June 2010 Page 3 of 8 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective May 14, 2010 Household Size 30% Median Income (Poverty Level) 50% Median Income 60% Median Income 80% Median Income (low income) Median Income ~ $16,350 $27,250 $32,700 $43,600 $54,500 2 18,700 31,150 37,380 49,800 62,300 3 21,050 35,050 42,060 56,050 70,100 4 23,350 38,900 46,680 62,250 77,800 5 25,250 42,050 50,460 67,250 84,100 6 27,100 45,150 54,180 72,250 90,300 7 29,000 48,250 57,900 77,200 96,500 g 30,850 51,350 61,620 82,200 102,700 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. 41 Age Christian -~ Religion Male Gender Income (see table) Heterosexual Sexual Orientation a Other (Please explain below) None Disability African American ~ Race, Color or ethnic group American Citizen ~ National origin ~' °~-,..J ~.~..~ ` ' r ,: a .. l_) 1 ' '~iman Rights Commission Application . .ne 2010 page 4 of 9 City of Iowa City ~ _~ wf~~ ~ Advisory Board/Commission/Committee ~",~~"~;~~ Application Form ~!-il~ ®F 1®tiY/6~ ~IITY T 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/Committee Name Human Rights Comission Term 3 yrs Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME Linda Starke HOME ADDRESS ~~ Rion+,~,.,.,.r Drive 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? iyr 1 omos Gender: Male ~ Ferrate OCCUPATION Retired EMPLOYER PHONE NUMBER: HOME319 512-4949 BUSINESS _ EXPERIENCE ANDlOR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I have a masters' degree in Social Work. My professional career was spent working in community mental health. In this ~acity I advocated for clients in many ways including those who were experienceing some form of disc. ,ination. My work also interfaced with police and the District Attorney's Office. This connection taught me that there are a few individuals who misrepresent events for personal reasons. Thus, I feel I can be balanced in my ~~ judgments. ~, WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? r-, ~- Ionly know what is written on the Iowa City web site about this board. .° _ ; .~} - _, ~_-- _._ WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOaAPPLYING)? I am a recent resident of I.C. I retired and moved here to be near my grandchildren. I love living here and would like to contribute to the community. I feel my education and work experience would be an assest to the Commission. My retirement affords me the time to devote to the needs of this commission. LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest None 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.) ' representations on this application will constitute just cause for removal of an appointee. If you fail t~ answer all the questions, Council may not consider your application. Human Rights Commission Application BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Human Rights Comission Name Linda Starke 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 8-. 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 . ~~~~ T -~.ae~_ ~'~~ OF lo~~ C~~ Date i oi18i2o10 BUSINESS NAME BUSINESS ADDRESS None -; ~:_ ~ NOTE: ~ ":representations on this application will constitute just cause for removal of an appointee. I~ you fail to answer all the questions, Council may not consider your application. Signature A new form must be completed if the above information changes or an ownership interest is acquired in/,/,an additional usiness. /-' + A Address 73 Brentwood Drive; Iowa City, IA Human Rinhfic (~nmmiccinn 4nnlirafiinn TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective May 14, 2010 ~usehold Size 30°ib Median Income (Poverty Level) 50% Median Income 60% Median Income 80% Median Income (low income) Median Income 1 $16,350 $27,250 $32,700 $43,600 $54,500 2 18,700 31,150 37,380 49,800 62,300 3 21,050 35,050 42,060 56,050 70,100 4 23,350 38,900 46,680 62,250 77,800 5 25,250 42,050 50,460 67,250 84,100 6 27,100 45,150 54,180 72,250 90,300 7 29,000 48,250 57,900 77,200 96,500 8 30,850 51,350 61,620 82,200 102,700 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, 1 1-8-94) [~PTI(~N~L PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN CHOOSING AN APPLICANT. Age (p(P Gender - ~~~,2. Income (see table) /V>ae.eQcs~ Vim' Sexual Orientation Other (Please explain below) • ~,` ~ ; ~, ; . . ~ ~ - a ~~1 \i~ J~+ !; . Religion c,~;~. Disability J!/dri~- Race, color /o!r ethnic group c.dtttli~,t-us'u National origin ~4,,~,r,G~„d'..' Human Rights Commission Application June 2010 page 4 of 9 City of Iowa City ~ r ` ~_,:.®~r Adviso Board/Commission/Committee ~:~~"',~""~~ rY ';~ " ~plication Form ~"~` CITY OF IOWA CITY THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING TH,~T,TIME. Advisory Board/Commission/Committee Name Human Rights Commission ~-- __ T~r,'m Jan 2011 _...~ Youth Advisory Commission {shall not be mare than 18 years of age at the trime'of application) Narne of Iowa City High School or high school equivalent: - __ _, - --- Signature of parent/guardian: NAME Erin Paiae Nadolny HOME ADDRESS ~40A. ~/_? RQ~PSter Ay~~lo ~~a i y IA ~ 5 Is your harne address {listed above) within the corporate limits of lawn Gity? ~ Yes ~ No How long have you been a resident of Iowa City? 5 yg~rs Gender: Male ~ Fema(e OCCUPATION Student _ EMPLOYER University of Iowa PHONE NUMBER: HOME 319-855-8510 BUSINESS NIA EXPERIENCE ANDIOR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ,sses taken focusing on human rights: Honors Seminar in Humanities: Race, Gender and Class in the U.S., ~nan Rights Advocacy, Argument for Peace I, II, International Human Rights Seminar. Also participated in the IWomen's Resource Center's Diversity Dialogue Circles and volunteered at Habitat for Humanity's Restore project. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I understand that the Human Rights Commission is responsible for the education of local citizens regarding their enjoyment of rights such as employment and education. It also recognizes positive action towards a more just and fair community by holding banquets and awards ceremonies. T CAN YOU MAKE TO OR APPL' I believe that human rights affect everyone, whether they know it or not. I want to take an active role in helping others to understand and begin enjoying the rights afforded every human under such documents as the UDHR. I am creative and energetic and can bring a fresh perspective to this commission. 1 want to make a difference. LIST POTENTIAL CONFLICTS OF INTEREST• See page 1 for information regarding Conflict of Interest No known conflicts. 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 ~Na (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. _. Human Rights Commission Application June 2010 Page 2 of 9 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING Name of City Board/CommissionlCommittee Human Rights commission Name Erin Paige Nadolny 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 8) 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 . ::Itl~~~ CI TY OF IUWA CITY Date 10/15!2010 BUSINESS NAME BUSINESS ADDRESS N/A ,__ _. - - ~ . ~. -_ . t.~ gc NOTE: Anew form must be completed if the above information changes or an ownership interest Sign Address 1409 1/2 Rochester Ave. Iowa City, IA 52245 If you fail to answer all the questions, Council may not consider your application. Human Rights Commission Application June 2010 Page 3 of 8 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective May 14, 2010 Household Size 30% Median Income (Poverty Level) 50% Median Income 60% Median Income 80% Median Income (low incomes Median Income 1 $16,350 $27,250 $32,700 $43,600 $54,500 2 18,700 31,150 37,380 49,800 62,300 3 21,050 35,050 42,060 56,050 70,100 4 23,350 38,900 46,680 62,250 77,800 5 25,250 42,050 50,460 67,250 84,100 6 27,100 45,150 54,180 72,250 90,300 7 29,000 48,250 57,900 77,200 96,500 g 30,850 51,350 61,620 82,200 102,700 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. 23 Age Religion Female Gender Income (see table) Heterosexual Sexual Orientation Other (Please explain below) NIA -~ Disability Caucasian, Polish decent Race, color or ethnic group U.S.A National origin ~:, ~_ ~ t:: -~.: _ --- ~ ;__- ~. Married to a Japanese national, I have vested interest in immigrants' rights `~__ - ~ ,; r,uman Rights Commission Application June 2010 page 4 of 9 Erin Paige Nadolny 1409 %z Rochester Avenue Iowa City, IA 52245 (319)855-8510 erin-nadolny @ uiowa.edu EDUCATION: The University of Iowa, Iowa City, IA B.A.Japanese B.A. International Studies- East Asia Studies/ Human Rights Cumulative GPA: 3.37/4.00 University of Iowa Honors Program Chukyo University, Nagoya, Japan ISEP Study Abroad Program Advanced Japanese- formal speech presentation and essay writing LANGUAGE PROFICIENCIES: Fluent in Japanese and English INTERNATIONAL EXPERIENCE: Anticpated May 2011 • Excelled in Japanese language abilities, especially speaking and fluent communication • Demonstrated strong writing skills, producing 20 plus page research papers and opinion-based reports • Gained a deep understanding of Japanese history, culture, society and political climate • Strong communication skills acquired through interaction with international peers, employers and faculty • Utilized "New Tactics in Human Rights"' Tactical Map with a group to organize a unique approach to specific human rights issues in class COMPUTER EXPERIENCE: • Proficient on the Windows computer system and familiar with the Macintosh computer • Competent on MS Word, PowerPoint and familiar with Adobe Photoshop • Typing skills: Average 65WPM EMPLOYMENT HISTORY: No Borders International School, Nagoya, Japan January 2010 -July 2010 • Worked full time teaching English and basic life skills to children ages 2 to 9 • Constructed daily lesson plans and developed original teaching methods for 12+ students • Conferred with a select group of 3 to 4 teachers to create a two week-long summer program • Translated Japanese e-mails, instructions and documents into English • Interpreted communications between Japanese and English speaking employees and parents Pizza on Dubuque, Iowa City, IA July 2006- present • Responsible for counting drawers reconciling up to $1,000 in cash and credit cards • Calculated labor percentages at the end of the day • Answered the phone and arranged delivery orders in a timely fashion • Designed original artwork and created signs advertising weekly promotions • Trained and supervised more than 5 new employees Bruegger's Bagel Bakery October 2004- February 2006 • In charge of daily food preparation • Ensured customer satisfaction providing prompt, quality service City of Iowa City ~ ~ 1 Advisory Board/Commission/Committee ~. ~~ + wlllrmr~i application Form ""`-':-- CITY OF IOWA CITY THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Human Rights Commission Term 2011-2013 Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parentlguardian: NAME Casey Lynn Daley HOME ADDRESS 1 m n i /9 F Fairrhilri InwarC~ity, IA 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? 3 years Gender:~IVlale ~ Female OCCUPATION Student EMPLOYER N/A ~ - PHONE NUMBER: HOME 319.594.9699 BUSINESS nvq .f wo~ol~~IrG ntlnrnQ erTIVITIFS WHICH YnU FEEL QUALIFYYOU FOR THIS POSITION: -- I am disables, gay, a single parent, and a student. I believe all of these characteristics provide me with insight into "le needs of a variety of members of our community, including individuals who may be considered members of a vulnerable population. I also have prior volunteer experience and an education emphasis in human rights. ~niunT ~~ vn~ to ooCeCAIT KAInWI Fr1r:F nG THIR ~r1VISC]RY 60ARD? rn iii ~u ~ vv~~ ~ ..~.~~... - -- lunderstand the monthly time committment of board members and am familiar with the quasi-judicial framework of the human rights commission. WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLYING)? I am passionate about the field of human rights and want the community in which I live to represent equality and honor for human dignity. I am a dedicated, loyal individual and I work tirelessly on any cause that increases the quality of life for persons both in my community and in the world in general. LIST POTENTIAL CONFLICTS OF INTEREST• See page 1 for information regarding Conflict of Interest None IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes U 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. ~Iman Rights Commission Application June 2010 Page 2 of 9 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Human Rights Commission Name Casey Daley r CITY OF IOWA CITY Date 10/13/2010 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 8-. 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 . Signature Address 1010 1/2 E Fairchild Iowa City, IA 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. Human Rights Commission Application June 2010 Page 3 of 8 NOTE: Anew form must be completed if the above information changes or an ownership interest is acquired in an additional business. TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective May 14, 2010 Household• Size 30% Median Income (Poverty Level) 50% Median Income 60% Median Income 80% Median Income flow income) Median Income 1 $16,350 $27,250 $32,700 $43,600 $54,500 2 18,700 31,150 37,380 49,800 62,300 3 21,050 35,050 42,060 56,050 70,100 4 23,350 38,900 46,680 62,250 77,800 5 25,250 42,050 50,460 67,250 84,100 6 27,100 45,150 54,180 72,250 90,300 7 29,000 48,250 57,900 77,200 96,500 8 30,850 51,350 61,620 82,200 102,700 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, 1 1-8-94) na-nnnin~ PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN CHOOSING AN APPLICANT. 32 Age Spiritual Religion Female Gender 18,700 Income (see table) Lesbian Sexual Orientation ~/ Other (Please explain below) Chiari I Malformation w/ Syrnx Disability White Race, color or ethnic group U.S. ~ National origin ~. , ~, ~.= ;> _ _ ~__.~ I am a single mother to a teenage daughter. ~ _ . ~ - riuman Rights Commission Application ,_~,, one 2010 page 4 of 9 -- _r City of Iowa City ~ - 1 ~~~ Advisory Board/Commission/Committee ~~:'";,,r,®,~~ i" opiication Form CITY OF IOWA CITY THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Term 1/1/11-1/1/14 Advisory Board/Commission/Committee Name Human Rights Commission Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: HOME ADDRESS 1570 S 1 t rn,~~° #~ '^`^~a Gity IA S~?40 NAME Jeannie Burns ~.> L~ Is your home address (listed above) within the corporate limits of Iowa City? ~ Yes =' No How long have you been a resident of Iowa City? 14;~ars Gender~`1171a1e fl Fergv~le~ ~ ~ ~,3 OCCUPATION p~gram ASS~~tant Int'I & Off Gam, 'may EMPLOYER Cornell College ~~ PHONE NUMBER: HOME 319-430-6958 BUSINESS ~~a Ra5 4~~i~_~ =- ,__ EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: ,r, C'n-Chair, Council on Multiculturalism, Cornell College; Member, International Studies Oversight Committee, Cornell lege; Volunteer Programmer, Council for International Visitors to Iowa Cities; Intern, Iowa Council for International Understanding; Volunteer, Onelowa; Two-time study abroad participant; Low-income & first gen. college grad WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I am aware that it works under the authority of the Iowa City Human Rights Ordinance and that in addition to providing information to the City Council on discriminatory issues, the Commission is-also interested in outreach. WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY aoAKU KtAJVIV r'vr~r+rr~i uvv I do not know (at least by name) any of the individuals currently serving on the commission so I cannot say that I will offer the unique voice of any particular group. I can say I hope to represent la City's young-professionals, IA grads who have stayed in Iowa/IC, the LGBT community, the low-income and first-generation college students/graduates LIST POTENTIAL CONFLICTS OF INTEREST• See page 1 for information regarding Conflict of 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.) .M.:.~ ..:..F.._.._W.~y_r,....., ._~.~,.. ~ ~ _.....~ Misrepresentations on this application will constitute just cause for removal of an appointee. If you al to answer all the questions, Council may not consider your application. Human Rights Commission Application June 2010 Page 2 of 9 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Human Rights Committee Name Jeannie Burns 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 8). 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 . Signature ~ r i ~~~'~`~~ '',~®~~~ CITY OF IOWA CITY Date 10!12/2010 Address 1570 ~ 1st Ave #1, Iowa City, IA 52240 If you fail to answer all the questions, Council may not consider your application. NOTE: Anew form must be completed if the above information changes or an ownership interest is acquired in an additional business. Human Rights Commission Application June 2010 Page 3 of 8 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective May 14, 2010 Household Size 30% Median Income (Poverty Level) 50% Median Income 60% Median Income 80% Median Income (low income) Median Income 1 $16,350 $27,250 $32,700 $43,600 $54,500 2 18,700 31,150 37,380 49,800 62,300 3 21,050 35,050 42,060 56,050 70,100 4 23,350 38,900 46,680 62,250 77,800 5 25,250 42,050 50,460 67,250 84,100 6 27,100 45,150 54,180 72,250 90,300 7 29,000 48,250 57,900 77,200 96,500 8 30,850 51,350 61,620 82,200 102,700 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. 26 Age Cultural Catholic Religion Female Gender <50%Median Income (see table) Bisexual Sexual Orientation Other (Please explain below) Disability Caucasian Race, color or ethnic group American ~lational origin ~; .._ . ,- = !. , `_ ^~ :_, , ~,_ _ Human Rights Commission Application June 2010 page 4 of 9 ~ r 1 City of Iowa City ~,.:.®~r .~m~'~~ Advisory Board/Commission/Committee ~ ~®,~~ ,-pplication Form CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees .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/Committee Name Human Rights Term -January 1, 2013 NAME Chelsea Moore HOME ADDRESS 325 E. College St. APT 1635 ZIP 52240 Is your home address (listed above} within the corporate limits of Iowa City? UYes I ~No How long have you been a resident of Iowa City? 4 years nCCUPATION Student rriONE NUMBER: .,.- ,.`? EMPLOYER N/A ?=~~"' ~-~ -~. BUSINESS ~'~'` '~ T „- ~~: c ~ `-7 --- r ~ ,:~ `") J -ny Ei:.. _,. ~, EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSIllONr . ~--' T-- In the four years I was an undergraduate at the University of Iowa, I engaged in a variety of activities and experiences that demonstrate my commitment to understanding and protecting human rights. First and foremost, I graduated with honors in International Studies with a concentration in Human Rights. Beginning my freshman year, I interned at the University of Iowa Center for Human Rights, where I solicited donations, organized events, conducted training sessions, and learned how to translate the concept of human rights to a local level. I also acted as the student liaison for One Community, One Book to increase student readership and participation. More recently, I became involved in Know Your Rights, an educational campaign to help immigrant communities understand their rights and responsibilities under U.S. law. Furthermore, I have worked or studied on five continents, which has allowed me to gain insight on how to effectively communicate and collaborate with people whose experiences or opinions are different from my own. I feel that these activities and experiences have prepared me to make valuable contributions to this committee. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I am familiar with the purpose and objectives of the Human Rights Commission, namely to address and rectify issues pertaining to discrimination in various settings in Iowa City. During my time working at the UI Center for Human Rights, I became aware of the community outreach and collaborative efforts with other community-based groups of this committee. I look forward to the '~, opportunity to learn more about the specific work carried out by this group. HOME (847) 840-6664 Human Rights Commission Application January 2010 Page 1 of 8 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? was not until I came to the University of Iowa that I truly understood- or cared- what human rights are. I will always be grateful that the University of Iowa allowed me to find and pursue my passion, which I intend to further study during my career as a law student. As I remain part of the University of Iowa community through the law school over the next three years, I am also looking forward to become a more active member of the community in Iowa City. Iowa City has been a nurturing and inspiring environment for me to learn and live, and t am eager to seize this opportunity to not be engaged in the community of Iowa City as well. I feel that I can apply my knowledge, enthusiasm, and diligence to make valuable contributions to a place I've been grateful to live for the past several years. Aside from the ways that I may be able to help, I also see this is a great learning experience, from which I can better understand human rights at a local level, as well as some of the issues specific to Iowa City. r~ d ~~~~ ~ -,- ., , ~,Y _- ~~ i ~ ~ n « ~ ~_ ~_ 1 _ . _ _ i.,,:,,, --~~ ( ~~ b .. 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. her 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. There are no potential conflicts with my work or personal life. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? AYES ~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.) not consider your application. Human Rights Commission Application January 2010 Page 2 of 8 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Human Rights Name Chelsea Moore 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 busiriesses 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 NIA N/A Q ~s~ ,~ 4'~ ec~a .~ ='--a ~~ -- rLill~~~ -~a.at~ CrrY OF IOWA CI-t-Y Date 6/31 /10 NOTE: Anew form must be completed if the above information changes or an ownership interest is ac~q~uir/e~d in~ ditional business. Signature~~w ~ ~~~ Address 325 E. College St. APT 1635 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 January 2010 Page 3 of 8 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective March 19, 2009 Household Size 30% Median Income (Poverty Level) 50% Median Income 60% Median Income 80% Median Income (low income) Median Income 1 $15,950 $26,600 $31,920 $42,550 $53,200 2 18,250 30,400 36,480 48,650 60,800 3 20,500 34,200 41040 54,700 68,400 4 22,800 38,000 45,600 60,800 76,000 5 24,600 41,050 49,260 65,650 82,100 g 26,450 44,100 52,920 70,550 88,200 7 28,250 47,100 56,520 75,400 94,200 8 30,100 50,150 60,180 80,250 100 300 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. 21 Age Religion Female Gender `~^"f ~ :~= ~ . `T- ~. Dig °f~ility ,F c-> ~.~~ ~ .~l L~, t ~ Income (see table) ,, ~.~; ..~:_y --_,_ . ~ ~_m Ra ~ ,color ~~ ~~~~`~-' • -- ~ o;r--~~hnic group _ Sexual Orientation ~- National origin Other (Please explain below) Human Rights Commission Application January 2010 Page 4 of 8 City of Iowa City ~ r _ 1 Advisory Board/Commission/Committee #.;~`~~ Application Form "`-"- CITY OF IOWA CITY THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Iowa City Human Rights Commission Term 2011-2013 Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME Julia Zalenski HOME ADDRESS RJR nakrrpst St apt. 4 Is your home address (listed above) within the corporate limits of Iowa City? 0/ Yes ~ No How long have you been a resident of Iowa City? 4 vears. 2 months Gender: Male ~ Female OCCUPATION Studen _ EMPLOYER University of Iowa College of Law PHONE NUMBER: HOME 319-331-4204 BUSINESS ~,a_~~,~.~na _ FxpFR~FNrF AND/oR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: Know Your Rights project member; Kids First pro bono project volunteer; founding member and co-president of the Society for International Human Rights Law at Iowa; UI Center for Human Rights intern (work included outreach pning and coordination as well as research and writing, 06-10); president of UI Amnesty International (08-10). wNe-r ~S vni ~R pRFSFNT KNOWLEDGE OF THIS ADVISORY BOARD? ~II understand the Human Rights Commission's fundamental goal to be eliminating discrimination of all types and to (promote equal opportunity in the Iowa City community. To this end, it addresses discrimination complaints and engages in education outreach activities. LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflicf ortlnterest = i _.- _ ~,. N/A ._ _ . _ r,? r-, ,_ IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? U Yes U 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. I ian Rights Commission Application June 2010 Page 2 of 9 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING Name of City BOard/COmmISSI0r1/COmmlttee Iowa City Human Rights Commission Name Julia Zalenski _~ r ~ ,~®~•~ -~a.a4_ CITY OF IOWA CITY Date 10/04/2010 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 8). 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 N/A hJ ~J . ~_J _~ x e f ~"a ._._ _ 4,v t' -'t..,. --~~i a v L ('.i ~.: ~, ', NOTE: Anew form must be completed if the above information changes or an ownership interest is a~~c(qu~-ir~~e~~d in an additional business. Signature ~~MtUt~U Address 828 Oakcrest St. Apt. 4, Iowa City, IA 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. ~ nan Rights Commission Application June 2010 Page 3 of 8 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective May 14, 2010 Household Size 30% Median Income (Poverty Level) 50% Median Income 60°i6 Median Income 80% Median Income (low income) Median Income 1 $16,350 $27,250 $32,700 $43,600 $54,500 2 18,700 31,150 37,380 49,800 62,300 3 21,050 35,050 42,060 56,050 70,100 4 23,350 38,900 46,680 62,250 77,800 5 25,250 42,050 50,460 67,250 84,100 6 27,100 45,150 54,180 72, 250 90, 300 7 29,000 48,250 57,900 77,200 96,500 8 30,850 51,350 61,620 82,200 102,700 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." IOrd. 94-3647, 11-8-94) OPTIONAL: PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN CHOOSING AN APPLICANT. Age Religion Gender Income (see table) Sexual Orientation Other (Please explain below) Disability Race, color or ethnic group I ~ National origin ~, ~~ 3 ~~ a r-a ,_ _ _ ~ "_; -., Haman Rights Commission Application e 2010 page 4 of 9 ,- ,.~, ~-, ~ _ 1 City of Iowa City ? ,~ ~r - ~~ ®_ Advisory Board/Commission/Committee ~~~"',~~ . ,~plication Form ~'`~ r CITY OF IOWA CITY THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THATTI ~~N' ~ J z®~~~y Advisory Board/Commission/Committee Name ~ ~f~I~2~N ? ~~~{~ $ Term ~ d ~ / Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: w w .~ e~ w ,rte n ~.- NAME M /~rL G/'1 TIJ A,~ Li~ y HOME ADDRESS /,~1~5 G ~.(/~tK ~~ 52Z~f.~' =owe crr'y Is your home address (listed above) within the corporate limits of Iowa City? .e--Yes ~ No How long have you been a resident of Iowa City? ~~Q1!' 70 Y~?S Gender: Male ~ Female... OCCUPATION MK ~N7~' UU~2~C ~2 ~ EMPLOYE~I~/l~ ~ G~ ~~~~ PHONE NUMBER: HOME~3~ ~~ L"--! Z 3.~ BUSINESS Ty EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: 'ORK~A Go/Z s.c. ~avS~N~ Ut~r ~-z~Y ~'~D ftOUSl/~!~ S~'Gt1oN8 ~0~/zftM G 2 ~~FtRS~ W.0/Zk S ~~ W 1tH s ~~10~2 G<fI ?.DNS ~o JOhNSON GOVNtY S E~2 GE/vTEJ~ CZ, 5 tf ~,q~S~ z T~~ wt Gc.~r co v .~ w c~'~T' , ~, WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? y. _ `=' TAE AhVI Sat y 6odI2D S ~P~o rr s w~~ A's ~s :~ = ~~; ~ N vM~ /V R/ U'ff i s A EPft/zTM~N i SU~/~ai2Ts ,q-wv /9'Av! SE-s COMM vNlT"Y ~~4.1~G?S _A -- --- ~.~,a~ ~r~.~,A-~ ~ Pvf3l,lC ON T~rF.llZ R!!rE-!tS ~~ ~~' WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISUKY tiVHKIJ KCHavi~ rvr~r~rr- ~: uw k'/VOWLE~E !~-ND (//Vl~~/Z STf}'/VD~'Nrr O ~'Gk/14 L'.~'7Y G/Yr_.x/!t CaMMv/V !~'~/ ~~,/z~~vL/t2Ly fi"~raSE' /N J~R~G~ ~ivDs SE'NS-,~'T/v/TY SZ'T~/'t7'! d/US, ThE ~vEG,t~S o~ SEIVID,~ G! T`/ZEIVS, Td G'!3 LT !~~'d LE LIST POTENTIAL CONFLICTS OF INTEREST See page 1 for information regarding Conflict of Interest ~'M ~~o y~'E = c.z~ y o~'zo~.r~~ czTy SEN/o2 cE~vT'~2 r-, IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? -~~es U No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes -~lo (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 i t consider your application. `I to answer all the questions, Council may no Human Rights Commission Application June 2010 Page 2 of 9 ~t ~ ~~~~~ ~ ~~~~~ BOARD, COMMISSION, & COMMITTEES -~-~-- BUSINESS LISTING CITY OF IOWA CITY Name of City ~ UMi~ ~ ~ l ~~T S Date ~~ Board/Commission/Committee Name M~~GA ~3,~~' L.~y 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 8). 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. Address If you fail to answer all the questions, Council may not consider your application. NOTE: Anew form must be completed if the above information changes or an ownership interest ac fired in an a d' Tonal busi ss. Signature Human Rights Commission Application June 2010 Page 3 of 8 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective May 14, 2010 Household 30% Median Income Size (Poverty Level) 50% Median Income 60% Median Income 80% Median Income (low income) Median Income 500 54 1 $16,350 $27,250 $32,700 $43,600 , $ 300 62 2 18,700 31,150 37,380 49,800 , 100 70 3 21,050 35,050 42,060 56,050 , 800 77 4 ,23,350 38,900 46,680 62,250 , 100 84 5 25,250 42,050 50,460 67,250 , 300 90 6 27,100 45,150 54,180 72,250 , 500 96 7 29,000 48,250 57,900 77,200 , 700 102 g 30,850 51,350 61,620 82,200 , 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 ~Dmmunity. Therefore, appointments shall take into consideration men and women`~f .va~dus racial, religious, cultural, social and economic groups in the city." (Ord. 94-.3647, 1 1 ~8=94) OPTIONAL: PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CON.SIDER~WHEN CHOOSING AN APPLICANT. ~~ Age ,4T~E.Z'Sr ~ Religion ~~/~f,~ L ~ Gender Disability 32 dd, Income (see table) ~-R Sexual Orientation Other (Please explain below) „T.~ Race, color w~~ or ethnic group ~- y. S ~ • National origin I RENT/ ~! ES ~ S TIz~NS G-C/V,a Efz ~ ND ~` ~'EM~L.~ NOf ~'L~' L ~ ~ ~!~ y Sr G~ Gay ACM LiL Human Rights Commission Application June 2010 page 4 of 9 City of Iowa City ~ r j Advisory Board/CommissionlCommittee ~ `III ~,~ rW,®~~i _ ,pp~ication Form ?r~ `, ~-„CITY``OF IOWA CITY ~~ F, _ Q ~ I~ r_ Individuals serving on Boards/Commissions/Committees play an important role in adv~is.~n~~he~Council on matters of interest to our community and its future. Applicants must reside in Iowa City. ~ ~`'>~k1 r~- ;'p `k'r` After a vacancy has been announced, the Council reviews all applications ~unng foie ~ot~ se`ssion. 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/Committee Name Human Rights Commission NAME Diane Finnerty HOME ADDRESS 728 Dearborn Street Is your home address (listed above) within the corporate limits of Iowa City? How long have you been a resident of Iowa City? 20 years r`CCUPATION Director of Faculty HR and Development/Adj Instructor rriONE NUMBER EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I have committed much of my adult life's work to issues related to diversity and human rights. From 1981-1994, I worked in the nonprofit sector providing direct services and administrative leadership in organizations promoting safety from sexual assault, domestic violence, and accessible women's healthcare services. I served as Diversity Resources Coordinator at the UI's Office of Equal Opportunity and Diversity (1994-2003), and as Director of Training and Cultural Competence in the UI School of Social Work's National Resource Center for Family Centered Practice (2003-2007). In these roles I provided hundreds of trainings on Title VII related topics and cultural competence issues. I have also taught as Adjunct Faculty on issues of international business, race/gender/class in the U.S., leadership in a diverse society, U.S./Latin American immigration, and diversity, oppression and discrimination. I have served as a private consultant to nonprofit, public and for-profit organizations on issues of diversity and organizational cultural competence. Throughout all of my work, my greatest learning has come from my experience working in and with the community. I have been an active volunteer in the Iowa City community for years in activities ranging from serving as a Girl Scout leader, PTO co-president, foster parent, public speaker, and event volunteer. ~niue-r is vni ~R FRF~I=NT KNr7Wl_EDGE OF THIS ADVISORY BOARD? I am familiar with the work of the IC Human Rights Commission through various means. I have served on numerous committees with current and former Human Rights Directors, have attended and spoken at the annual Human Rights Award Breakfast, and have known several members of the commission over the years. 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. HOME 337-4673 EMPLOYER UI 0 Yes Term Unexpired or 2011 ZIP 52240 No BUSINESS 335-3991 Human Rights Commission Application January 2010 Page 1 of 8 WHAT CONTRIBUTIONS DO YOU FEEL YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? ,.y hope in participating in this commission is to work with a group of committed individuals to discuss and address key issues facing our community. I am particularly committed to addressing issues of race and class in our community, and have extensive experience working with other White people in exploring issues of racism and White privilege. I am also interested in supporting recent immigrants of all nationalities and statuses in the community, and have been along-standing support of LGBT rights. More than being asingle-issue person, though, I truly Want to engage with others in providing leadership on the thorny issues that promise to further divide the Iowa City community, unless we develop new and creative ways to address them. I have recently worked, for example, with the Neighborhood Centers of Johnson County to facilitate community planning sessions toward developing strategies to address the mythic "Southeast Side." I recently spoke at the Kiwanis and The Center ~, (Senior Center) on issues of the Changing Face of Iowa." I co-chair the Iowa Latino Conference statewide planning committee 'and am pleased to be partnering with the ICCSD to bring the statewide conference to Iowa City in October 2010. I have worked with the UAY and other local LGBT groups to address issues facing LGBT teens, partners, and parents. I certainly don't come with any answers, but I would contribute my whole heart to working with others to fashion approaches that might serve to unite the community, rather than those that further divide and disempower. 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 `'gat apply for funding from the City. "Affiliation" includes being a board member or employee of the agency. .her 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 ['nriP of Iowa. please contact the City Attorney's office at 356-5030. I have nothing that I perceive would pose a conflict of interest. ~~ .._ - - :~ c-- ~ . ; ~~~- __ J IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? YES ON© w^ ~ ,.z_ DO YOU CURRENTLY SERVE. ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~YE.S ~ NO (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Human Rights Commission Application January 2010 Page 2 of 8 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Human Rights commission Name Diane Finnerty 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 ~~ L~ ~ i C~7 ..~! ..-. °'s f,'i tiJ v u ~ I r 1 ~.~®~,~ ,rind. ~ ~. wr®"~~ -•ti.at~ CITY OF IOWA CITY Date (~ ~"~~ "- I ~ NOTE: Anew form must be completed if the above information changes or an ownership interest i cquired in an additional business. C~~ Signature 1G~-~ Address 728 Dearborn Street Misrepresentations on this apNuua~iuii w~~~ .,~~~~~~~u~.,,..~~~ ~~~~~ Human Rights Commission Application January 2010 Page 3 of 8 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective March 19, 2009 Household Size 30% Median Income (Poverty Level) 50% Median Income 60% Median Income 80% Median Income (low income) Median Income 1 $15,950 $26,600 $31,920 $42,550 $53.,200 2 18,250 30,400 36,480 48,650 60,800 3 20,500 34,200 41,040 54,700 68,400 4 22,800 38,000 45,600 60,800 76,000 5 24,600 41,050 49,260 65,650 82,100 g 26,450 4.4,100 52,920 70,550 88,200 7 28,250 47,100 56,520 75,400 94,200 8 30,100 50,150 60,180 80,250 100 300 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 va~us racial, religious, cultural, social and economic groups in the city." (Ord. 94-3647, 1 1-~8,-94) ~ L _ ~'-:~ ~ - „ JA c-+ ..~+ 1....i. _uZa OPTIONAL: ~,~~- PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO C0111.SI:DER~'~IVHEI~ ~~ -~ ;,. CHOOSING AN APPLICANT. ~:, .t .~ -- tJ' 49 qge None Religion F Gender Median Income (see table) Lesbian Sexual Orientation Other (Please explain below) Parent of Adult Child with Disa ~ Disability Race, color White or ethnic group U.S. ~ National origin Human Rights Commission Application January 2010 Page 4 of 8 City of Iowa City ~ - ~ ? -~ ..~ ~~~ ' Board/Commission/Committee ~ ;.~~ ~®,~~ Advisory _ .-~_~-_ r--~pp~~Cat~on Form 'i CITY OF IOWA CITY Individuals serving on Boards/Commissions/Committees play an important role in advising the Council on matters of interest to our community and its futui`e. 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, WED FOR THREE MONTHOS ONLY AND AU OMATICALLY CONOSIDEREDIFORRNY VACANCY DURING THAT CONSIDER TIME. .~ mission/Committee Name ~~-- i rri~i~p- Term ~ ~f Advisory Board/Co NAME /~ ~ ,~. ZIP ~ZZ'L 6~ HOME ADDRESS rn ~' f! ~° • Is your home address (listed above) with the corporate limits of Iowa City? Yes ~ No aim How long have you been a r sident of Iowa City? ~_, nCCUPATION ~ ~ '-, ~ EMPLOYER rrIONE NUMBER: HOME ~~~ ~-~l ~ T ~l BUSINESS 1 ~-- EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: • / 1 c:. --' ~.ly-t Gtr ~~~~ t~ ~6^r- vwh S i~ ~ ~ 7/»` ~" p 1. , '~ 5 /nom •- N ~ ' "~ ~ ~ '~~ ~ - ,~ ~~ s ~ Sty ~ ~ r r ~„ `~rzr 1i3~ ~ ;~~ `_ ~-- - E ~.:; .xf,~ M~...~.~ ~~~ ~ ~ . _~ r._._ `.~._~, . ~~ -~ a ~ _- . ,T WHAT IS YOUR PRESENT KNOWLEDGE OF THIS DyIS RY BOARD? ' - c. e-tr' Cii--- l ~t '°.- N r ~ -~' O ~f~~7 G'/~ ~h r l S 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. Human Rights Commission Application; January 2010 Page 1 of 8 WHAT CONTRIBUTIONS DO YOU FEf.L YOU CAN MAKE TO THIS ADVISORY BOARD (OR STATE REASON FOR APPLYING)? _ , c~ l~~' i~~ ~~~ yr•-~S ~ G~ a~ r ~~~--- n q« ~ f ~~-~ ~~ ~ ~ ~...~ ~~s ~C~ ~.-~{---- Si ~~ ~v, ~ ~ _ ~ ~ ~ ~, v/ ~ ~0 S t~~ ~ ~ ~.. U- ~...--- ""-0` ~ 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. ner 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. ^~ ~? -- ~--, ~ r . ~ ~+ C'7-~v ~ <~ ~ ~ ~' r z ~ ~; ;: ~~ = ~~ 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. Human Rights Commission Application January 2010 ~ Page 2 of 8 BOAFaD, COMMISSION, & COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Name ~~ _~r :rlll~~~~t -•~~ CITY OF IOWA CITY Date ~ 7 ~ e~ 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 NAIUIE BUSINESS ADDRESS ~~~ ~~ ~., ~~ c.~ ~' :~.? rw - %=~ _ :.._ a ,~ ..,t ~..,,.~ L~ e `L7 ~ ~ _~ ~ i .. ~~ J NOTE: Anew form must be completed if the above information changes or an ownership interest is acquired~n additional business. Signature Address If you fail to answer all the questions, Gouncll may not consiaer your a1.1Nii~ativii. Human Rights Commission Application January 2010 Page 3 of 8 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective March 19, 2009 Household Size 30% Median Income (Poverty Level) 50% Median Income 60% Median Income 80% Median Income Ilow income) Median Income ~ $15,950 $26,600 $31,920 $42,550 $53,200 2 18,250 30,400 36,480 48,650 60,800 3 20,500 34,200 41,040 54,700 68;400 4 22,800 38,000 45,600 60,800 76,000 5 24,600 41,050 49,260 65,650 82,100 g 26,450 44,100 52,920 70,550 88,200 7 28,250 47,100 56,520 75,400 94,200 g 30,100 50,150 60,180 80, 250 100 300 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, 1 1-8-94) npTlnlva~~ rv ~~ E_;? ~ PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CON~119~R-1rIkIHEN•~..~ CHOOSING AN APPLICANT. ,{M~=~ Age ~, _~ ;- --- - _. N ~ i.~. ,~ _ • R ligion l~ .. ~ F; c.~ ,,~ Gender ~~ •-(`~ Income (see table) r Sexual Orientation a Other (Please Explain below) --- Disability Race, color or ethnic group ~,} s National origin Human Rights Commission Application January 2010 Page 4 of 8 21d 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, 2011 -January 1, 2015 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 20, 2010. 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 Mike Moran, Acting Parks & Recreation Director at 356-5110. PARKS AND RECREATION COMMISSION PARKS AND RECREATION COMMISSION ATTENDANCE RECORD YEAR 2010 NAME M ~„~ O O 1~ N 01 ~ ~ ~ r~ •" o ~ N TERM .- `~` N r M O v r N ° ~ oo °' ° `' EXPIRES David 1/1/11 O/E O/E O/E X X X X LQ X O/E Bourgeois Clay 1/1/14 X X X X X X X LQ X X Claussen Lorin 1/1/13 O/E X X X O/E X O/E LQ X X Ditzler Maggie 1/1/13 X X O/E X X O/E X LQ X X Elliott Craig 1/1/11 X X X X X X X LQ O/E O/E Gustaves on Aaron 1/1/13 X O/E X X O/E X O/E LQ X X Krohmer Margaret 1/1/12 X O/E O/E X X X X LQ X X Loomer Jerry Raaz 1/1/12 X O/E X X X O/E X LQ X X John 1/1/14 O/E X X X X X X LQ O/E X Westefeld KEY: X = Present O = Absent O/E = Absent/Excused NM = No meeting LQ = No meeting due to lack of quorum * = Not a member at this time Spouses and relatives of City Council Members and members of comparable County Boards and certain 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 7, 2010 Application Deadline: Wednesday, 5:00 p.m., October 20, 2010 Council Appointment Date: October 26, 2010 After 12/06/10 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. PARKS & RECREATION COMMISSION Two Vacancies -Three-Year Terms January 1, 2011 -January 1, 2014 (Term expires for David Bourgeois, Craig Gustaveson) Gender Balance Requirement: 1 Female (F) (M) David Bourgeois D 1477 Buckingham PI (M) Jeffrey Martin ~ Barrington Road ~ Denotes a completed application has been filed. City of Iowa City ~ r j -`~.®~r Adviso Board/Commission/Committee ~,,~'''~~ rY Application Form "`-"- CITY OF IOWA CITY THIS APPLICATION IS A PUBLIC pOCUMENT 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/Committee Name Parks & Recreation Commission Term 1/1/11 Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME JeffrekG Martin HOME ADDRESS 1015 Barrington Road 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? Since 1991 Gender: Male ~ Female OCCUPATION Contracts Administrator EMPLOYER Universit~of Iowa PHONE NUMBER: HOME 319-351-3331 BUSINESS ~i o_~~s_~i ~u __ EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: 1980s - As a resident of Muscatine, I served on the Cable TV committee and the city's housing commission. 19,r '~3 Board of Directors, Montessori School of Iowa City 20~~-05 Board of Directors, Peace & Security Funders Group -representing my employer, the Stanley Foundation. 2007-2009 -Board Member, Peace and Security Initiative -another national collaboration of like-minded groups WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? Two friends -John Westefeld and Craig Gustaveson -serve on the board. As with every agency, there is always a demand to do more with fewer resources. Serving the wide-ranging interests of a highly diverse community is a constant challenge, but is vital to maintaining the character of the city. My family is very familiar with the offerings - from arts classes to the swimming pool at Mercer where my daughter learned to swim. WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLYING)? I have extensive experience on boards and commissions and have developed a clear understanding oTT the role of the governance function vis a vis management. I have strong written and oral communication skills, food meeting facilitation abilities, and extensive experience with strategic planning. I would welcome the chance-'to contribute to the continued development of a robust and diverse parks and recreation system that enhancethe clrixture of the city. . fem. 5.-_~ . ~.~ ~ -i LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict~of In#~rest~ ~= None __- .., - _, ._, ~..r,_ IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~/ Yes ~ ~Io DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes /QNo (it has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) .srepresentations 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. C;Pnaral Annli~atinn BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/COmmISSion/Committee Parks & Recreation Commission ~~~®d1 -~.as~._ CITY OF IOWA CITY Date j ~~~ ~ ~ ~ Name Jeffrey G. Martin 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, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, 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 N/A ~. ,~., v c- ,.. ., s ~ .. ~ J :".. 'I NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. A licant Si nature v pp g Signature of parent/guardi o h ~ ry Commission only): Address 1015 Barrington Road Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail answer all the questions, Council may not consider your application. C;r~nPral Annliratinn City of Iowa City r Advisory Board/Commission/Committee ~,~~•~ . apl ication .Form '''`~`` CITY OF IOWA CITY THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY~~",~ /S-I~DERED' )FO~,~~Y~VACANCY DURING THAT TIME. j Adviso Board/Commission/Committee Name ~~v ' ~~} ~C ~.1..~- Term L// rY Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME ~-JCP.~1 ~-t.~('G~1 r HOME ADDRESS ~~ ~ ~j Is your home address (listed above) within the corporate limits of Iowa City? ~ Yes ~ No How long have you bee re ident of I ~ a City? Gender: Male ~ Female PATION c~Q~ I ~ ~ Gf OCCU EMPLOYER PHONE NUMBER: HOME-~I~~ ~~ C~ 1 C~ ~ ~ BUSINESS EXPERIENCE AND/OR,~CTIVITIES YOU FEEL QUALIFY YOU FOR THIS POSITION: ~~ ~~ 1 ~~, ~1~ .~....~.~~~-.~-r ~~~~n~nn ~nr~c nC TuIC 4r1\/ICf1RY R(IORr)? YVFiHI IJ TVUR r't[Ca~i~i r~ivvrr~wv~ ~+~ -- -- r+a c^; ~ ~.1,,., ~ ~ „ WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FO "P,PL ING ?. =-.~, £_~: ~, :~,_ LIST POTENTIAL CONFLICTS OF INTEREST• See page 1 for information regarding Conflict of Interest IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? Yes U No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes ~No rit i,a~ hPPn (:nuncil oolicv not to permit an individual to serve on two Boards or Commissions at the same time.) ._ ..~- ---- - - e ~ ~ --- 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 June 2010 Page 2 of 8 BOARD,. COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Name u~ ~~~~.®~ ~III~~~ ~~°'~~ -~..~ CITY OF IOWA CITY Date I ~ ~ ~ { ~ 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, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate, if there are none. Applicant Signature. Signature of parent/guardian (Youth Advisory Commission only): 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. acquired in an "ditio al b sine. General Application June 2010 Page 3 of 8 NOTE: A new form must be completed if the above information changes or an ownership interest is 21e 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, 2011 -January 1, 2014 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 20, 2010. 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 Marcia Klingaman, Neighborhood Services Planner at 356-5237. Spouses and relatives of City Council Members and members of comparable County Boards and certain 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: Council Announcement Date: September 7, 2010 Application Deadline: Wednesday, 5:00 p.m., October 20, 2010 Council Appointment Date: October 26, 2010 After 12/06/10 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. PUBLIC ART ADVISORY COMMITTEE Two Vacancies -Three-Year Terms January 1, 2011 -January 1, 2014 (Term expires for Annadora Khan, Jan Finlayson) Gender Balance Requirement: 1 Female (F) No applications as of Wednesday, 5:00 p.m., October 20, 2010 D Denotes a completed application has been filed. Senior Center Commission Attendance Record Year 2010 7/15 8/19 9/9 10/21 1 Name Term Expires 1/21 2/18 3/25 4/22 5/20 8/17 Mercedes i3em- Klug Chuck felling 12/31/11 12/31/12 X X X X X X X X X X X X X X NM NM X X Rose Hanson 12/31/11 -- - -- -- -- -- X NM X Jay Honohan 12/31/10 X X X X X X X NM X Michael Lensing 12/31/10 X X X O/E X X O/E NM X Sarah Maiers 12/31/09 O/E O/E X X X X X NM X Jean Martin 12/31/12 X X X X X X X NM X Key: X = Present O = Absent OJE = Absent/Excused NM = No meeting -- = Not a member "I U-Lb-'1 U 21f NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: SENIOR CENTER COMMISSION Two Vacancies -Three-Year Terms January 1, 2011 -December 31, 2013 The duties of members of the Senior Center Commission are to: Serve in an advisory role to the City Council with regard to needs of the Senior Center. Make recommendations with regard to policies and programs at the Senior Center. Join staff and other interested persons in seeking adequate financial resources for operation of the Senior Center. Encourage full participation by senior citizens in the programs of the Senior Center. 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. 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 20, 2010. 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. Spouses and relatives of City Council Members and members of comparable County Boards and certain 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: 2 Council Announcement Date: September 7, 2010 Application Deadline: Wednesday, 5:00 p.m., October 20, 2010 Council Appointment Date: October 26, 2010 After 12/06/10 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. SENIOR CENTER COMMISSION Two Vacancies -Three-Year Terms January 1, 2011 -December 31, 2013 (Term expires for Michael Lensing, Jay Honohan) Gender Balance Requirement: 1 Male (M) (M) Michael Lensing ^D (Currently serving 1St three-year term) 411 East Fairchild (M) Jay Honohan ~ (Currently serving 4th three-year term) 1510 Somerset Ln ~ Denotes a completed application has been filed. City of Iowa City + ~ s .~~.~+~ Advisory Board/Commission/Committee ~ ~"'~'~~ .wr®'~~ ,application Form ''`~'s-- CITY OF IOWA CITY THIS P,PPI_ICATION IS A PUBI_.IC DOCUMENT AND AS SUCH CAN BF_. REPRODUCED AND DISTRIBUTED FOR THE PIJBLIC, WITH THE EXCEPTION OF THE IAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION W!1_L_ BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR AP~lY VACANCY DURING THAT TIME. Advisory BoardlCommission/Committee Name ~C~ ~,1~ ~V ~~ r~ {-Qt C~ ~''7 M t SS- En. Term 2 c~/ ! ~- 2 Q ~ 3 Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME ley H Hnnnhan HOME ADDRESS 1~~n cnmarcP.t.l C] Ir~wa City IA 5?24n Is your home address (listed above) within the corporate limits of Iowa City? ~ Yes ~ No How Eong have you been a resident of Iowa City? Ginr:P 1960 _ Gender: Male ~ Female OCCUPATION ~pmi_ratirort attorn .y EMPLOYER self em~loved PHONE NUMBER: HOME (319) 338-6990 BUSINESS .~.3~) :~~~_s~no w=x~Fa't=r~c~R ANI~IaR i.~,GTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: participant at the Center for several years. Experience as Police Judge, and City Attorney for Iowa City. Coordinator of Volunteer Attorneys at the Center since 1997. Active in the Community since 1960 serving on the United Way Board, Church Board, City relations Chamber committee. Active law practice since 1960. l1uHAT Is Ybt1R PRESENT KNOWLEDGE OF TI-11S A©VISORY BOARD? As a commission member and chair, I am well acquainted with the commission's role in it advisory capacity for the staff and council. I have assisted staff to some degree with the budget for the Center so I am familiar with the budget for the Center. WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FORAPPLYING ? I have contributed both my time and experience in the past several years. I will continue to contribute in the same way. My occupation experience lets me contribute with ideas which will benefit the Center. ~, ~_=~ E:,.. '~ r tc-r ~~-r~ntrint rnntF€ or:TS n~ ICrITFRFST~ See c~aae 1 for information reaardina Conflict of Inter>3st? ' ra -,~_, None ~ • ~-~~ ,- ~, + . IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes ~ Na `=~~' DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ~~Yes ~No ;It has been Council policy not to permit an individual #o serve on two Boards or Commissions at the same time.) Misrepresentations on this application wil- constitute dust cause ror removal or an appointee. to nnc".,or III Iho rr„ee+innc (`ni ~nril mw nn+ rnncirlar vni it annlir.Atinn General Application June 2010 Page 2 of $ BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee ~~ ~ ~ ~~Y ~e ~ ~/ ~v ~"~ r'°i I S S I l/71 Name Jay H. Honohan -•ti.as._ CITY OF IOWA CITY 2~5'll~ Date Section 362.5 of the Code of Iowa generally prohibits, with certain imporkant exceptions, a member of a city Baard or Gommissian from having an interest in a city cantract. A copy of Section 362.5 is attached (see page 7}. List all businesses in which you, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sale proprietor; partner, 5% ar mare of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS Old Feed Store Associates, owner of an office building 330 E. Court, Iowa City, IA 52240 rented to the law office of Honohan, Epley, Braddock phone (319) 351-8100 & Brenneman (partnership both my spouse and I are general partners) ; ~.- w - - ~ _ ». ~ .. ~.-:o-:, ~; . „ ; .~ -~~ ~ , ;., ~ NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Applicant Signature- Signature of parentlgua 9 l~ ~~io uth Advisory Commission only): Address 1510 Somerset Ln Iowa City IA 52240 1 Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Counal may not consider your application. General Application June 2010 Page 3 of 8 City of Iowa City - r i ~_.:.®~r Advisory Board/Commission/Committee ~ ~"'~'`~~ Application Form ~-~-- CITY OF IOWA CITY THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board/Commission/Committee Name Senior Center Commission Term Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME Michael J Lensing HOME ADDRESS 411 Fast Fairchild 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? Since 1970 Gender: Male ~ Female OCCUPATION Fi moral Dlr ctor __ EMPLOYER Lensing Funeral & Cremation Service PHONE NUMBER: HOME 319-358-9630 BUSINESS ~1A-:TSB-Fi171 EXPERIENCE AND/OR AGTIVITItS WF11GF1 YUU rttL tluHLir t Tvu rvr~ i nip rw~ ~ ~uw.~- I f~^~ better qualified now because of my past Commission experience. _ `~' ~, .. .__ C._, ~niunT Ic vn11Q DQGCGAIT KAI[1W1 Fr)C;F (]F THIS ADVISORY 60AFtU"! The Commission helps to oversee the Senior Center. We are kept informed of policies, programming and the financial status of the Center. We act as a sounding board for seniors at the Center. -_. WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLYING)? I am a senior--- a young senior, 58. Most seniors at the Center are over 58, so I feel I can help interject ideas and thoughts of the baby boomers. The Center must keep pace with the changing demographics. LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ~ Yes U 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.) ~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 June 2010 Page 2 of 8 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board/Commission/Committee Senior Center Commission r =.:.®~,~ ~m~ ~ • ~wr®~~~ -n.at~_ CITY OF IOWA CITY Date Name Michael J. Lensing 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, your spouse/domestic partner, or parent if Youth Advisory Commission applicant, 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 Lensing Funeral and Cremation Service 605 Kirkwood Ave, Iowa City,lA The Kirkwood Room 521 Kirkwood Ave, Iowa City, IA Faithful Companions Pet Remembrance Services 210 Holiday Rd, Coralville, IA NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Applicant Signature ~ Signature of parent/guardi n (Youth Advis ry Com fission ly): Address 411 East Fairchild l Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail answer all the questions, Council may not consider your application. General Application June 2010 Page 3 of 8 21 NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: YOUTH ADVISORY COMMISSION Two Vacancies -Two-Year Terms January 1, 2011 -December 31, 2012 One (1) person -City High Representative One (1) person -West High Representative The mission of the youth Advisory Commission is to promote understanding and awareness of Iowa City among Iowa City youth, allow a select group of youth to help make decisions concerning them and their peers, enable youth members to utilize and expand on their leadership abilities, to serve as a mechanism for communication between youth and adults in Iowa City and create a bridge whereon youth and adults can develop partnerships. Membership shall consist of seven [7] members appointed by the City Council currently enrolled in an Iowa City high school or high school equivalent. Four members shall represent City, Regina, Tate, and West high schools. The three remaining members shall be at large. All ages shall be calculated on the date of the filing of applications, and shall not be more than 18 years of age at the time of application. All members shall be residents of Iowa City. Applications must be received by 5:00 p.m., Wednesday, October 20, 2010. 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.icpov.orA. Questions about the Iowa City Youth Advisory Commission should be directed to Marian Karr, City Clerk at 356-5041. Spouses and relatives of City Council Members and members of comparable County Boards and certain 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: Council Announcement Date: September 7, 2010 Application Deadline: Wednesday, 5:00 p.m., October 20, 2010 Council Appointment Date: October 26, 2010 After 12/06/10 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. YOUTH ADVISORY COMMISSION Two Vacancies -Two-Year Terms January 1, 2011 -December 31, 2012 (Term expires for Luan Heywood, Zach Wahls) One (1) person -City High One (1) person -West High Gender Balance Requirement: 1 Female (F) No applications as of Wednesday, 5:00 p.m., October 20, 2010 D Denotes a completed application has been filed.