HomeMy WebLinkAbout2011-11-01 AppointmentNolan Klouda
309 Finkbine Ln. Apt. 9
Iowa City, IA 52246
October 19, 2011
Mayor Matt Hayek and City Council Members
City of Iowa City
410 E. Washington Street, Iowa City, IA 52240
Dear Mayor Hayek and City Council:
It is with regret that I tender my resignation from the Iowa City Telecommunications
Commission, effective Monday, October 24, 2011 following the monthly meeting
scheduled for that day.
I am grateful for having had the opportunity to serve on a commission in Iowa City for
the past 11 months, but I have accepted a job offer in another state. I have thoroughly
enjoyed working with the top -notch city staff as well as my fellow commissioners, and I
hope for their continuing success in service to this fine community.
Sincerely,
Nolan Klouda,
Commissioner
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L� 14a
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD:
AIRPORT ZONING BOARD OF ADJUSTMENT
One vacancy — Unexpired + 5 -yr Term
Effective Upon Appointment, ending December 31, 2011
The powers and duties of the Airport Zoning Board of Adjustment are:
1. To hear and decide appeals where it is alleged there is an error in any order, requirement,
decision, or determination made by an administrative official in the enforcement of the Airport
Zoning Chapter.
2. To hear and decide special exceptions to the terms of the Airport Zoning Chapter upon which
such board is required to pass under the Airport Zoning Chapter.
3. To authorize upon appeal in specific cases such variance from the terms of the Airport Zoning
Chapter as will not be contrary to the public interest, where owing to special conditions a literal
enforcement of the provisions of the Airport Zoning Chapter will result in unnecessary hardship,
and so that the spirit of the Airport Zoning Chapter shall be observed and substantial justice done.
Iowa City- appointed members of boards and commissions must be eligible electors of the City of
Iowa City. The Board meets at the call of the Chairperson.
Applications must be received by 5:00 p.m., Wednesday, October 26, 2011. The City Iowa City
encourages diversity in the appointment of citizens to boards and commissions. Persons interested in
being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application
forms are available from the Clerk's office upon request or on the City website at www.icgov.org.
Questions about the Johnson County /Iowa City Airport Zoning Board of Adjustment should be
directed to Michael Tharp, Airport Operations Specialist at 356 -5045.
Spouses and relatives of City Council Members and members of comparable County
Boards and Commissions are not eligible for appointment to City Boards and
Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in-
law, brother, sister, brother- in- law, sister- in- law, step- father, step- mother, step-
child, aunt, or uncle. (Resolution 85 -354)
Males: 1
Females: 1
Council Announcement Date: June 13, 2006; August 1, 2006; September 5, 2006;
September 19, 2006; November 14, 2006; December 12,
2006; January 9, 2007; February 20, 2007; March 20, 2007;
May 1, 2007; June 5, 2007; July 24, 2007; September 18,
2007; November 5, 2007; December 11, 2007; January 29,
2008; March 11, 2008; April 14, 2008; May 13, 2008; June
17, 2008; July 15, 2008; August 26, 2008; October 6, 2008;
November 18, 2008; January 6, 2009; February 24, 2009;
March 24, 2009; May 19, 2009; June 16, 2009; July 28,
2009; September 15, 2009; October 20, 2009; December 1,
2009; January 25, 2010; March 2, 2010; April 6, 2010; May
10, 2010; June 15, 2010; August 17, 2010 (Gender Balance
in Effect); September 21, 2010; November 16, 2010;
December 7, 2010; January 10, 2011; February 15, 2011;
March 22, 2011; May 3, 2011; June 7, 2011; August 2,
2011; September 6, 2011; October 4, 2011
Application Deadline: Wednesday, 5:00p.m., October 26, 2011
Council Appointment Date: November 1, 2011
After 11/15/10 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
AIRPORT ZONING BOARD OF ADJUSTMENT
One Vacancy - Unexpired + 5 -yr Term
Ending December 31, 2011
Carl Williams resigned
Gender Balance Requirement: None
No applications as of Wednesday, 5:00p.m., October 26, 2011
ODenotes applicant completed the Confidential page of the application.
Z14
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD:
AIRPORT ZONING BOARD OF ADJUSTMENT
One vacancy — Five -Year Term
January 1, 2009 - December 31, 2013
The powers and duties of the Airport Zoning Board of Adjustment are:
1. To hear and decide appeals where it is alleged there is an error in any order, requirement,
decision, or determination made by an administrative official in the enforcement of the Airport
Zoning Chapter.
2. To hear and decide special exceptions to the terms of the Airport Zoning Chapter upon which
such board is required to pass under the Airport Zoning Chapter.
3. To authorize upon appeal in specific cases such variance from the terms of the Airport Zoning
Chapter as will not be contrary to the public interest, where owing to special conditions a literal
enforcement of the provisions of the Airport Zoning Chapter will result in unnecessary hardship,
and so that the spirit of the Airport Zoning Chapter shall be observed and substantial justice done.
Iowa City- appointed members of boards and commissions must be eligible electors of the City of
Iowa City. The Board meets at the call of the Chairperson.
Applications must be received by 5:00 p.m., Wednesday, October 26, 2011. The City Iowa City
encourages diversity in the appointment of citizens to boards and commissions. Persons interested in
being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application
forms are available from the Clerk's office upon request or on the City website at www.icgov.org.
Questions about the Johnson County /Iowa City Airport Zoning Board of Adjustment should be
directed to Michael Tharp, Airport Operations Specialist at 356 -5045.
Spouses and relatives of City Council Members and members of comparable County
Boards and Commissions are not eligible for appointment to City Boards and
Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in-
law, brother, sister, brother- in- law, sister- in- law, step- father, step- mother, step - child,
aunt, or uncle. (Resolution 85 -354)
Males: 1
Females: 1
Council Announcement Date: September 23, 2008; November 3, 2008; December 16, 2008;
February 10, 2009; March 10, 2009; April 6, 2009; May 19,
2009; June 16, 2009; July 28, 2009; September 15, 2009;
October 20, 2009; December 1, 2009; January 25, 2010;
March 2, 2010; April 6, 2010; May 10, 2010; June 15, 2010;
August 17, 2010 (Gender Balance in Effect); September 21,
2010; November 16, 2010; December 7, 2010; January 10,
2011; February 15, 2011; March 22, 2011; May 3, 2011; June
7, 2011; August 2, 2011; September 6, 2011; October 4, 2011
Application Deadline: Wednesday, 5:OOp.m., October 26, 2011
Council Appointment Date: November 1, 2011
After 11/15/10 (3 mo from the announcement date) Council may appoint any qualified applicant
without regard to gender.
AIRPORT ZONING BOARD OF ADJUSTMENT
One Vacancy - Five -Year Term
January 1, 2009 - December 31, 2013
Term expires for Dennis Keitel
Gender Balance Requirement: None
No applications as of Wednesday, 5:OOp.m., October 26, 2011
❑X Denotes applicant completed the Confidential page of the application.
14c
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD:
AIRPORT ZONING COMMISSION
One vacancy — Six -Year Term
January 1, 2006 - December 31, 2011
Duties of the Airport Zoning Commission are:
1. To recommend amendments to the current Iowa City Airport Zoning regulations, including the
repeal thereof.
2. To recommend the adoption of new Airport Zoning regulations.
Iowa City- appointed members of boards and commissions must be eligible electors of the City of
Iowa City. The Board meets as required.
Applications must be received by 5:00 p.m., Wednesday, October 26, 2011. The City of Iowa City
encourages diversity in the appointment of citizens to boards and commissions. Persons interested in
being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application
forms are available from the Clerk's office upon request or on the City website at www.icgov.org.
Questions about the Iowa City Airport Zoning Commission should be directed to Michael Tharp,
Airport Operations Specialist at 356 -5045.
Spouses and relatives of City Council Members and members of comparable County
Boards and Commissions are not eligible for appointment to City Boards and
Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in-
law, brother, sister, brother- in- law, sister- in- law, step- father, step- mother, step-
child, aunt, or uncle. (Resolution 85 -354)
Males: 1
Females: 1
Council Announcement Date: September 20, 2005; November 1, 2005; December 13,
2005; January 23, 2006; February 28, 2006; March 21,
2006; April 18, 2006; June 13, 2006; August 1, 2006;
September 5, 2006; September 19, 2006; November 14,
2006; December 12, 2006; January 9, 2007; February 20,
2007; March 20, 2007; May 1, 2007; June 5, 2007; July 24,
2007; September 18, 2007; November 5, 2007; December
11, 2007; January 29, 2008; March 11, 2008; April 14, 2008;
May 13, 2008; June 17, 2008; July 15, 2008; August 26,
2008; October 6, 2008; November 18, 2008; January 6,
2009; February 24, 2009; March 24, 2009; May 19, 2009;
June 16, 2009; July 28, 2009; September 15, 2009; October
20, 2009; December 1, 2009; January 25, 2010; March 2,
2010; April 6, 2010; May 10, 2010; June 15, 2010; August
17, 2010 (Gender Balance in Effect); September 21, 2010;
November 16, 2010; December 7, 2010; January 10, 2011;
February 15, 2011; March 22, 2011; May 3, 2011; June 7,
2011; August 2, 2011; September 6, 2011; October 4, 2011
Application Deadline: Wednesday, 5:OOp.m., October 26, 2011
Council Appointment Date: November 1, 2011
After 11/15/10 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
AIRPORT ZONING COMMISSION
One Vacancy - Six -year Term
January 1, 2006 - December 31, 2011
Term expires for Mark Anderson
Gender Balance Requirement: None
No applications as of Wednesday, 5:OOp.m., October 26, 2011
El Denotes applicant completed the Confidential page of the application.
1aa
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD:
AIRPORT ZONING COMMISSION
One vacancy — Six -yr Term
January 1, 2010 - December 31, 2015
Duties of the Airport Zoning Commission are:
1. To recommend amendments to the current Iowa City Airport Zoning regulations, including the
repeal thereof.
2. To recommend the adoption of new Airport Zoning regulations.
Iowa City- appointed members of boards and commissions must be eligible electors of the City of
Iowa City. The Board meets as required.
Applications must be received by 5:00 p.m., Wednesday, October 26, 2011. The City of Iowa City
encourages diversity in the appointment of citizens to boards and commissions. Persons interested in
being considered should contact the City Clerk at City Hall, 410 E. Washington Street. Application
forms are available from the Clerk's office upon request or on the City website at www.icgov.org.
Questions about the Iowa City Airport Zoning Commission should be directed to Michael Tharp,
Airport Operations Specialist at 356 -5045.
Spouses and relatives of City Council Members and members of comparable County
Boards and Commissions are not eligible for appointment to City Boards and
Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in-
law, brother, sister, brother- in- law, sister- in- law, step- father, step- mother, step-
child, aunt, or uncle. (Resolution 85 -354)
Males: 1
Females: 1
Council Announcement Date: September 15, 2009; November 2, 2009; December 1,
2009; January 25, 2010; March 2, 2010; April 6, 2010; May
10, 2010June 15, 2010; August 17, 2010 (Gender Balance
in Effect); September 21, 2010; November 16, 2010;
December 7, 2010; January 10, 2011; February 15, 2011;
March 22, 2011, May 3, 2011; June 7, 2011; August 2,
2011; September 6, 2011; October 4, 2011
Application Deadline: Wednesday, 5:OOp.m., October 26, 2011
Council Appointment Date: November 1, 2011
After 11/15/10 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
AIRPORT ZONING COMMISSION
One Vacancy - Six -year Term
January 1, 2010 - December 31, 2015
Term expires for Brian Sponcil
Gender Balance Requirement: None
No applications as of Wednesday, 5:OOp.m., October 26, 2011
0 Denotes applicant completed the Confidential page of the application.
14e
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD:
BOARD OF ADJUSTMENT
One vacancy — 5 -Yr Term
January 1, 2012 — January 1, 2017
Duties: In appropriate cases and subject to appropriate conditions and safeguards, the Board
may make special exceptions to the terms of the Zoning Chapter in harmony with the general purpose and
intent of the ordinance and in accordance with general or specific rules contained therein. The Board may
grant variances to the Zoning Chapter only in the case of "unnecessary hardship." The hardship must be
substantial, serious, real, and of compelling force, as distinguished from reasons of convenience,
maximization of profit or caprice. The Board may also hear and decide appeals where it is alleged there is
an error in any order, requirement, decision, or determination made by a City official in the enforcement of
the Zoning Chapter.
Iowa City appointed members of boards and commissions must be eligible electors of the City of
Iowa City. The Board meets the second Wednesday of each month at 5:00 p.m.
Applications must be received by 5:00 p.m., Wednesday, October 26, 2011. 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 Commissions are not eligible for appointment to City Boards
and Commissions. This includes: spouse, child, mother, father, mother- in- law,
father- in- law, brother, sister, brother- in- law, sister- in- law, step- father, step-
mother, step - child, aunt, or uncle. (Resolution 85 -354)
Males: 2
Females: 2
Council Announcement Date: September 20, 2011
Application Deadline: Wednesday, 5:00 p.m., October 26, 2011
Council Appointment Date: November 1, 2011
After 12/19/2011 (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, 2012 - January 1, 2017
Term expires for Adam Plagge
Gender Balance Requirement: None
No applications as of Wednesday, 5:OOp.m., October 26, 2011
0 Denotes applicant completed the Confidential page of the application.
14f
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD:
BOARD OF APPEALS
One Vacancy— Five -Year Term
January 1, 2009 - December 31, 2013
One (1) Mechanical Professional
It is the duty of members of the Board of Appeals to hold appeal hearings on matters concerning the
International Building Code, International Residential Code, Uniform Plumbing Code, National Electric
Code, International Mechanical Code, International Fire 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 4:00 p.m. or at the call of the Building Official.
Applications must be received by 5:00 p.m., Wednesday, October 26, 2011. 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 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 23, 2008; November 3, 2008; December 16, 2008;
February 10, 2009; March 10, 2009; April 6, 2009; May 19,
2009; June 16, 2009; July 28, 2009; September 15, 2009;
October 20, 2009; December 1, 2009; January 25, 2010; March
2, 2010; April 6, 2010; May 10, 2010; June 15, 2010; August
17, 2010 (Gender Balance in Effect); September 21, 2010;
November 16, 2010; December 7, 2010; January 10, 2011;
February 15, 2011; March 22, 2011; May 3, 2011; June 7,
2011; August 2, 2011; September 6, 2011; October 4, 2011
Application Deadline: Wednesday, 5:00p.m., October 26, 2011
Council Appointment Date: November 1, 2011
After 11/15/10 (3 mo from the announcement date) Council may appoint any qualified applicant
without regard to gender.
BOARD OF APPEALS
One vacancy - Five -Year Term
(1) One Mechanical Professional
January 1, 2009 - December 31, 2013
Term expires for Tim Fehr (Mechanical Professional)
Gender Balance Requirement: None
No applications as of Wednesday, 5:00p. m., October 26, 2011
I] Denotes applicant completed the Confidential page of the application.
14g
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD:
BOARD OF APPEALS
One Vacancy— Unexpired Term
Effective Upon Appointment - December 31, 2014
One (1) Building Design Professional
It is the duty of members of the Board of Appeals to hold appeal hearings on matters concerning the
International Building Code, International Residential Code, Uniform Plumbing Code, National Electric
Code, International Mechanical Code, International Fire 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 4:00 p.m. or at the call of the Building Official.
Applications must be received by 5:00 p.m., Wednesday, October 26, 2011. 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: January 10, 2011; February 15, 2011; March 22, 2011;
May 3, 2011; June 7, 2011; August 2, 2011; September 6, 2011;
October 4, 2011
Application Deadline: Wednesday, 5:OOp.m., October 26, 2011
Council Appointment Date: November 1, 2011
After 04/10/11 (3 mo from the announcement date) Council may appoint any qualified applicant
without regard to gender.
BOARD OF APPEALS
One Vacancy - Unexpired Term
Building Design Professional
Effective Upon Appointment — December 31, 2014
(Unexpired term for Stephen Buckman)
Gender Balance Requirement: None
No applications as of Wednesday, 5:OOp.m., October 26, 2011
0 Denotes a completed application has been filed.
14h
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
HUMAN RIGHTS COMMISSION
Three Vacancies — 3 -Yr Terms
January 1, 2012 - January 1, 2015
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 26, 2011. 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
2011
/MPptinn Datel
NAME
TER
M
EXP.
1/18
2/15
3/15
4/12
5117
6/21
7/19
8/16
9/20
10/18
11/15
12120
Dianne Day
1/1/12
X
X
X
X
X
X
X
X
O/E
X
Wangui
Gathua
1/1/12
O/E
O/E
O/E
O/E
X
O/E
X
X
X
X
Martha
Lubaroff
1/1/12
O/E
O/E
X
X
X
X
X
O/E
X
O/E
Howard
Cowen
1/1/13
X
X
X
O/E
O/E
O/E
X
O/E
X
O/E
Constance
Goeb
1/1/13
X
X
X
O/E
X
O/E
X
X
X
X
Harry
Olmstead
(8 -1 -2010)
1/1/13
O/E
X
X
X
X
X
X
X
X
X
Orville
Townsend,
Sr.
1/1/14
X
X
X
X
X
X
X
X
X
X
Diane
Finnerty
1/1/14
X
X
X
X
O/E
X
X
X
X
X
David B.
Brown
1/1/14
X
X
X
O/E
O/E
O/E
X
O/E
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 Commissions are not eligible for appointment to City Boards
and Commissions. This includes: spouse, child, mother, father, mother- in- law,
father- in- law, brother, sister, brother- in- law, sister- in- law, step- father, step-
mother, step - child, aunt, or uncle. (Resolution 85 -354)
Males: 4
Females: 2
Council Announcement Date: September 20, 2011
Application Deadline: Wednesday, 5:00 p.m., October 26, 2011
Council Appointment Date: November 1, 2011
After 12/19/2011 (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, 2012 - January 1, 2015
Term expires for Wangui Gathua, Martha Lubaroff, Dianne Day
Gender Balance Requirement: 2 Female, 1 None
(F) Margaret M Putman 0
2590 Cascade Ln
(F) Judith Bryant rx-1
419 Elmridge Ave
(F) Megan Schwalm -Bell 0
914 Iowa Ave
(F) Shams Ghoneim 0
1104 Wylde Green Rd
(M) Henri Harper rx-1
701 Chestnut Ct
(F) Kim Hanrahan M
435 Grant St
(F) Anna Nelson 0
809 Weeber St
0 Denotes applicant completed the Confidential page of the application.
City of Iowa City = i
Advisory Board /Commission /Committee #� �L
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
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 Margaret M Putman HOME ADDRESS 2590 Cascade i n Iowa C it 452246
Is your home address (listed above) within the corporate limits of Iowa City? ❑Ye`sC --, No
How long have you been a resident of Iowa City? -1 yr + ors at UI Gender: a(0 � Fem��
OCCUPATION Director of Special Events & Leadership Prograi EMPLOYER IC Area Charilb rr of CommereeF
PHONE NUMBER: HOME 319 -491 -2247 BUSINESS
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITI®N: W
During my undergraduate year at the University of Iowa I studied Anthropology and International Studies with an
�mphasis in human rights advocacy. More importantly, I feel that human rights advocacy in our community is an
(extremely important issue and I am committed to upholding human rights.
.e.0 A•r 10 vn110 ooGCGAIT VMnwi Fnr;F nF THIS ADVISORY BOARD?
WWI 1A. .V . vv.. . ..ry v... .- •--- - - - - -- -- - - - -- - -- - -- - - -
1 admit that I do not know much about the Commission but have heard wonderful testimony to its activities and
presence in the community. I understand that the Commission works extensively with members in the community to
eliminate discrimination and aims to uphold equality in Iowa City. I would be honored to serve on this Commission.
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FOR APPLYING)?
I can offer a fresh perspective, valuable input and passion for the Human Rights Commission's goals. I am a 2010
graduate of the University of Iowa and am extremely proud of the Iowa City area. I feel that we are an open
community and would be honored to ensure that openness and equality are foremost qualities of this community. I
am energetic, willing to learn and a hard worker.
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest
I currently work for the Iowa City Area Chamber of Commerce. While this is not part of the city council, etc. I have
come into contact with various city leaders throughout my time here and want to let the Commission know this in
advance. It has no effect on my ability to serve as a balanced and subjective Commission member.
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 Q✓ 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
I
to answer all the questions, Council may not consider your application.
riuman Rights Commission Application
June 2010 Page 2 of 9
BOARD, COMMISSION, & COMMITTEES
BUSINESS LISTING
Name of City
Board /Commission /Committee Human Rights Commission
Name Margaret M. Putman
I r j
ui
®
1-0im wr ®���
CITY OF IOWA CITY
Date 10/14/2011
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
None
c.a
4 !'1
NOTE:
Signatur
Address
A new form must be completed if the above information changes or an ownership interest
is acquired in an additional business.
Misrepresentations on this application will constitute just cause for removal of an appointee.
If you fail to answer all the questions, Council 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.
2 Age
Female Gender
50 -60% Income (see table)
Heterosexual Sexual Orientation
= Other (Please explain below)
Raised Catholic, not practicing n Religion
None Disability
estern European
Race, color
or ethnic group
US
National origin
(uman Rights Commission Application - •�
June 2010 page 4 of 9
�r,
City of Iowa City r
Advisory Board /Commission /Committee.``''
3SMAM"M��
,3plication 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 ti b Term 60 12—
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
HOME ADDRESS 1 q
-;�
Is your home address (listed above)
within the corporate limits of Iowa City?
0
N=
How long have you been a resident of Iowa City?
Gende ale
F le
OCCUPATION --J
EMPLOYERG
t
PHONE NUMBER: HOME 31q°
G (o
BUSINESS
.
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
�.• �� 7 Gil Itic a - v �� � Q ` � u, c.o kd, ...
�a�, ,>m^ � r�2� -� /,.� �i.�/ J � f�ku��r.,
�� tB. Jl -Kw�d `�Z ii�WCIGCL.� L�{+� (4J �'��"`— �.`.�' {� � �) � J�G'�"'w
J Af i.n
1A►uA-r IL' v i io DDccCA1T VK1r1v11 nF THIS AnVISORY BOARD?
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLYINGI "e
S (-1, ,0 j c.,c , % u.a,e cQt ^u i 41 yu a^{ �v �-uir' -, c,-;, 2 9 ,( tt
lr
ca,,, l� r"
ak
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? FlYes ']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
June 2010 Page 2 of 9
BOARD, COMMISSION, & COMMITTEES
BUSINESS LISTING
Name of City
Board /Commission /Committee 911/VN O-on War. fl J!
Name
%; III.1.,,
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
C�sL
RJ
j
0
C rl
NOTE: A new form must be completed if the above information changes or an ownership interest
is acquired in an additional business.
Signature
Address 146 Cz J rV\ ' 1 a I C C- T Wa 0- A' Ll �
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
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
e- m Le Gender
'55-D I Income (see table)
Sexual Orientation
Other (Please explain below)
,,-2^ Disability
Race, color
or ethnic group
((� . National origin
C
r r C-) =
Human Rights Commission Application
June 2010 page 4 of 9
City of Iowa City _ I i I
Advisory Board /Commission /Committee; ~'''�
7pplication 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 2012 -2015
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 Megan Schwalm -Bell HOME ADDRESS 914 Iowa Ave, Iowa City, IA 52240
Is your home address (listed above) within the corporate limits of Iowa City? 7 Yes ❑ No
How long have you been a resident of Iowa City? 3 months Gender: Male F-1 Female
OCCUPATION Program Coordinator Iowa NEW Leadership EMPLOYER women's Resource and Action Center
PHONE NUMBER: HOME 319- 936 -8656 BUSINESS Rig - RSA, -14136
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
Extensive training on diversity /cultural competency issues. PhD (ABD) in Educational Policy and Leadership. I
parent transracially.
Vw1/1�w I1 rr1/'�r Ar TLIIC All \ /1 Qnov Of%A MM-?
VMAI !a TUUMrmr_JCIYI n114llVV1.GVVCVr I "ill /-lvvwvnI wr%iw: —J -
I am familiar with the board because of my work with the Women's Resource and Action Cut f at University of
--I c
Iowa.
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLYING)?
Dedication to the advancement of equality and justice. Strong organizational skills. Interested in being active in local
government.
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for Intormation regarding L;onTUCt OT interest
I have applied to be on the Johnson County Historical Preservation Commission.
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ✓0 Yes F—] No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? FYes W] 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 Iowa City Human Rights Commission
Name Megan Schwalm -Bell
Ask
CITY OF IOWA CITY
Date 10/17/2011
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
Indigo Body Art Gallery
2419 2nd Street, Unit #H, Coralville, IA 52241
r.�
e,
NOTE: A new form must be completed if the above information changes or an ownership interest
is acquired in an additional business.
Signature
Address 914 Iowa Ave, #1, Iowa City, IA 52240
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.
.-lman 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)
nPTlnluw -
PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN
CHOOSING AN APPLICANT.
F31 Age
I Female Gender
Median Income (see table)
Heterosexual Sexual Orientation
Other (Please explain below)
'Auman Rights Commission Application
_une 2010 page 4 of 9
Religion
none Disability
White Race, color
or ethnic group
US National origin
CD
`< „k�l • 9
i....7,' -� x�
City of Iowa City ' r
Aw
Advisory oard /Commission /Committee
ry ,,,�, ®,�';t
Application Form
CITY OF IOWA CITY
THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLI,
WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED
FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY jVACANCY DURING THAT TIME.
Advisory Board /Commission /Committee Name T�- �vr �k (2w1wL)25-t- ,._Term 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 Shams M. Ghoneim HOME ADDRESS 11 o4 WY DF GREEN RD.
Is your home address (listed above) within the corporate limits of Iowa City? 0 Yes n No
How long have you been a resident of Iowa City? 49 Years Gender: Male n Female n
OCCUPATION Qetvreci u.1. Rcaccarch Staff EMPLOYER Universes of Iowa
PHONE NUMBER: HOME 319-351-5045 BUSINESS N
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
I am and have been an active community member on behalf of minorities locally and nationally. I currently serve on
the ACLU -IA Board of Directors, Member & former President of the JH Consultation of Religious
Cc junities(CRC),member and former Chair /Co -Chair of the UI Council on Disability Awareness(CDA), former Co-
cha.. of HARRT of Iowa City, current EXC. member of the IC Mosque /AI Eman Islamic center,serve as a community
member of the ICPC editorial board,Coordinator& Chair of the Iowa Chapter of the Muslim Public Affairs Council
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
My very first exposure to the Advisory Board was many years ago when one of our children at age 16 was treated and
paid differently than her colleauges at a local IC business. We submitted the case to the IC Human R. Commission
and after their investigation, it was determined that there was just cause. That experience and many others have
demonstrated to me that we need such organization to be the voice of the voiceless.
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)?
I have been for many years now indirectly approached to run for this most important position but for many reasons, I
was unable to make this committment. This year I have decided in view of so many real and or pe cieved
racial, ethnic,sexual, religious etc. concerns shared by a wide range of Iowa Citians, that I should ntribute,to these
discussions and concerns facing our beloved community.
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding ConfiieC'bf Indierest ; --,
None
l .C!
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 R]No
(It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.)
4isrepresentations 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.
Human Rights Commission Application
June 2010 Page 2 of 9
BOARD, COMMISSION, & COMMITTEES
BUSINESS LISTING
Name of City
Board /Commission /Committee Human Rights Commission A 00 (2___
Name Shams M. Ghoneim
�1 III t ",
CITY OF IOWA CITY
Date October 24,2011
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
It
NOTE: A new form must be completed if the above information changes or an ownership interest
is acquired in an additional business.
Signature
Address 1104 WYLDE GREEN RD.IOWA CITY,IA,52246
^Misrepresentations on this application will constitute just cause for removal of an appointee.
_. you fail to answer all the questions, Council may not consider your application.
Human Rights Commission Application
_ li ina 7(11 n Pana R of R
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
_3
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)
13TIONAL:
PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN
CHOOSING AN APPLICANT.
Age 65
Gender
-Fe-� le-
Income (see table)
100 7 .
Sexual Orientation
Other (Please explain below)
Human Rights Commission Application
June 2010 page 4 of 9
AVL' l Religion
Disability
Race, color
or ethnic group
National origin
li
City of Iowa City _ r 1
Advisory Board /Commission /Committee
Application Form ,Oft -
CITY OF IOWA CITY
THIa 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 Commision Term Jan -12 -Jan 15
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 Henri Harper HOME ADDRESS 701 Chestnut Ct Iowa City la 52240
Is your home address (listed above) within the corporate limits of Iowa City? 0 Yes F1 No
How long have you been a resident of Iowa City? 12 years Gender: Male 0 Female
OCCUPATION myEp Yip & FastTrac Director EMPLOYER MYEP Mayors Youth Empowei
PHONE NUMBER: HOME319 936 -6611 BUSINESS Youth Programs
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
Director and Founder of FasTrac Cultural and Diversity Awareness Program for Youth; Juvenile Court Liaison for the
ICCSD for 12 years; giving families the understanding of how human and civil rights contribute to their continued
gr( ) and progress through originating annual civil rights tours across the US, as well as frequgrr t opportunities for
you,., to learn and contribute to their local community and gain self confidence in their own abilit change and help
others. `T_ "` ra
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
The board's goal is to advocate and educate the community in the area of civil and huma!:bZotsJgcall d
nationally.
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPryING)?
(see attatched for full document) I hope to bring more focused attention to issues in human rights -Io individuals and
the community. I also hope to personally become more aware of issues we currently face in human and civil rights. I
hope to gain more of an understanding through seeing and hearing individuals with different opinions than myself, and
to be a part of that discussion and solution. Regarding the youth and families who I work with, I feel it would be
extremely helpful to have the insight from the advisory board when working with them. I would greatly value having
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest
Key -Daw lawncare business, Mayor's Youth Empowerment Program.
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? t/0 Yes [:] No
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
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 Commission
Name Henri
� r j
• T4
CITY CITY OF IOWA CITY
Date 10/21/11
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
Key -Daw Lawncare
701 Chestnut Court, Iowa City IA 52240
fT i 3 ��
- co
NOTE: A new form must be completed if the above information changes or an ownership interest
is acquired in an additional business.
Signature
Address 701 Chestnut Court, Iowa City IA 52240
114isrepresentations on this application will constitute just cause for removal of an appointee.
.. you fail to answer all the questions, Council may not consider your application.
Human Rights Commission Application
L me 7n1 n pnno q of R
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 T
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)
aTlnlvnl
PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN
CHOOSING AN APPLICANT.
Age
Gender
Income (see table)
Sexual Orientation
Other (Please explain below)
Human Rights Commission Application
June 2010 page 4 of 9
\-) `<
Religion
Disability
Race, color
or ethnic group
ZLf� CK
National origin
FV
C.I7
e
r -� A
�a
What contributions can you make to the Advisory Board?
I hope to bring more focused attention to issues in human rights to individuals and
the community. I also hope to personally become more aware of issues we
currently face in human and civil rights. I hope to gain more of an understanding
through seeing and hearing individuals with different opinions than myself, and to
be a part of that discussion and solution. Regarding the youth and families who I
work with, I feel it would be extremely helpful to have the insight from the advisory
board when working with them. I would greatly value having input in the process
and also being a part of helping others change their outlook on how these issues
effect everyone involved. My goal has always been to model the behavior that I
expect from the youth who I work with. For me it is extremely important to be a part
of the solution in educating and advocating for others. My comment to the students
and families who I work with applies here: "to be a part of change, you need to be
open to change yourself in order to change the perception of others."
L� 'MY 1 V Ii
City of Iowa City
Advisory Board /Commission /Committee
,pplication 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 1/1/2012- 12/31,
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 Kim Hanrahan HOME ADDRESS 435 Graol Street
Is your home address (listed above) within the corporate limits of Iowa City? F&/1 Yes ❑ No
How long have you been a resident of Iowa City? 53 years Gender: Male ❑ Female 0
OCCUPATION social worker MSS I MSW EMPLOYER United Action for Youth
PHONE NUMBER: HOME 319.530.8145 BUSINESS
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
�e Attached
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)?
See Attached
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? L'J Yes U No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? E] 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
June 2010 Page 2 of 9
r`Z
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)?
See Attached
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? L'J Yes U No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? E] 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
June 2010 Page 2 of 9
City of Iowa City
Advisory Board /Commission
Application Form
Experience and /or activities which you feel qualify you for this position:
I was born and raised in Iowa City and decided to stay and raise my family here. I have
spent my entire professional career working in and around Iowa City. I am a licensed
Master Social Worker and have worked at a variety of social service agencies including,
The Neighborhood Centers of Johnson County, the Iowa City Community School
District, the Johnson County Public Health Department (in the WIC /Child Health Clinics)
and am currently employed at United Action for Youth. I have also volunteered at DVIP,
RVAP, the Crisis Center, the Free Lunch Program and the International Women's Club. I
have worked with diverse populations and have an understanding of the barriers and
challenges they must contend with on a regular basis. My concentrated areas of study
when I was in graduate school were issues in Cultural Competency and Diversity which
means I was and am dedicated to issues of equality and fairness and how best to work
with diverse populations.
What is your present knowledge of this advisory board?
I have read and understand the general duties of the commission; beyond this I know the
advisory board also is responsible for discrimination complaints, fair housing, harassment
complaints and immigration issues.
What contributions can you make to this advisory board?
I have a lot of experience working with people from diverse backgrounds and firsthand
knowledge of challenges people face when they move to Iowa City. I have always been
interested in social justice issues and have dedicated my life to working toward
eliminating barriers for social equality. I have developed strong, positive relationships
with many agencies and organizations throughout this community and know these
connections can be very beneficial as difficult issues arise. I am an effective
communicator and team member and I believe that I could contribute greatly to the
Human Rights Commission.
N
C�
`•_•
'max
-"'�
..wemis
4m '"' �.
Ali
.ve+"'1
Cif
�•�ur
f%
BOARD, COMMISSION, & COMMITTEES
BUSINESS LISTING
Name of City
Board /Commission /Committee Human Rights Commission
Name Kim Hanrahan
���. ®rte
k "m40
CITY OF IOWA CITY
Date 10/20/2011
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
None
r.a
C)1
1
i
CJ
NOTE: A new form must be completed if the above information changes or an ownership interest
is acquirgd in an additional business.
Signature
Address 435 Grant St.
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
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
677250
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
j 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)
nDT1nn1ei
PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN
CHOOSING AN APPLICANT.
53 Age
Female Gender
Income (see table)
Sexual Orientation
F-1 Other (Please explain below)
None Religion
None Disability
Race, color
or ethnic group
National origin
Duman Rights Commission Application = '
June 2010 page 4 of 9 "
CD
Duman Rights Commission Application = '
June 2010 page 4 of 9 "
City of Iowa City i i i
Advisory Board /Commission /Committee,.+
.pplication 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 ONLYAND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME.
Advisory Board/Commission /Committee Name Human Rights Commission Term 111/12- 1!1115
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 Anna Nelson HOME ADDRESS 809 Wephpr Strep
is your home address (listed above) within the corporate limits of Iowa City? 0 Yes F] No
How long have you been a resident of Iowa City? 1978 - 1996.2008 -present Gender: Male ❑ Female z
OCCUPATION homemaker EMPLOYER NA
PHONE NUMBER: HOME 319 - 535 -0226 (dial area code) BUSINESS NA
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
Public service: Studied politics and women's studies at Michigan State, government at Harvard, and law at Yale. Worked at the White House.
)rked in the Department of Justice, in the Violence Against Women Office. Social justice: Volunteer at Shelter House. Taught health classes to
risk populations in IC. Created music & art therapy programs at IC agencies for chronically ill. Evaluated psychosocial rehabilitation facilities
Ifor state of Michigan. Worked as rape crisis advocate. Assistant-taught remedial HS English in IC. Nonprofit management: Cofounded Ms. JD,
a national network for women in law; served as Vice President & Vice Chair of the Board. Coordinated service - teaming events & legislative
uiuAr lL- vn11n 0oCCCk1T 1[IVAWI 1=nliF nF THIS ADVISORY BOARD?
My understanding is that the Commission works with the Human Rights Division on an annual awards breakfast
and banquet (one for youth contributions to HR), and occasionally coordinates other programming with area
agencies (when the event and its sponsors accord with the Commission's mission). The Commission meets publicly
at least once a month.
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)?
I was bom and raised in Iowa City. I've been back about three years, settled In with time to give. Condensed to a paragraph, the background I bring
to the Commission might seem a bit "kitchen sink." Here are common threads: I studied government and law as a tool to make life better — because
I care about people. I've worked for women's rights since I was 18; since my 20s I've also worked with and for populations challenged by mental
illness. I am a woman with a disability living below the poverty line who has been lucky enough to get a world -class education and some great
opportunities. I can represent some parts of Iowa City that too often don't get a voice. But my contribution Isn't a demographic; Its passion and
talent for human rahts work however modest
UST 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 Nct]
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes [Z]No
(It has been Council policy not to permit an individual to serve on two Boards or Commissiop} at th "ame°ti e.}
Misrepresentations on this application will constitute just cause for removal of ar bppoi�e. If�u 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 /Commission /Committee Human Rights Commission
Name Anna Nelson
CITY OF 10WA CITY
Date 10/2412014
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
None.
N
N
NOTE: A new form must be completed if the above information changes or an ownership interest
is acquired in an additional business.
Signature
Address 809 Weeber Street, 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.
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
1 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.
33 Age
F Gender
below poverty line Income (see table)
Sexual Orientation
Other (Please explain below)
Religion
disabled Disability
Race, color
or ethnic group
National origin
�a
'luman Rights Commission Application
a �✓
June 2010 page - --
na
-F-
'luman Rights Commission Application
a �✓
June 2010 page - --
na
14i
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
PARKS AND RECREATION COMMISSION
One Vacancy — 4 -yr Term
January 1, 2012 — January 1, 2016
The duties of the members of the Parks and Recreation Commission are to recommend and review
policies, rules, regulations, ordinances, and budgets relating to parks, playgrounds, recreation centers,
and cultural functions of the City and make such reports to the City Council as the Commission deems in
the public interest; to exercise broad responsibility for the development of parks, recreation centers,
playgrounds, and cultural facilities to serve the City -- including the creation and appointment of advisory
groups to make studies.
Iowa City- appointed members of boards and commissions must be eligible electors of the City of Iowa
City. The Parks and Recreation Commission meets the second Wednesday of each month at 5:00 p.m.
Applications must be received by 5:00 p.m., Wednesday, October 26, 2011. 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
October 12, 2011
Page 3 of 3
PARKS AND RECREATION COMMISSION
ATTENDANCE RECORD
YEAR 2011
NAME
N
CD
�.�
r.
o
eo
o
v
CM
m
TERM
N
M
1l1
00
N
EXPIRES
David
1/1/15
O/E
O/E
X
X
X
X
LQ
X
X
X
Bourgeois
Clay
1/1/14
X
X
X
X
X
X
LQ
X
X
X
Claussen
Lorin
1/1/13
X
X
O/E
X
X
Ditzler
Maggie
1/1/13
X
O/E
X
X
X
X
LQ
X
X
O/E
Elliott
Allison
1/1/13
X
X
X
Gnade
Aaron
1/1/13
O/E
O/E
X
O/E
X
X
LQ
O/E
X
X
Krohmer
Lucie
1/1/15
X
X
X
X
O/E
X
LQ
X
X
O/E
Laurian
Margaret
1/1/12
O/E
X
X
X
X
X
LQ
X
O/E
O/E
Loomer
Jerry Raaz
1/1/12
X
X
O/E
O/E
X
O/E
LQ
John
1/1/14
X
X
X
X
X
X
LQ
X
X
X
Westefeld
Joe
1/1/16
X
Younker
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 Commissions are not eligible for appointment to City Boards
and Commissions. This includes: spouse, child, mother, father, mother- in- law,
father- in- law, brother, sister, brother- in- law, sister- in- law, step- father, step-
mother, step - child, aunt, or uncle. (Resolution 85 -354)
Males: 5
Females: 3
Council Announcement Date: September 20, 2011
Application Deadline: Wednesday, 5:00 p.m., October 26, 2011
Council Appointment Date: November 1, 2011
After 12/19/2011 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
PARKS AND RECREATION COMMISSION
One Vacancy - 4 -yr Term
January 1, 2012 — January 1, 2016
Term expires for Margaret Loomer
Gender Balance Requirement: 1 Female
(F) Joye Ashton McKusick 0
805 Normandy Dr
(M) Michael Healy 0
430 Hawaii Court
(F) Cara Hamann 0
5131/22nd Ave
(M) Jeffrey Martin 0
1015 Barrington Rd
(M) John Thomas 0
509 Brown Street
0 Denotes applicant completed the Confidential page of the application.
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 4R k5 + he C r 2 *- i't b n Term frr,_
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 I., /� fon IitS r c.k HOME ADDRESS �' D M"orrn� rn�,� , —
Is your home address (listed above) within the corporate limits of Iowa City? 0 Yes 1-1 No
How long have you been a resident of Iowa City? °% i' yr.5� Gender: Male Female
OCCUPATION reA of . % e-( EMPLOYER
PHONE NUMBER: HOME 17 1/ (o BUSINESS
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSIT �-
�k' ry
�W I !ice � I` cG i'T�r' �h PL �4'R��s� v G i
, i� w .�• � N . m y cay- ge. 4.. C T \ V P \[4f tO r,& ., .4 v •t d �b i e efr �' •zz
WHAT iS Yn1 iR PRFSFNT KNOWLEDGE OF THIS ADVISORY BOARD? c,
..w is Q, S ► ` 5 $�� � V � �a �S t-cr 1 �.� +�; , �` o i � E'.�
'f 5 -f Iced d e v'4 1 o p,-- m r- n " c A` �ec : - if i r
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FOR APPLYING)?
1 Y7 0-1 V -l\i c%
e
en l i tr & C or W, rn ct-Yz
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? 0 Yes "No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes F—]No
(It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.)
Ml 11M mm"MR-MM11-
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.
Ueneral Application
June 2010 Page 2 of 8
BOARD, COMMISSION AND COMMITTEES
BUSINESS LISTING
Name of City �� ��
Board /Commission /Committee
Name
.,
�� - 4
t lll��
CITY OF IOWA CITY
Date —a 7-1f
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
m
r..
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/gua dia
Address
outh Advisory Commission only):
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 3 of 8
City of Iowa City r i
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 Parks and Recreation Commission Term Ending 1/1/14
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 Healy HOME ADDRESS 43o Hawaii Court Iowa (may, Iowa
Is your home address (listed above) within the corporate limits of Iowa City? REPS 0_ , Fo
How long have you been a resident of Iowa City? 1year and 1 month Genpq!�MWe male F]
OCCUPATION Residency Coordinator EMPLOYER Uniyeri f I oa r�
PHONE NUMBER: HOME (518)301 -0702 BUSINESS �
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION'
The three activities, which I believe provide me with the experience to serve on this commission, were my time
we ig in the New York State Assembly, the office of the president at the University at Albany and at the department
of i- .idential life at the University at Albany. These positions have provided me with a combination of experiences in
committee work, administrative review of budgets, rules and policies, as well as developing culturally specific
programming.
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
Of most importance, this commission is responsible for oversight over the policies, regulations and rules regarding the
parks and recreational centers as well as developing new partnerships and incentives, while keeping cultural
inclusion, effectiveness and the public good in mind. This can be seen through the public discussion on behalf of the
Iowa Coalition of Off -Road Riders regarding the request to build a mountain bike trail within a park in the Iowa City
limits and the necessary review, discussion and decision making process that follows.
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLYING)?
I have been involved in state politics and have seen the direct impact that involved and passionate individuals have
made upon the community in which they live in. With this in mind I believe that I can bring my experience, provide a
fresh prospective, and bring a desire to serve the citizens of Iowa City. I have lived in Iowa City for a little over a year
now and have been able to develop a sense of community through many activities and events including the parks,
playgrounds, recreational centers and I want to help provide beneficial oversight and guidance for the future.
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest
N/A
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ✓0 Yes ❑ No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? FlYes ❑✓ 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 Parks and Recreation Commission
Name Michael Healy
�'► Z t&�iiL
CITY OF IOWA CITY
Date 6/27/2011
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
/A
N/A
iff
NOTE: A new form must be completed if the above information changes or an ownership interest is
acquired in an additional busigess.
Applicant Signature
Signature of parent/guardian (Youth Advisory
Address 430 Hawaii Court, Iowa City, Iowa
ission only):
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
t City of Iowa City 1
Advisory ard /Commission /Committee' `� "`""`'
i"y 'wrm"v�i
)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 Parks and Recreation Commission Term Present - 1/1/14
Youth Advisory Commission (shall not be more than 18 years of age at the time of c-Wlication)
Name of Iowa City High School or high school equivalent: ° r
Signature of parent /guardian:
NAME Cara Hamann HOME ADDRESS 513 1/2 2nd Ave a y lA+ _
Is your home address (listed above) within the corporate limits of Iowa City?
How long have you been a resident of Iowa City? 3 years Gender: Mal Female 0
OCCUPATION Research Assistant and Graduate Student EMPLOYER University of Iowa
PHONE NUMBER: HOME 319 - 594 -5770 BUSINESS jig -saa -5770
�VMCMICKU-C: AwmrnO A(- TIVITIFfi w141rH Yn1I FEEL QUALIFY YOU FOR THIS POSITION:
F -r the past several years I have led a grassroots effort to both promote bicycle riding and racing and to increase
I lumber of women bicyclists in the greater Iowa City area. In this role I continually make recommendations and
implement efforts to further the initiative. I also have over 8 years experience analyzing and evaluating data and
programs as part of my research and continuing work as a graduate student.
..ILJ AT 10 vni 10 oo =eGk1T 1CMnW1 Fnr.F nF THIS ADVISORY BOARD?
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FOR APPLYING -e
I am applying to this board for several reasons: 1) to represent females in the area 2) to represent all types of
outdoor sport and recreation enthusiasts, with emphasis on areas that I have perspective -- bicycling, running, hiking,
swimming, farmer's market, and trails 3) to contribute to the maintenance and long -term development of the park and
recreation experience in the area at both micro and macro levels.
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 F✓ 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
,o 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 Parks and Recreation Commission
Name Cara Hamann
CITY OF IOWA CITY
Date 06/28/2011
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
c.
oJ
4.
N
CD
NOTE: A new form must be completed if the above information changes or an ownership interest is
acquired in an additional business. �,7 Ap plicant Signature ("
Signature of parent /guardian (Youth Advisory Commission only):
Address 513 1/2 2nd Ave, 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.
General Application
June 2010 Page 3 of 8
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 Parks & Recreation Commission Term 1
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:
i
NAME Jeffrey G. Martin HOME ADDRESS 1015 Barrington Road
Is your home address (listed above) within the corporate limits of Iowa City? W Yes � No
How long have you been a resident of Iowa City? since 1991 Gender: Male R1 Female
OCCUPATION Contracts Administrator EMPLOYER University of Iowa
PHONE NUMBER: HOME 319-351-3331 BUSINESS
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' 93 Board of Directors, Montessori School of Iowa City
20u - -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?
A friend - John Westefeld - currently serves on the board, and another friend - Craig Gustaveson - formerly served.
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 FOR APPLYING)?
I have extensive experience on boards and commissions and have developed a clear understancMg of the role of the
governance function vis a vis management. I have strong written and oral communication - skills, g5bd meeting
facilitation abilities, and extensive experience with strategic planning. I would welcome thncgto cute to the
continued development of a robust and diverse parks and recreation system that enhances e cL@ure oft a city.
c� g
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding ConfiQ;f Interest,
None
w
co
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ❑✓ Yes No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? nYes ❑✓ No
(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;pnP.ral Annlir:atinn
BOARD, COMMISSION AND COMMITTEES
BUSINESS LISTING
Name of City
Board /Commission /Committee Parks & Recreation Commission
Name Jeffrey G. Martin
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 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
--.{ c-)
r--
• u
l�
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/guard
Address 1015 Barrington Road
sory Commission only):
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.
(;PnPm1 Annlirafinn
Marian Karr
From: John Westefeld <jestefeld @mchsi.com>
Sent: Wednesday, September 14, 2011 10:46 PM
fo: Council
Subject: Jeff Martin- -Parks and Recreation Commission
This correspondence will become a public record.) am writing to support Jeff Martin, who is interested in joining the
Parks and Recreation Commission and committed to the kinds of issues dealt with by the Commission. Jeff has applied
previously for the Commission, and I know he is very interested. I know Jeff well. He has an extensive background in
fundraising, and I think he would be an excellent Commission member.
Thanks for your consideration.
John Westefeld, current member and former chair, Parks and Recreation Commission
City of Iowa City
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 PUBLI,
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 Term Exp. 1/1/16
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 John Thomas HOME ADDRESS 509 Brown Street, Iowa Culy IA 52245
Is your home address (listed above) within the corporate limits of Iowa City? 0 Yes F] No
How long have you been a resident of Iowa City? One year and ten months Gender: Male R1 Female F
OCCUPATION Landscape Architect EMPLOYER Retired
PHONE NUMBER: HOME 319- 338 -1841 BUSINESS NA
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
In the 1970's, I was employed as a gardener with the County of Marin (California) for over 3 1/2 years and received a
certV2 -ate in landscape maintenance. From 1986 -2009, 1 was employed as a landscape architect with the City of San
Frai. co. My work included the design of new parks, as well as park renovations. The park planning process
included community meetings to identify program needs, and public agency reviews for code compliance,
conformance with maintenance standards, and design approval by a peer group of design profes*nals.
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? E; -
My present knowledge consists of reading the minutes from previous meetings. (z e`
>_ -v
-ca i
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR PPLYJNG)`
Parks and recreation are one of the foundations of a community's commonwealth. During °thy career des@nmg public
parks and open spaces in San Francisco, I became keenly aware of the opportunities and challefes currently facing
parks and recreation agencies. As an Iowa City resident, I would like to contribute my experience to the management
and development of its park facilities.
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? ✓V Yes [_� No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes ZNo
(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
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 John Thomas
Parks & Recreation
CITY OF IOWA CITY
Date 9/6/2011
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
NONE
p
CA
Fla
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/9
ian (Youth Advisory Commission only):
Address 509 Brown Street, Iowa City IA 52245
Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail
+ -inswer all the questions, Council may not consider your application.
General Application
June 2010 Page 3 of 8
14j
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMITTEE:
PUBLIC ART ADVISORY COMMITTEE
Two Vacancies — 3 -Yr Terms
January 1, 2012 — January 1, 2015
Duties of the Public Art Advisory Committee include developing by -laws and procedures for the Iowa
City Public Art Program; administering the Public Art Program by determining the placement of public art,
the type of art to be used in a specific project, and the artist to be engaged; overseeing the acceptance of
gifts of art; overseeing the maintenance and disposition of public art; and overseeing expenditures of the
Public Art Program budget.
Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa
City. The Public Art Advisory Committee meets the first Thursday of each month at 3:30 p.m.
Applications must be received by 5:00 p.m., Wednesday, October 26, 2011. 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 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 20, 2011
Application Deadline: Wednesday, 5:00 p.m., October 26, 2011
Council Appointment Date: November 1, 2011
After 12/19/2011 (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, 2012 - January 1, 2015
Term expires for Patrick Carney, DaLayne Williamson
Gender Balance Requirement: 1 Male, 1 None
No applications as of Wednesday, 5:OOp.m., October 26, 2011
ODenotes applicant completed the Confidential page of the application.
14k
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
SENIOR CENTER COMMISSION
Two Vacancies — 3 -Yr Terms
January 1, 2012 - December 31, 2014
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 26, 2011. 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 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:
Council Announcement Date: September 20, 2011
Application Deadline: Wednesday, 5:00p.m., October 26, 2011
Council Appointment Date: November 1, 2011
After 12/19/2011 (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, 2012 - December 31, 2014
Term expires for Rosamond Hanson, Mercedes Bern -Klug
Gender Balance Requirement: 2 Females
No applications as of Wednesday, 5:00p.m., October 26, 2011
0 Denotes applicant completed the Confidential page of the application.
141
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
YOUTH ADVISORY COMMISSION
Three Vacancies — 2 -Yr Terms
January 1, 2012 - December 31, 2013
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 26, 2011. 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 Youth Advisory Commission should be directed to Marian Karr, City
Clerk at 356 -5041.
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Spouses and relatives of City Council Members and members of comparable County
Boards and Commissions are not eligible for appointment to City Boards and
Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in-
law, brother, sister, brother- in- law, sister- in- law, step- father, step- mother, step-
child, aunt, or uncle. (Resolution 85 -354)
Males: 2
Females:
Council Announcement Date: September 20, 2011
Application Deadline: Wednesday, 5:OOp.m., October 26, 2011
Council Appointment Date: November 1, 2011
(Recommendations to be made by Council liaison)
After 12/19/11 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
YOUTH ADVISORY COMMISSION
Three Vacancies — Two Year Term
January 1, 2012 — December 31, 2013
Term expires for Jerry Gao, Alexandra Tamerius, Caroline Van Voorhis
Gender Balance Requirement: 1 Female, 2 None
(F) Katherine Rapp M
4314 Cumberland Ln
121 Denotes applicant completed the Confidential page of the application.
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 Youth Advisory Commission Term to fill vacancy
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: Qg�q;'1N H:Gr J _r,_ -
Signature of parent/guardian: ' -? { � _I?f� 4✓c
NAME Katherine Rang HOME ADDRESS 4314 Cumberland Lane. Iowa City 52245
Is your home address (listed above) within the corporate limits of Iowa City? 0 Yes F] No
How long have you been a resident of Iowa City? 4 years Gender: Male 1:1 Female 0
OCCUPATION stutient EMPLOYER N/A
PHONE NUMBER: HOME (319)354 - 4022 BUSINESS NSA
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
I am president of the junior class at Regina. I was one of 200 sophomores in Iowa selected to attend Iowa HOBY, a
service -based leadership conference. At HOBY, I was one of two students selected to attend the World Leadership
,nference (400 students attend from several countries). I was selected for CYLP, a youth service program for IC.
1w1u w9. 1C %/^tin poccCA1T iekintnn Gnr-_F r'1F TIdIS AnVISARY R(]ARD?
YV"P%1 1%7 1 VV1\ ■%W V W -. _ _ _. _ -_ __ __ _
The Youth Advisory Commission is a way for youth to be involved in the Iowa City community. Young leaders are
given the opportunity to be a part of important issues, discussions, and decisions in Iowa City. The Youth Advisory
Commision is essential in representing the youth of Iowa City.
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)?
I believe I am a great leader. After attending HOBY, I am especially motivated to be very involved in my community.
I aspire to make a difference and to be a part of making changes in Iowa City. The opportunity to represent the youth'
of Iowa City would be a great honor. Using leadership and service to be involved in the community is my goal.
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 [Z]No
(It has been Council policy not to permit an individual to serve on two Boards or Commissiorat the-same time.)
Misrepresentations on this application will constitute just cause for removal of a" poirTee. If4.0 fail
to answer all the questions, Council may not consider your application. 4C- - '-
neral Application o' ZZ a e it
June 2010 Page 2 of 8 C1.)
C.
N
�Qi� ®fit
BOARD, COMMISSION AND COMMITTEES �InN
BUSINESS LISTING
CITY OF IOWA CITY
Name of City
Board /Commission /Committee Youth Advisory Commission Date 07/10/2011
Name Katherine Rapp
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.
NOTE: A new form must be completed if the above information changes or an ownership interest is
acquired in an additional business.
Applicant Signature Kc ? �-N
Signature of parent/guardian (Youth Advisory Commission only): tL-
Address 4314 Cumberland Lane, Iowa City 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.
neral Application
June 2010 Page 3 of 8
Marian Karr
From: Marian Karr
nt: Monday, July 11, 2011 5:00 PM
'Colleen Rapp'; Council
Subject: RE: Youth Advisory Commission
Thank you for your letter. A copy will be provided to the City Council with your application.
Marian Karr, IVIMC
City Clerk
From: Colleen Rapp [mailto:colleenrapp @msn.com]
Sent: Monday, July 11, 20114:54 PM
To: Council
Cc: Marian Karr
Subject: Youth Advisory Commission
City Council Members -
My name is Katherine Rapp and I am a junior at Regina High School. The purpose of this email is to let you
know that I have applied for a position on the Youth Advisory Commission. I think I am well qualified for this
role. I am the junior class president at my high school. In my role as class president, I have so far been in
charge of fundraising efforts including planning and running high school baseball concessions. My additional
responsibilities will include planning prom 2012 and fundraising for senior trip.
. addition, I was selected to represent my school at Iowa HOBY (Hugh O'Brien Youth Leadership
Conference). Two hundred juniors -to -be from the state of Iowa attended this service -based leadership
conference last month. At this conference, I leaned how to be a confident, enthusiastic, and passionate
leader. I also learned the importance of being involved in my community. At Iowa HOBY, I was one of two
students selected to go to the World Leadership Congress later this month. This week long leadership
conference will include 400 student leaders from across the United States and several other countries.
I have been selected for CYLP (Community Youth Leadership Program), a leadership program in Iowa City that
is based on learning about and providing service to our community.
I hope to have the opportunity to contribute to the Youth Advisory Commission. I am eager to become even
more involved in the community. I think I would be a very beneficial addition to the commission.
Thank you for your time!
Sincerely,
Katherine Rapp
14m
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
YOUTH ADVISORY COMMISSION
One Vacancy - Two -Year Term
January 1, 2011 - December 31, 2012
One (1) person — Tate High
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 26, 2011. 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 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 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: October 26, 2010; December 7, 2010; January 10, 2011;
February 15, 2011; March 22, 2011; May 3, 2011; June 7, 2011; August 2, 2011; September
6, 2011; October 4, 2011
Application Deadline: Wednesday, 5:OOp.m., October 26, 2011
Council Appointment Date: November 1, 2011
(Recommendations to be made by Council liaison)
After 01/24/11 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
YOUTH ADVISORY COMMISSION
One Vacancy — Two Year Term
January 1, 2011 — December 31, 2012
One (1) person — Tate High
Gender Balance Requirement: None
No applications as of Wednesday, 5:OOp.m., October 26, 2011
❑x Denotes applicant completed the Confidential page of the application.