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HomeMy WebLinkAbout2011-12-06 Appointment22a 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, November 30, 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; November 1, 2011 Application Deadline: Wednesday, 5:00p.m., November 30, 2011 Council Appointment Date: December 6, 2011 After 11115/10 (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., November 30, 2011 Term is expiring and is being advertised as a new full five -year term. ElDenotes applicant completed the Confidential page of the application. 22b 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, November 30, 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; November 1, 2011 Application Deadline: Wednesday, 5:OOp.m., November 30, 2011 Council Appointment Date: December 6, 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., November 30, 2011 D Denotes applicant completed the Confidential page of the application. 22c. 4L 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, November 30, 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; November 1, 2011 Application Deadline: Wednesday, 5:00p.m., November 30, 2011 Council Appointment Date: December 6, 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, 5:00p.m., November 30, 2011 Term is expiring and is being advertised as a new full six -year term. O Denotes applicant completed the Confidential page of the application. zza 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, November 30, 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; November 1, 2011 Application Deadline: Wednesday, 5:00p.m., November 30, 2011 Council Appointment Date: December 6, 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, 5:00p.m., November 30, 2011 El Denotes applicant completed the Confidential page of the application. M 22e 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, November 30, 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. X1 lxlxlxl xlxlxlxlxl lxlxl><I><Ixl w xxmxx OD xxmxm w xxxxx 03 D >O D zo D-M Z �mC- ;ac n-4 � M vz -i cL D m CD -U :3 � u 2. @ m zoox 3 CD CD N :3. o cn 11 rn 11 a CD (�D z 11 n D "-0 > >' OZ NCD N (D 3. (D 7 (D (D C-- 3 = x a (0 n CD c o CD 00000 X� pa p ,�� N N N N O N O -0 m O O O X1 lxlxlxl xlxlxlxlxl lxlxl><I><Ixl w xxmxx OD xxmxm w xxxxx 03 D >O D zo D-M Z �mC- ;ac n-4 � M vz -i 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; November 1, 2011 Application Deadline: Wednesday, 5:00 p.m., November 30, 2011 Council Appointment Date: December 6, 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 (M) Larry Baker I] 1217 Rochester Ave I] Denotes applicant completed the Confidential page of the application. City of Iowa City r � 1 Advisory Board /Commission /Committee S '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 Board of Adjustment Term Jan -2012 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 Larry Baker HOME ADDRESS 1917 Rochester Ave Is your home address (listed above) within the corporate limits of Iowa City? 0✓ Yes ❑ No How long have you been a resident of Iowa City? 3o years Gender: Male Z Female El OCCUPATION writer EMPLOYER self PHONE NUMBER: HOME 338 -2838 BUSINESS EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: r member of same board. Former City Councilmember. Former member of Planing and Zoning Commission. LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conf td " .Inter t ',—:J None Ul r1.7 IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? Q Yes U 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.) 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. ,eneral Application June 2010 Page 2 of 8 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board /Commission /Committee Board of Adjustment Name Larry Baker CITY OF IOWA CITY Date I Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 7). List all businesses in which you, your spouse /domestic partner, or parent if Youth Advisory Commission applicant, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. ` ? Applicant Signature '� Signature of parent/gua dian (Youth Address 1217 Rochester Ave 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. ,eneral Application June 2010 Page 3 of 8 =21f NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: PLANNING AND ZONING COMMISSION One Vacancy — Unexpired Term Effective Upon Appointment — May 1, 2015 The duties of the Planning and Zoning Commission members include making (or causing to be made) surveys, studies, maps, plans, or charts of the whole or any portion of the municipality and any land outside which - -in the opinion of the Commission - -bears relation to a comprehensive plan; also include recommending to the City Council from time -to -time amendments, supplements, changes, and modifications to the Zoning Ordinance. Iowa City- appointed members of boards and commissions must be eligible electors of the City of Iowa City. This Commission conducts formal meetings the first and third Thursdays of each month at 7:30 p.m. (Informal workshops are held the preceding Mondays at 7:30 p.m.) Applications must be received by 5:00 p.m., Wednesday, November 30, 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 Planning and Zoning Commission should be directed to Robert Miklo, Sr Urban Planner at 356 -5240. 10/19/2011 m z 0 0 X m ii ii u n D o oc CD�y c0 c0 3 m C� �m �Q x �0 z c o , m �CL 0 c 3 *TTX nmvz r_"D r>OXD -< D -- i=z -< MmtnMC -0 m-i;um N C m m ;u X- m—q° rzc- cnx>0 mica 3? *Mxzn-< =m>00 >r rm �z -< m 000000ax-4 m cn cn cn cn cn cn cn M M wcncnivwa�rnm3 X X X X X X ; i o XXXXXX ; w XXXXXX ;N N Co XXXxXX� X m X X X X X V co XX�X�XXCn 00 XXXXxxX� 0o X X X X X X X �o N X XXxxX° y X. X X X X X s z T O X D m m *TTXMmvz mrDOXD -< D D -< MmcnMm :q=zmm-ixm N C m m ;u M- M--l- cn ;g > o z_ jc° cn D 3�=mz =0 �mXZ> F-r �z rm < m 00o00o0x-4 cn cn cn cn cn cn cn M m w cn cn iv w rn rn m� X X X X X X ; N w N X X X X X ; y XXXXXX ;W XXXXXX ;y XXXX °X X X X X X cn X °XXXX °� XXxoXxoN X °OXXXXy X X X X X X 00 X X X X X X X X X X 0 X X XXXXXXX-L XXxxxxx� X ; 0XXXXN 0 X I X X X X X Z& W X I XXXXX r D z DZ �z z 90 0 N Dp z �MZ n0 v� cn z 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: 4 Council Announcement Date: October 18, 2011 Application Deadline: Wednesday, 5:00 p.m., November 30, 2011 Council Appointment Date: December 6, 2011 After 01/16/2012 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. PLANNING AND ZONING COMMISSION One vacancy — Unexpired Term Effective Upon Appointment — May 1, 2015 Wally Plahutnik resigned Gender Balance Requirement: 1 Male (F) Paula Swygard 0 426 Douglass St (M) John Thomas D 509 Brown Street (F) Phoebe Martin M 1824 G Street 0 Denotes applicant completed the Confidential page of the application. City of Iowa City r i Olt Advisory Board /Commission /Committee 1"t� 1- lkpplication 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 Planning and Zoning Commission Term immediate 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 Paula Swyaard HOME ADDRESS 426 Douglass Street, Iowa City 52246 Is your home address (listed above) within the corporate limits of Iowa City? 7 Yes F1 No How long have you been a resident of Iowa City? 27 years Gender: Male F] Female ❑✓ OCCUPATION - • R.Universi1y PHONE NUMBER: HOME 338 -1980 BUSINESS SFi6-1194 EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: Active in the Miller Orchard Neighborhood Association (MONA) meetings /workshops regarding the Miller Orchard iighborhood Plan and Riverfront Crossings. Editor of the Miller Orchard Neighborhood newsletter. Member of the oniverCity Neighborhood Partnership committee. Advocated for MONA at Planning & Zoning meetings. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? Board members gather and objectively review information in order to make recommendations to the City Council regarding proposed zoning ordinance changes and changes to the city's comprehensive plan. They evaluate development plans and listen attentively to city residents to serve as stewards of responsible city planning. WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)? My involvement in the Miller Orchard Neighborhood has piqued my interest city planning and land use, & I would like to become more involved the greater Iowa City area. I'm willing to listen to and encourage input during meetings, and believe I can maintain an objective approach & look at the big picture. Able to devote time to do a thorough job. LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest My general interest in my home neighborhood area - the Miller Orchard Neighborhood. Other than that, none. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ❑✓ Yes N(5 DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSJflN? -c Yew ]No (It has been Council policy not to permit an individual to serve on two Boards or CommissiQrtE� t%same time.) Misrepresentations on this application will constitute just cause for removal of an 4poi3 ;ee. "u fail to answer all the questions, Council may not consider your application. General Application W June 2010 Page 2 of 8 `°' BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING r�� r 1 ► ANm? W ,i �0 CITY OF IOWA CITY Name of City Board /Commission /Committee Planning and Zoning Commission Date 11/21/2011 Name Paula Swygard 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 Spouse, Craig Swygard, is self - employed as a 426 Douglass Street, Iowa City, IA musician and music teacher, therefore sole proprietor of his own business �a C — �4 W 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/guardian (Youth Advisory Commission only): Address 426 Douglass Street, Iowa City 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. General Application June 2010 Page 3 of 8 Paula J. Swygard 426 Douglass Street, Iowa City, Iowa 52246 319.338.1980 (H) pswygard @gmail.com Employment 319.356.1194 (W) paula- swygard @uiowa.edu Secretary to the Director and Residency Training Coordinator Division of Child and Adolescent Psychiatry, University of Iowa 1984 — present Teacher Amarillo (Texas) Independent School District, Horace Mann Junior High fall 1982 — June 1984. Teacher of 7th 8th and 9th grade English in a school with a high minority and low income population. Mt. Pleasant (Iowa) High School fall 1976 — spring 1979. Teacher of sophomore English, Media Workshop, and Effective Writing. Faculty sponsor for the yearbook and newspaper. Education 1971 -1975 University of Iowa, Iowa City, IA B.A. with major in English Volunteer Experience Committee Member, UniverCity Neighborhood Housing Partnership, City of Iowa City 2010 - present Active Member, Miller Orchard Neighborhood Association, Iowa City, IA 2008 - present Editor, Miller Orchard Neighborhood Newsletter, Iowa City, IA spring 2011 - present Hobbies Gardening, genealogy, walking my dog, spending time with my family and friends. References References available on request hJ C" �y i � City of Iowa City r i Advisory Board /Commission /Committee �,- .;' IN Application Form CITY O 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 Planning and Zoning Commission Term Expires 5/1/15 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 John Thomas HOME ADDRESS 5og Brown Street 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 ?2 years Gender: Male 0 Femalen OCCUPATION Landscape Architect (retired) EMPLOYERNA PHONE NUMBER: HOME 319 -338 -1841 BUSINESS NA EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: practiced landscape architecture for 28 years, including 23 years as a landscape architect with the City and County of San Francisco, Department of Public Works. Through my professional practice as well as personal interest, I have considerable knowledge of land use planning and environmental design in an urban setting, as well as the workings of city government. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? My present knowledge of the Planning and Zoning Commission has primarily been gained over the past year. Through my interest in numerous rezoning applications, I have become familiar with the various zoning classifications pertaining to each application, and the Planning and Zoning Commission's process of review and approval. In addition, I have gained a good knowledge of the City's Comprehensive Plan (1997) and Central District Plan (2008). WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLYING)? My 28 years of professional practice in landscape architecture and urban planning have provided me with the practical knowledge required to evaluate matters -of the kind considered by the City of Iowa City's Planning and Zoning Commission. I consider myself an open, fair - minded person, able to deliberate matters of consequence in a group setting. I am committed to ensuring that Iowa City's land use planning is based on a careful consideration of its planning policies and zoning code. LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest None d IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? [_� Yes N~ DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? bylepq ✓No (It has been Council policy not to permit an individual to serve on two Boards or Commissi . ,6s `at tl�e sarrle ne.) Misrepresentations on this application will constitute just cause for removal of an appoiMee. 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 Planning and Zoning Commission Name John Thomas t%4-- � M-1114 CITY OF IOWA CITY Date 11/29/11 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 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 , `- 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/ r( Address 509 Brown Street ian (Youth 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 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 �- i Term (�� ©IS 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 110^ HOME ADDRESS Is your home address (listed above) within the corporate limits of Iowa City? © Yes F1 No How long have you been a resident of Iowa City? a adYe---� Gender: Male [-� Female OCCUPATION n I4, EMPLOYER 31-o PHONE NUMBER: HOME 3 iq- ,S �'S� BUSINESS 3101- 2L(ig OS& I :XPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT IS YOUR PRESENT KNOWLEDGE OF TH15 ADVISUKY bUAKU r t� WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON F0Ftb#PLY1NG ? e CD % LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Int r st IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? Yes 1:1 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. General Application June 2010 Page 2 of 8 • Experience and /or activities which you feel qualify you for this position: I am a member of the Greater Iowa City Home Builders Association, co -chair of the HBA Women's Council, co -owner of Martin Construction, designer for Martin Construction, and a Realtor. I am a fourth generation Iowa City native. What is your present knowledge of this advisory board? It is my understanding that this board initiates and conducts surveys, plans, studies, etc., of Iowa City, discusses and assesses zoning ordinances, and considers how various plans and requests modify or extend ordinances. The board also maintains a comprehensive vision of Iowa City in the short and long term. • What contributions can you make to this advisory board? I am able to moderate and mediate among people with various interests and backgrounds. 1 have business experience that helps me negotiate, research and access resources. I work with and am familiar with all sorts of Iowa City institutions such as banks, schools, small businesses, large developers, etc. , :. C a - <I C-1 - BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING III ,A ww ®��tl CITY OF IOWA CITY Name of City Board /Commission /Committee � 11i �E-J Date f ��° %� Name 32-,Z_ 3VI "t\-- 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 C- q0 .- �s.•� ry+us�c'a at .......� !'M16' ��" --k --may. tl 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/guardian (Youth Advisory Commission only): Address �$ ���- VC0_1X1 -TA 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 :2:2g 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, November 30, 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. p CD a p tri II ts' O 11 � II > b p 0 N 0 W 0 0 N 0 CD CD CD O a CD CD m p CD a p ts' O a 0 N 0 W 0 0 N 0 CD CD O O 0 O � O W �C�CO>CO Ox L." X X X X x x tTj �o C r. A A EL a N A O A A O p Ga a eD m N S C cc CD a Q F W c Q ,< <, -4o 12 0 �3 CD CD 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; November 1, 2011 Application Deadline: Wednesday, 5:00 p.m., November 30, 2011 Council Appointment Date: December 6, 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 (F) Michal Milstein 0 523 Fairchild St (M) Tom Glorfield I] 725 Bradley St (F) Melissa Mitchell rx-1 910 -1/2 S Summit St (M) John Engelbrecht 0 913 E Jefferson St (M) Andrew Brodie M 1210 Grant Ct 0 Denotes applicant completed the Confidential page of the application. City of Iowa City r Advisory Board /Commission /Committee Application Form U! r� c �"�-�-- � 10 �C • vV ccswr-ti -on St- CITY OF IOWA CITY THIb 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 Public Art Advisory Committee 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 Michal Esther Milstein HOME ADDRESS 523 Fairchild St. Iowa City IA 52245 Is your home address (listed above) within the corporate limits of Iowa City? R1 Yes F� No How long have you been a resident of Iowa City ? August 9011 Gender: Male F] FemaleF OCCUPATION Graduate Student EMPLOYER University of Iowa PHONE NUMBER HOME (323) 633 -1517 BUSINESS ppq)eSo -n99F (family number) EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:,,,— WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)? ** *PLEASE 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? R] Yes [:1 No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? FYes ✓❑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 ._ answer all the questions, Council may not consider your application. General Application 1. •IAA A M--.- n _t A * * *F -ASE SEE ATTACHED * ** •.� �: S Jssam�j WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? r 3 ** *PLEASE SEE ATTACHED * ** WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)? ** *PLEASE 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? R] Yes [:1 No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? FYes ✓❑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 ._ answer all the questions, Council may not consider your application. General Application 1. •IAA A M--.- n _t A EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I am a first year graduate student in the University of Iowa's Nonfiction Writing Program (Masters in Fine Arts). I have been awarded the Iowa Arts Fellowship, one of the highest honors awarded in Iowa's many prestigious fine art programs (see http:/ /www.grad.uiowa.edu /iowa -arts- fellowships for details). My first book, Undisclosed: Secrets of the AIDS Epidemic, will be released December 1, 2011 and is currently being reviewed by the Pulitzer Board. It's a collection of memoirs, narrative prose, and visual art from some of the epidemic's longest - surviving victims. I am currently in the process of translating the Argentinian classic Operacion Masacre from Spanish to English (to learn more about the book, please visit http : / /en. wikipedia .org /wiki/Operaci6n_Masacre). Many members of the writing community regard this piece as the first book written in the True Crime genre (it predates In Cold Blood by a decade). My translation will be the first time this watershed book will be available in English. In my undergraduate years, I served as president of my sorority Alpha Epsilon Phi and was awarded Sorority President of the Year by the University of California, San Diego. I graduated with Honors with Highest Distinction in Writing, and also pursued a pre - medical curriculum. I was a statewide finalist in the Ina Coolbrith Poet Laureate contest, and have contributed to numerous academic art publications. I am currently organizing a Visual Autobiography exhibition that will showcase graduate student work on December 0' in the Public Art Space. The event will combine graphic art, film, written narrative, and audio recording to explore the origins of memory and autobiography. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I have familiarized myself with the board's many accomplishments, including the Sculptor's Showcase, Poetry in Public program, and Literary Walk (which I follow everyday on my walk to school). I researched the selection process behind art pieces (open competition, limited competition, and direct invitation) as well as the spatial distribution of the work around Iowa City. I know that the advisory committee consists of seven members that are responsible for the development by -laws and procedures, placement of public art, overseeing expendres, and engaging with artists and commissioners. WHAT CONTRIBUTIONS CAN YOU TAKE TO THIS ADVISORY BO -RD *ASM FOR APPLYING)? rnS J I relocated from Southern California to Iowa City because of the town's dedicafidii io apessible art. I had lived in Los Angeles and San Diego my entire life (23 years), but immediately felt at home when I visited the university and its surrounding areas. I had also been accepted to the graduate writing programs at Columbia University and Johns Hopkins University, but felt that Iowa City was the ultimate environment to develop my craft and my appreciation of local art. I am applying for this position because I want to give back to the town that helped me make the best decision of my life. I want to contribute my connections with the Iowa writing and visual art programs (Writer's Workshop, Nonfiction Writing Program, Center for the Book, Translation Workshop, International Writing Program, Playwrights Workshop, Art History Graduate Program, etc). I am equally dedicated to discovering artists who are not associated with the university and to sharing their work with the city. There is an unbelievable amount of talented artists who have never been encouraged to showcase their work, and I want to use my outgoing spirit and discipline to help them contribute to Iowa City's rich artistic tradition. r1-1 1 CID BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board /Commission /Committee Public Art Advisory Committee Name Michal Esther Milstein `m�''"�� Ji CITY OF IOWA CITY Date 11/04/2011 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 ONE NONE r.3 0 az o r:> NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an a Applicant Signature Signature of parent/guardian (Youth Advisory Commission only): Address 523 Fairchild St. Iowa City IA 52245 Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail t^ answer all the questions, Council may not consider your application. General Application I—_ nnwn r%_..- City of Iowa City r j Advisory Board/Commission/Committee: "''''� /` oplication 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 Public Art Advisory Committee Term 1/1/12-1/1/15 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 Tom Glorfield HOME ADDRESS 725 Bradley St., Iowa City, IA 52240 Is your home address (listed above) within the corporate limits of Iowa City? F✓ Yes F] No How long have you been a resident of Iowa City? 11 years Gender: Male 0✓ Female ❑ OCCUPATION Director of Program Services EMPLOYER Keystone Assessment, LLC. PHONE NUMBER: HOME 319 - 594 -5329 BUSINESS 31g-rim-ling _XPERIENCE AND /OR ACTIVITIES WHICH YOU 1-1--tL QUALIrY YUU rUK I nla rU01 11UN; I',-- always had a love of the arts, which led me to my undergrad degree is in Fine Arts. Initial plans were to go on become an art instructor or a curator. However, other opportunities in the business world presented themselves and my life took a different path. But, I've always kept my foot in the "art world'; teacher painting aft drawing classes, becoming lead docent at the Sioux City Art Center, and assisting in curating and p§iii� ntirt�variggs shows. w1 nw AA \r PIA ♦ r%r%,% VVP1A1 R) YUUK rmmacm 1 MMWVVL.cvvc yr I nw rwvrvv.�. L+vr+.w. - Little to none, but I'm eager to learn and bring a fresh perspective. J " TY, ? 6 WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLY(i111G)? I believe my background in fine arts and my passion will be an assest. In my professional life, I work with a variety of advisory committees from the Federal to State levels which I also believe to be an assest. LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest NIA IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ❑✓ Yes U No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes [Z]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 co 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 Public Art Advisory Committee Name Tom Glorfield �11111.r worm dl �t VIII Ot CITY OF IOWA CITY Date 11/08/2011 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 �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/guardian (Youth Advisory Commission only): Address 725 Bradley St., Iowa City, IA 52240 Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail 110 answer all the questions, Council may not consider your application. General Application June 2010 Page 3 of 8 City of Iowa City I k Advisory oard /Commission /Committee`.- "; rY mpplication 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 THA�;TIME. Advisory Board /Commission /Committee Name Public Art Advisory Committee _{ s -. T� Jarguary 2012 Youth Advisory Commission (shall not be more than 18 years of age at the t!!�e.of applicat of n) Name of Iowa City High School or high school equivalent: Ml Signature of parent/guardian: -� •,� NAME- Meiiss6 Mitchell' HOME-ADDRESS 910 1/2 S Summit St' Is your home address (listed above) within the corporate limits of Iowa City? W✓ Yes F-1 No How long have you been a resident of Iowa City? 9 years Gender: Male El Female OCCUPATION Stijdpnt EMPLOYER PHONE NUMBER: HOME 319- 631 -4330 BUSINESS r Wmrrin �klt •M a Kinlno nnT1Xn-r1GC WWICH Y[)tI FEEL QUALIFY YOU FOR THIS POSITION: gave an undergraduate degree in the Fine Arts (printmaking) from the University of Iowa, and am very interested in the intersection of the arts and public life. m lZMAIA 11 Gr1l'-G r1F TI-IIC AnviSnRY BOARDY WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAF'1'I_YINUlY I would be honored to serve my community as a committee member of this board, and can offer my dedication to both the arts and to Iowa City. 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 L—J No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes [Z]No fit has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2010 Page 2 of 8 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board /Commission /Committee Public Art Advisory Committee Name Melissa Mitchell CITY OF IOWA, CITY Date 11/03/2011 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. c..� NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Applicant Signature // -3- Signature of parent/guardian (Youth Advisory Commission only): Address 910 112 S Summit St 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 3 of 8 City of Iowa City r Advisory Board /Commission /Committee; Application Form ~~ CITY OF IOWA CITY THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC, WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. Advisory Board /Commission /Committee Name Public Art Advisory Committee 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 John Engelbrecht HOME ADDRESS 913 E. Jefferson St. Iowa City Is your home address (listed above) within the corporate limits of Iowa City? F,/] Yes ❑ No How long have you been a resident of Iowa City? 9 Years Gender: Male 0 Female F1 OCCUPATION Artist H Program Director EMPLOYER The James Gang H PS1 PHONE NUMBER: HOME 319- 331 -8893 BUSINESS EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I received my MFA in Art from Iowa in May of 2009. Since then, I have poured my time and energy into Public Space One, a community arts venue,as Program Director. In my tenure, Public Space One has become a hotspot for many diverse circles in Iowa City's cultural community. We run several groundbreaking programs out of the space including Free Art School and SOUP (a monthly micro - granting, community building meal), with more on the way. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? have little present knowledge of the board, though a general interest in public art being dynamic, engaging, and available within the fabric of our everyday lives. My goal at Public Space One is in making art accessible and exciting to a broader population and contextualizing what is often an esoteric field. But to stick to the question, I have read a few of the past months minutes and am aware (though haven't met) the board members. WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FOR APPLYING ? have a vested interest in the cultural life of this city. What was supposed to be a three -year residency has turned into 9, and with two kids fully (and happily) embedded in the ICCSD, I plan on the potential of 9 more years. Given his, I hope to use my experience working with community groups and artists at Public Space One to increase the amount of dynamic, contemporary and socially- engaged public art offerings Iowa City can present. LIJ I FU I LN I IAL GUNFLIGTS OF INTEREST: See page 1 for information regarding Conflict of Interest am a contracted employee of The James Gang, a local community - building nonprofit (my role is Program Director of Public Space One). In this position, we have applied for and received city funds for our Free Art School program. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ❑✓ Yes E No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION?.., �Yes,ZvNo (It has been Council policy not to permit an individual to serve on two Boards or Comm issions=at =fhe same t-" ��v._. Misrepresentations on this application will constitute just cause for removal of an gpRintg'e If you fail to answer all the questions, Council may not consider your application. +? - '�.. .. .. ....1 A 1'_.- vc ci ai rNNm,au�i i _- June 2010 Page 2 of 8 - ''' BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board /Commission /Committee Public Art Advisory Committee Name John Engelbrecht m CITY OF IOWA CITY Date 11/30/11 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 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. C� t4� ... NOTE: A new form must e corn acquired in an additional b sineE Applicant Signature Signature of parent/guar ' c Address 913 E. Jefferson St. Iowa if the above information changes or an ownership interest is M11 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 11 r i — .....�4 Advisory Board /Commission /Commitee ,n 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 Public Art Advisory Committee Term Jan. 2012 -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 Andrew (Andy) Brodie HOME ADDRESS 1210 Carant ut Is your home address (listed above) within the corporate limits of Iowa City? X Yes ❑ No How long have you been a resident of Iowa City? — 10 years OCCUPATION Film Programmer & writer /filmmaker PHONE NUMBER: HOME 319- 541 -5443 EMPLOYER BUSINESS Gender: Male 0 Female El Freelance & FilmScene co- founder EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: While studying film and English at the University of Iowa, I served on the Bijou Theater's Board of Directors before working for two years as the cinema's programming director. I have since worked at film festivals and venues across the country, including annually for the past seven years at the renowned Telluride Film Festival in Colorado. I do a variety of promotional work, including local events -- most recently the Alloy Orchestra /Metropolis show at the Englert, which more than 500 people attended. I recently co- founded FilmScene, a 501(c)3 working to establish a full -time art -house cinema and film center in downtown Iowa City. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I follow news and programs related to Public Art and believe quite strongly that it is essential for a vibrant community. I know that funds are limited and that to continue the high -level of excellence Iowa City enjoys with local art and culture will require careful consideration and creative thinking. WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)? I never cease to be amazed at the incredible creativity and talent of artists in Iowa City and around the state. I'd like to find new opportunities to work with them to enrich our community. I welcome the task /challenge of finding new ways for art to exist in public spaces that both surprises and engages. As appropriate, I'd also be interested in the use of online tools (social networks, etc.) to communicate with artists and the public. LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest I recently co- founded FilmScene, a film arts nonprofit. While not anticipated, should FilmScene be eligible for and decide to apply for any public art funding during my tenure on the committee, I'd need to recuse myself from any discussion /vote. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? Yes :t7-- C" DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMfSSl01 es X❑No (It has been Council policy not to permit an individual to serve on two Boards or Commit tens atthe 0-me time.) .- �r Misrepresentations on this application will constitute just cause for removal of- an a oint ,—.,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 Name of City Board /Commission /Committee Name Andrew C. Brodie BUSINESS LISTING Public Art Advisory Committee Lot , 'M=i CITY OF IOWA CITY Date Nov. 30, 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 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/guardian (Youth Advisory Commission only): Address I a/0 6ra4l- C�. _L oLoct to !A :5 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 zz� Marian Karr From: Andy Brodie <andy @andybrodie.com> Sent: Monday, December 05, 2011 12:35 PM To: Council Subject: Application for Public Art Advisory Committee Dear Council Members - As an applicant to fill one of two current vacancies on the Public Art Advisory Committee, I wanted to send a quick email ahead of the Council meeting scheduled for this Tuesday, December 6, at which you'll fill the seats. Please feel free to contact me by phone or email with any questions you may have regarding my application. Due to limited space on the application, I omitted an activity which I feel also qualifies me for this position: I currently serve on the Historic Theaters Committee of Preservation Iowa and attend meetings every few months at the State Historical Building in Des Moines to work on committee activities. Recent committee work has focused on an online database of historic Iowa movie theaters and planning for future programming to promote the venues. Preservation Iowa has created a website for the project called Hollywood in the Heartland, accessible at www. preservationiowa .org /hollywood /. Thank you for your time and consideration. Best, Andy Brodie 1210 Grant Ct Iowa City, Iowa 52240 319 - 541 -5443 andy @andybrodie.com This correspondence will become a public record. M 22h 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, November 30, 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. szOOx JIM m n u u u zz>> -u 20 Qt�Qt� 0 38 rt o a. a 0 m 0= o� crN C• O .. �. tD J � s c o = �' ? �m O d m - G I m _ m N x x m x x i x o m o x x m x x s m x y s 4 3 _ r s x x x x s x m s x m x x s x m 3 s x m x x s x mC)o x x x m s x x CA x m m x 0 s s s o a. a 0 m 0= o� crN C• O .. �. tD J � 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; November 1, 2011 Application Deadline: Wednesday, 5:OOp.m., November 30, 2011 Council Appointment Date: December 6, 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 (F) Rosamond Hanson 0 (Currently serving unexpired term) 320 E Washington St, Apt 8C ED Denotes applicant completed the Confidential page of the application. City of Iowa City r 1 Advisory Board /Commission /Committee,.., 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 (f e- ,-lte- 1 %' l ,C, /e%J 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: NAMEk &rzw-op d L. 'HOME AD DRESS varnt--- l(r' hZ)ZZ% A07%, NYC Is your home address (listed above) within the corporate limits of Iowa City? y�Yes No 19 How long have you been a resident of Iowa City? _ I JN�r Gender: Male Female �"' OCCUPATION V'6= 46rc.—c:J EMPLOYER PHONE NUMBER: HOME ;w'! "3'3�% BUSINESS =V0=C21=K1rc AAInlnO A(_TIVITIFA WMRIM YOU FEEL QUALIFY YOU FOR THIS POSITION: r._ . �, � ee-�► �..n a c-1 y,� �a>r �:r- o `Z` e c, av' 1 .wiuAT IL- vnl M C20CQC 1T LCAInw1 =n(,= nF THIS AnvISORY BOARD? % (+ Ce m 5s5- on �'-h jam% t'� �\ % %! C. � ma -f rah Chart j a; l f, �° YOU MAKE TO THIS j0erX Jr u) c-4 irc �r e � %"P�,c hi 1-/, f 0/0 e r ct ��4 c. L.1%71 rV 1 G111 I Lr%.. vv.v V.v. v v. .... �. ..�.... �..� �. - --• ----- ---- -- --- -- - - - - -- ` CD IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? Yes U No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes PNo (It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2010 Page 2 of 8 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING CITY OF IOWA CITY Name of City Board /Commission /Committee . o a i�tz oZ� ��?tty- Date CC1.111 ;171 Name P' 54149,, er;rr Ci L wao ?c, 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 Am" (f— 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/guar Ian (Youth Advisory Commission only): Address � t , Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2010 Page 3 of 8 22i NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: YOUTH ADVISORY COMMISSION Two 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, November 30, 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.orq. Questions about the Iowa City Youth Advisory Commission should be directed to Marian Karr, City Clerk at 356 -5041. X z p O X u�rniiu D� O O a y N iCM r+rt M 3�x a `o ' O N cD A =• c O c �D M v z� >z0 N m 0 j ...�0� ic vN O z 3 m mM w w w w w w w C.) M ic x x x x x x N w x x x x x x W x x x x x x z z z z z z x x m x x x V ' x x x x x 0 • m s X X x X x rn Q x x Q x x Qi c �D M v z� >z0 N m 0 j ...�0� ic vN O z 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; November 1, 2011 Application Deadline: Wednesday, 5:OOp.m., November 30, 2011 Council Appointment Date: December 6, 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 Two Vacancies — Two Year Term January 1, 2012 — December 31, 2013 Term expires for Alexandra Tamerius, Caroline Van Voorhis Gender Balance Requirement: 2 None (M) Malin Craig ❑x 2415 Mayfield Rd 0 Denotes applicant completed the Confidential page of the application. City of Iowa City Advisory Board/Commission/Committee #� _" WA S.% 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 Youth Advisory Commission Term two Years 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: �nneM ADDRESS 2415 Mayfield Roan - Is your home address (listed above) within the corporate limits of Iowa City? 0✓ Yes How long have you been a resident of Iowa City? seven years Gender: Male 0 OCCUPATION student EMPLOYER- PHONE NUMBER: HOME 339 -9403 BUSINESS EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL C YOU FOR THIS POSITION: 212 Female have been an active volunteer in the community with groups like Best Buddies, the Free Lunch Program, ToGather ,gether, and activities through my school and church. uuuAT IQ vn11R pRFCFNT ICMnWI FDGF OF THIS ADVISORY BOARD? WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BoAKD (KtASUNF-UKAFFLTINV) r I have been an active community volunteer and I would like to encourage other youth in the Iowa City community to get involved as well. In the seven years I have lived in Iowa City I have enjoyed interacting with many types of people and I look forward to being part of the discussions involving youth. LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest NO vy-, Cti IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? U Yes �L j No= DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSXQR? <.Ye [Z]No (It has been Council policy not to permit an individual to serve on two Boards or Commissign at thamee.) Misrepresentations on this application will constitute just cause for removal of ala,�-006F#ee. IRj Qu fail to answer all the questions, Council may not consider your application. General Application ° June 2010 Page 2 of 8 `D BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board /Commission /Committee Youth Advisory Commission Name Malin Craig CITY Of IOWA CITY Date 11/3012011 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 r 0 m.ri c_ NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Applicant Signature_ / ' ' 1/ Signature of parent/guardian (Y Address 2415 Mayfield Road 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 Z 22j 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, November 30, 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: 2 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; November 1, 2011 Application Deadline: Wednesday, 5:OOp.m., November 30, 2011 Council Appointment Date: December 6, 2011 (Recommendations to be made by Council' liaison) After 01/24111 (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., November 30, 2011 121 Denotes applicant completed the Confidential page of the application.