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HomeMy WebLinkAbout2012-11-13 AppointmentNOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: PARKS AND RECREATION COMMISSION Two Vacancies — Four -Year Terms January 1, 2013 - January 1, 2017 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, November 7, 2012. 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, Parks & Recreation Director at 356 -5110. M 19a NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF APPEALS Two Vacancies — Five -Year Terms January 1, 2013 - December 31, 2017 One (1) Home Builders Association Representative One (1) Licensed Plumber Or A qualified trade representative, (if after 3 months no professional applies or is appointed) 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, November 7, 2012. 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. XI ZOOXx 90(nC--D- iiaKmu° < v0=ra.�, 0 o u z u 0 v a m z a -- = X v — 0 cn N 3 O CL 0 CD 3 3 0 D � 3 � =3 m CD (0 0 v O N CD CD a m X C.0 w w w w R� 00000 m cnw -�rvry m cn Z� N TI z K a N 7 i N D Z,o �L N i N C- z= N z= N c z� K9 i N CD Z K m N Z 0 K N z 0 O X X X X < i N v i N DW M 0 as C) �, (D a ;u'0 (D '0 0 CD 0w CL tn. Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step- father, step- mother, step - child, aunt, or uncle. (Resolution 85 -354) Males: 3 Females: 0 Council Announcement Date: September 18, 2012 Application Deadline: Wednesday, 5:00p.m., November 7, 2012 Council Appointment Date: November 13, 2012 After 12/17/2012 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. BOARD OF APPEALS Two vacancies — Five Year Terms January 1, 2013 — December 31, 2017 Term expires for John Roffman, Andrea French One (1) Home Builders Association Representative One (1) Licensed Plumber Or a qualified trade representative, if after 3 months no professional applies or is appointed Gender Balance Requirement: 2 Females (M) John Roffman 0 (Currently serving 5th full term) 1314 Burry Dr (M) Ben Anderson M .445 Garden St (F) Andrea French I] (Currently serving 1st full term) 531 S 1 s' Ave IZI Denotes applicant completed the Confidential page of the application. City of Iowa City r 1 Advisory Board /Commission /Committee �;��I�; -'� PnIplication 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 John Roffman Term 5 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: NAME _John Roffman HOME ADDRESS 1314 Burry Dr_, Iowa City, IA 52246 Is your home address (listed above) within the corporate limits of Iowa City? ❑✓ Yes F� No How long have you been a resident of Iowa City? 46 years Gender: Male 7 Female OCCUPATION General Contractor EMPLOYER John Roffman Construction, Inc. PHONE NUMBER: HOME 319 - 351 -3141 BUSINESS 319- 631 -1RnR (yell) EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY You RIP THIS PnSITInN- 20 years previous experienc on the board VMAI 10 TUUK rKtN=-N I KNOWLEDGE OF THIS ADVISORY BOARD? Present board member µr r rn WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FOR APPLYING ? Representative of the Iowa City Homebuilders Association 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? 0✓ Yes F1 No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? F]Yes 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 answer all the questions, Council may not consider your application. General Application June 2012 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board /Commission /Committee John Roffman Name John Roffman CITY OF IOWA CITY Date 10/26/2012 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 John Roffman Construction, Inc. 1314 Burry Dr., Iowa City, IA 52246 J &J Real Estate 1015 Oakcrest, Iowa City, IA 52246 Linn Street Place, LLC 1015 Oakcrest, Iowa City, IA 52246 E, r.s G -4 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 Address 1314 Burry Dr, n (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 2012 Page 3 of 7 City of Iowa City r 1 Advisory Board /Commission /Committee - "''� nplication 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 Appeals Term 01/01/2013 Youth Advisory Commission (shall not be more than 18 years of age at the time of application) Name of Iowa City High School or high school equivalent: Signature of parent/guardian: NAME Ben Anderson HOME ADDRESS 445 Garden St. Is your home address (listed above) within the corporate limits of Iowa City? n✓ Yes F] No How long have you been a resident of Iowa City? 8 months Gender: Male ❑✓ Female OCCUPATION (,Pneral Contractor EMPLOYER Anderson Construction LLC PHONE NUMBER: HOME 319 - 214 -3444 - BUSINESS same XPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I `-eve been in the construction business for nearly 10 years, active in the redevelopment of infill properties in .ver, CO prior to relocating here in February 2012 for my wife, an Iowa City native, to attend graduate school and for us to be closer to her parents. I am a member of the Iowa City HBA. I build using modern technologies and green building techniques; Energy Star, etc. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? The board holds meetings to hear appeals to allowing alternative materials and methods W 4-d usi in acardance with all relevant building codes.' �.... c') -s— -�, WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FORLYtNG ? I believe that my knowledge and experience would make me a good fit for this position. 1 iii new to the community but hope to be here for a long time and wish to help the community to reach it's goals and .objecti4 without sacrificing a quality and desierable end product. LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest NA IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ❑✓ Yes ❑ No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? RYes -]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 2012 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board /Commission /Committee Board of Appeals Name Ben Anderson r 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 Anderson Construction LLC 445 Garden St. Iowa City IA 52245 NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an add it pAaL busiryesj<" y Applicant Signature Signature of parent/gua rr( outh ry Commission only): Address 445 Garden 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. General Application June 2012 Page 3 of 7 City of Iowa City Advisory Board /Commission /Committee tiplication 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 �hv��� �� Term S^ 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 F,leo m I-1 HOMEADDRESS �� f (sf ✓t= ry �r:-7 Is your home address (listed above) within the corporate limits of Iowa City? � Yes No How long have you been a resident of Iowa City? Gender: Male El Female OCCUPATION e < u,,6,e -� EMPLOYER Dc- PHONE NUMBER: HOME `�--1 `al - 1 1 S 13 BUSINESS -3 1 9 — G ,31 J 1 SZ EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? Cz' WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLYING)? f�3 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 n 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.) Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail j answer all the questions, Council may not consider your application. f General Application June 2012 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING _�. b i J 14 2 CITY OF IOWA CITY Name of City Board /Commission /Committeea� , � d �P� t S' Date Z� 7 2 Name 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 O L� a!smrwat d i 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 X31 S, / s ive 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 2012 Page 3 of 7 NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF ADJUSTMENT One vacancy — Five -Year Term January 1, 2013 — Ending January 1, 2018 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 7, 2012. 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: 4 Females: 1 Council Announcement Date: September 18, 2012 Application Deadline: Wednesday, 5:00p.m., November 7, 2012 Council Appointment Date: November 13, 2012 After 12/17/2012 (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, 2013 — January 1, 2018 Term expires for Caroline Sheerin Gender Balance Requirement: 1 Female No applications as of Wednesday, 5:00p.m., November 7, 2012 0 Denotes applicant completed the Confidential page of the application. 19c NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: HUMAN RIGHTS COMMISSION Three Vacancies — Three -Year Terms January 1, 2013 - January 1, 2016 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, November 7, 2012. 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. Page 13 of 14 KEY: X = Present 0 = Absent O/E = Absent/Excused NM = No meeting /No Quorum R = Resigned - = Not a Member TERM 10/1 11/2 12/1 NAME EXP. 1/17 2/21 3/20 4/17 5/15 6/19 7/17 8/21 9/18 6 0 8 Dr. Howard 1/1/13 X X O/E X O/E X O/E X O/E X Cowen Constance 111/13 X O/E X X O/E O/E X X X X Goeb Harry 1/1/13 X X X X X X X X X X Olmstead (8 -1 -2010) David B. 1/1/14 X O/E 0/E O/E R R R R R R R R Brown Diane 1/1/14 O/E X X X X X O/E X O/E O/E Finnerty Orville 1/1/14 X X X X X X X X X X Townsend, Sr. Henri Harper 1/1/15 O/E X O/E R R R R R R R R R Kim 1/1/15 X X X X X X X O/E X X Hanrahan Shams 1/1/15 O/E X X X X X X X X O/E Ghoneim Jessie 1/1/15 - - - - - O/E X X O/E X Harper (Appointed 6-5-12) Dan Tallon 1/1/14 - - - - - - - X X X (Appointed 7- 31 -12) KEY: X = Present 0 = 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: 3 Females: 3 Council Announcement Date: September 18, 2012 Application Deadline: Wednesday, 5:OOp.m., November 7, 2012 Council Appointment Date: November 13, 2012 After 12/17/2012 (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, 2013 — January 1, 2016 Term expires for Howard Cowen, Constance Goeb, Harry Olmstead Gender Balance Requirement: None (F) (M) (M) (F) Katie Anthony M 23 Wakefield Ct Harry Olmstead IZI 1951 Hannah Jo Ct Joe Coulter Fx1 1818 N Dubuque St Alexis Wallenburg 0 714 Westgate St, Apt 78 (Currently serving unexpired term) 0 Denotes applicant completed the Confidential page of the application. City of Iowa City r 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 ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME. 0 e e /J Advisory Board /Commission /Committee Name Human Rights Commission Term &eAte Cer 6 ON 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 parentfguardian: h,7 NAME Katie Anthony HOME ADDRESS 23 wakefi .Id t_ Iowa its fA 52240 Is your home address (listed above) within the corporate limits of Iowa City? W✓ Yoh Nod How long have you been a resident of Iowa City? off /on 13 years Gender-Male rl Femalea OCCUPATION Education $ Marketing Director EMPLOYER Iowa City AreaAsrin otREALTORSO PHONE NUMBER: HOME 319 - 325 -1480 BUSINESS s�g_s�a_r,4nn EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: am currently the staff liaison for the Fair Housing Ambassadors Committee at ICAAR. Prior to that, I was a :ALTOR® and chair of the same committee for approximately 4 years.[ helped write and was an instructor for the mortgage readiness course in conjunction with the Iowa City Housing Authority. CLIP 2012 graduate. ;c, Nt,'Nt h sprdtrs Ile v,,( J C howgo n 241 eta CA,.,r WHAT 15 TUUK Mt:UM r KNOWLEDGE OF THI5 ADVISORY BOARD? The Human Rights Commission protects residents from discrimination and promulgates advocacy of human rights laws to include (but not limited to) race,color,sex,sexual orientation,gender identity,religion,national origin, mental disability,physical disability,and familial status.Human Rights Awards are also decided through this Commission. WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FORAPPLYING ? I am passionate about Fair Housing.My experience as a real estate agent and as staff member at ICAAR mixes well with the other Commissioners and their fortes.) recognize that Human Rights is elemental to every person despite differences or similarities.Living in Iowa City and the area for 23 years I have a feel for the community and its leaders. LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest I IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? [7 Yes n 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. Human Rights Commission Application June 2012 Page 2 of 8 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING Name of City Board /Commission/Committee Human Rights Commission Name Katie Anthony r CITY OF IOWA CITY Date 07/27/2012 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. i BUSINESS NAME I BUSINESS ADDRESS Tri County Real Estate (Partner with spouse) I PO Box 82, Iowa City IA 52244 NOTE: A new form must be completed if the above information changes or an ownership interest is 4cquired in an additional business. Signature L" Address .93 w -� ��� - �/W7t le D 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 2012 Page 3 of 8 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective February 9, 2012 Household Size 30% Median Income (Poverty Level) 50% Median Income 60% Median Income 80% Median Income (low Income) Median Income 1 $16,900 $28,150 $33,780 $45,000 $56,300 2 19,300 32,150 38,850 51,400 64,300 3 21,700 36,150 43,380 57,850 72,300 4 24,100 40,150 48,180 64,250 80,300 5 26,050 43,400 52,080 69,400 86,800 6 28,000 46,600 55,920 74,550 93,200 7 29,900 1 49,800 59,760 79,700 99,600 8 31,850 53,000 63,600 84,850 106,000 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. F56 Age Female Gender Income (see table) Sexual Orientation Other (Please explain below) man Rights Commission Application June 2012 page 4 of 8 Religion Disability White RaRq, color or Shnic group =National pr jgin City of Iowa City rI r _ _ Advisory Board /Commission /Committee A Q implication 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 2013 - 2016 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 Harm Olmstead HOME ADDRESS 1951 Hannah Jo Ct_ Is your home address (listed above) within the corporate limits of Iowa City? K_/1 Yes No How long have you been a resident of Iowa City? 3.5 years Gender: Male Female OCCUPATION m imd crhnnl hQnr_hP_r EMPLOYER PHONE NUMBER: HOME 319- 338 -2931 . BUSINESS EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSIT) N: C' -pleting a 2.5 year term on the IC Human Rights Commission and I'm the currrent Charrpe soy me I er of the - all son County Para-Transit Advisory Committee; member of the Johnson County, Civiab mmenitie licy. Board; Chairperson of the. Board of Directors of Access to Independence; co -clerk of IG F� akers). r .tea ■aw � wa nwr�rav ww � ww� _. r;,-> :• "•• VVnAI 10 T VUM rMCOCR 1 I%NVYYLCUbC Vr i T71a7 AuVi UMT OWMIJ r " Having served for the past 2.5 years i have a keen working knowledge of how the commission functl6ns. WHAT CONTRIBUTIONS CAN YOU MAKE TO THiS ADVISORY BOARD REASON FOR APPLYING)? I feel that I have much to offer in way of my prior experience on the commission and have unfininished work to do before- leaving. I am better focused on the impact that education has on people in our community when given the opportunity to learn abouttheir Human Rights. LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? Yes r No DO YOU CURRENTLY SERVE ON ANOTHER L IOWA CITY BOARD OR COMMISSION ?.. QYes XNo (it has been Council policy not to permit an individual to serve on two Boards or Commissions of the same time.) Risrepresentations on this application will constitute just cause for removal of an appointee. 'If you fair Lo answer all the questions, Council may not consider your application. Human Rights Commission Application June 2012 Page 2 of 8 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING Name of City Board /Commission /Committee Human Nights Commission Name Harry Olmstead I. r 1 _�. - CITY OF IOWA CITY Date 10/11/2012 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 NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Signature Address 1951 Hannah Jo Ct., Iowa City, IA 52240 Misrepresentations on this application will constitute just cause for removal of an appointee. . r you fail to answer all the questions, Council may not consider your application. Human Rights Commission Application June 2012 Page 3 of 8 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective February 9, 2012 Household Size 30% Median Income (Poverty Level) 50% Median Income 60% Median Income 80% Median Income (low income) Median Income 1 $16,900 $28,150 $33,780 $45,000 $56,300 2 19,300 32,150 38,850 51,400 64,300 3 21,700 36,150 43,380 57,850 72,300 4 24,100 40,150 48,180 64,250 80,300 5 26,050 43,400 52,080 69,400 86,800 6 28,000 46,600 55,920 74,550 93,200 7 29,900 49,800 59,760 79,700 99,600 8 31,850 53,000 63,600 84,850 106,000 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. 62 Age Imale Gender 30 %median Income (see table) straight Sexual Orientation F-10ther (Please explain below) Quaker Religion above the knee amputee in a Disability white Race, color or ethnic group American National origin Human Rights Commission Application June 2012 page 4 of 8 . r\J 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 "I TIME. Advisory BoardlCommission /Committee Name Human Rights Commission Term 2013 -2016 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 Joe D. Coulter HOME ADDRESS 1818 North Dubuque Street Is your home address (listed above) within the corporate limits of Iowa City? Fx] Yes ❑ No How long have you beers a resident of Iowa City? Since 1985 Gender: Male M Female F] OCCUPATION Professor EMPLOYER The University of Iowa PHONE NUMBER: HOME (319) 354 -7492 BUSINESS (319) 384 - 14781' r EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSiTIO 2 Z5 t See attached Biographical Sketch cN) IAII1 AT I[11I/1l IA ^I-' I Ile' AM111r r119V rn^A MM-1 V I IY1! IV a WVI\ ri \ILV LI`!I I%IIV YV""✓t L VI 1111,.! 1V YM1 VI%I Followed activities and programs conducted by the Human Rights Commission professional acquaintance with some current /former Commission members, current service on Ad Hoc Diversity Committee. WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)? Knowledge, appreciation, and experience in working with local community members and groups involved with civil /human rights issues in Iowa City, the State of Iowa, and regionally. LIST POTENTIAL CONFLICTS OF INTEREST: See page I for information regarding Conflict of Interest No financial Conflicts of Interest. Potential Conflicts of Interest with my employer, and with other organizations with which I serve. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? Yes nNo (Until 3/2013) DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ❑x 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. 1 Inman Rights Commission Application January 2012 Page 2 of 9 i � t BOARD, COMMISSION, & COMMITTEES !! BUSINESS LISTING CITY OF IOWA CITY Name of City Board /Commission /Committee Human Rights Commission Date Oct. 25, 2012 Name Joe D. Coulter 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 I ry r.a ....... yJ V Y J NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional bupiness. Signature Address 1818 North Dubucrue _S_tr_eet, Iowa City IA 52245 Misrepresentations on this application will constitute just cause for removal of an appointee, If you fail to answer all the questions, Council may not consider your application. human Rights Commission Application January 2012 Page 3 of 9 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Eff -ctive February 9, 2012 Household Size 30% Median Income (Poverty Level) 50% Median Income ._----_ _._ ......... _ .... 60% Median Income ...... _ ... ....._ 80% Median Income (low income) -- Median Income 1 f $16,900 $28,150- $33,780 $56,300+ - 2 19,300 32,150 - 38,850 51,400 64,300 3 21,700 36,150 43,380 57,850 72,300 4 24,100 40,150 48,180 64,250 80,300 5 26,050 43,400 52,080 69,400 86,800 6 28,000 46,600 55,920 74,550 93,200 7 29,900 49,800 59,760 79,700 99,600 8 31,850 -_ - 53,000 63,600 84,850 _. 106,000 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 �variou� racial, religious, cultural, social and economic groups in the city." (Ord. 94 -3647, 11- 8-_94) ry OPTIONAL: PLEASE PROVIDE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSi'R HEIi� CHOOSING AN APPLICANT. ry 68 Age Native R-dligion Male � I Gender 1$106,000 Pluf Income (see table) Male I Sexual Orientation Other (Please explain below) ;man Rights Commission Application ..anuary 2012 page 4 of 9 None � I Disability Amer. Ind. /White Race, color or ethnic group United States origin BIOGRAPHICAL SKETCH Provide the following infonnation for the key personnel and other significant contributors in the order listed 01i,�r Fagg Follow this format for each person. DO NOT EXCEED FOUR PAGES. -1 --d r P+ NAME POSITION TITLE Joe Dan Coulter Professor ,rt eRA COMMONS USER NAME^ jcoulter ,v EDUCATION /TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and INSTITUTION AND LOCATION University of Oklahoma, Norman University of Oklahoma Medical Center, Oklahoma City University of Texas Medical Branch, Galveston Universita di Pisa, Pisa, Italia University of Edinburgh, Edinburgh, Scotland DEGREE I YEAR(S) I FIELD OF STUDY B. A. 1966 Psychology Ph.D. 1971 Biological Psychology Post -doc 1971 Neurophysiology Post -doc 1973 Neurophysiology Post -doc 1974 Neurophysiology A. Personal Statement Dr. Coulter is an enrolled member of the Citizen Potawatomi Nation of Oklahoma (federally recognized) and currently active in teaching, research /scholarship, and community /public service in American Indian/ Alaskan Native health. Since joining the College of Public Health in 2004, he teaches, conducts seminars, and makes public presentations /trainings on racial /ethnic health disparities, the development of cultural competence, and organizing community -based participatory health programs. He has conducted /contributed to collaborative research /scholarship in the areas of children's oral health in Northern Plains tribal communities, tribal )reparedness and emergency response, establishing working relations in clinical and translational research in partnership with Federally Qualified Community Health Centers, and development /evaluation of biomedical research programs in tribal colleges and communities. He holds membership in the American Indian Science & Engineering Society, National Indian Education Association, National Institute for Native Leadership in Higher Education, the American Indian and Alaskan Native Professors, the Society for Chicanos and Native Americans in Science, the Native Research Network, the American Indian, Alaskan Native, Native Hawaiian Caucus of the American Public Health Association and the American Indian Higher Education Consortium. Dr. Coulter is a member of the External Advisory Committee of the Montana State University (MSU) Idea Networks for Biomedical Research Excellence program, an NIH program to improve biomedical infrastructure for Montana's higher education system and tribal colleges. He also serves MSU on the External Advisory Committees of the NIH supported American Indians into Research Program, Center for Native Health Partnerships, and the Culturally Connected Community Goals programs. In 2008, he was appointed to the External Advisory Committee of the Northern Plains Tribal Epidemiology Center of the Great Plains (Aberdeen Area) Tribal Chairman's Health Board. He has served on the Association of Schools of Public Health (ASPH) Diversity Committee, the ASPH- Indian Health Service Taskforce, and the ASPH /AAMC Expert Panel on Cultural Competence. He also serves as faculty advisor to American Indian and Alaskan Native students on campus and established and directed the Life Sciences Comprehensive Enrichment Program for pre - college American Indian /Alaskan Native students at The University of Iowa. He assisted in the establishment of the Iowa First Nations Program that provides resident tuition status for members of American Indian Tribes/Nations historically linked to the State of Iowa. He is an advisor to the Historical Preservation Project of the Meskwaki Nation of Iowa, served on the Iowa Governor's Equal Employment Opportunities Task Force, and has served three terns on the Iowa Advisory Committee of the United States Commission on Civil Rights. In 2008, Dr. Coulter was appointed to the Iowa Commission of Native American Affairs, State Department of Human Rights. In 2011, he began service to the Governance Board of the Regional Health Equity Council of the �Jational Partnership for Action (NAP) to End Health Disparities of the U.S. Department of Health and Human Services, Office of Minority Affairs. PHS 398/2590 (Rev. 06/09) Page — Biographical Sketch Format Page B. Positions 1975 -78 Assistant Professor, Department of Physiology & Biophysics and Department of Psychiatry & Behavioral Sciences, University of Texas Medical Branch, Galveston, Texas 1975 -85 Member, Marine Biomedical Institute, Galveston, Texas 1978 -84 Associate Professor, Department of Physiology & Biophysics and Department of Psychiatry & Behavioral Sciences, University of Texas Medical Branch 1980 -81 Associate Program Director, Behavioral & Neural Sciences Division, National Science Foundation, Washington, D.C. 1983 -85 Assistant, Office of the Associate Dean for Community Affairs, University of Texas Medical Branch 1984 -85 Professor, Department of Physiology & Biophysics and Department of Psychiatry & Behavioral Sciences, University of Texas Medical Branch 1985 -92 Head, Department of Anatomy, College of Medicine, University of Iowa, Iowa City, Iowa 1988 -96 Chair, Neuroscience Graduate Program, Graduate College, University of Iowa 1996 -99 Interim Associate Provost for Diversity and Director, Opportunity at Iowa, Office of the Provost, University of Iowa 1999 -04 Associate Provost for Diversity and Director, Opportunity at Iowa, Office of the Provost, University of Iowa 1985- Professor, Department of Anatomy and Cell Biology, College of MediciiW1 University of Iowa C 1985- Professor, Neuroscience Graduate Program, Graduate College, Urr' 1-sity-_bf Iowa.. x –- 1993-04 Coordinator /Liaison, American Indians & Alaskan Natives. OppctqityVnt Iowa, Office of the Provost, University of Iowa 1994- Participating Faculty, American Indian and Native Studies Prograaan oll of£ eral Arts and Sciences, University of Iowa 2004 -08 Associate Dean for Diversity, College of Public Health, University of loym 2004- Professor, Community and Behavioral Health, College of Public, Health, University of Iowa Honors (Selected) 1996 Association of American Medical Colleges, Elected Officer /Distinguished Council of Academic Societies Service Member 1999 -04 Explorations in Biomedicine: Native American Faculty Scientist Issues In Science Education and Research, American Physiological Society, Montana State University 2001 Association of Neuroscience Departments and Elected Officer /Distinguished Programs Service Member Federal Review /Advisory Committees: (Selected since 2000 from a total of 27 since 1980) 1999 -2004 Member, Research Centers in Minority Institutions Review Committee, National Center for Research Resources, NIH 2001, 2002 Member, Special Emphasis Panel, Biomedical Research Infrastructure Network, National Center for Research Resources, NIH 2002 Member, Special Emphasis Panel, Centers of Biomedical Research Excellence, National Center for Research Resources, NIH 2002 -2004 Chair, Research Centers in Minority Institutions Review Committee, National Center for Research Resources, NIH 2003, 2004 Chair, Special Emphasis Panel, Centers of Biomedical Research Excellence, National Center for Research Resources, NIH PHS 398/2590 (Rev. 06/09) Page — Biographical Sketch Format Page 2003 Member, Special Emphasis Panel, Pre - doctoral Awards for Minority Students and Students with Disabilities, NIH Center for Scientific Review 2004 Member, Committee of Visitors, evaluation of Tribal Colleges and Universities Program, National Science Foundation 2005 Member (Ad hoc) Research Centers in Minority Institutions Review Committee, National Center for Research Resources, NIH 2005 Member, Broadening Participation in Computing Review Panel, National Science Foundation 2006 Member, Special Emphasis Panel, Pre- doctoral Awards for Minority Students and Students with Disabilities, NIH Center for Scientific Review 2008 Member, Special Emphasis Panel, Clinical and Translational Science Awards, National Center for Research Resources, NIH 2008 Member, Research Centers in Minority Institutions and IDeA Review Committee, National Center for Research Resources, NIH 2009 Member, Community -Based Participatory Research, Panel 2, National Center for Minority Health and Health Disparities, NIH 2012 Member, Healthcare Safety and Quality Improvement Research (HSQR) Study Section, Agency for Healthcare Research and Quality 2012 Member, Transdisciplinary Collaborative Centers for Health Disparities Research Review Panel, National Institute for Minority Health and Health Disparities, NIH C. Selected peer- reviewed publications from a total of 79 (in chronological order): Gwyn, D.G., Ritchie, T.C. and Coulter, J.D. 1985. The central distribution of vagal catecho lain inergic neurons which project into the abdomen in the rat. Brain Res., 328:139 -144. Fabian, R.H. and Coulter, J.D. Transneuronal transport of lectins. 1985. Brain Res., 344:41 -48. Ritchie, T.C., Fabian, R.H. and Coulter, J.D. 1985. Axonal transport of antibodies to subcellular and protein fractions of rat brain. Brain Res., 343:252 -261. Ritchie, T.C., Fabian, R.H., Choate, J.V.A. and Coulter, J.D. 1986. Axonal transport of monoclonal antibodies. J. Neurosci., 6:1177 -11 Ritchie, T.C., Thomas, M.A. and Coulter, J.D. 1989. A nerve terminal protein with a selective distribution in spinal cord and brain. J. Neurosci., 9:2697 -2709. Cabalka, L.M., Ritchie, T.C. and Coulter, J.D. 1990. Immunolocalization and quantitation of a novel nerve terminal protein in spinal cord development. J. Comp. Neurol., 295:83 -91. �y a Wright, D.J., Ritchie, T.C. and Coulter, J.D. 1991. Distribution and developmeriBl expi9p on of the nerve terminal protein NT75 in rat cerebellum. J. Comp. Neurol., 304.53 rwnt 5. CM, - Kanekar, S. S., Ritchie, T. C. and Coulter, J. D. 1993 Spinal cord afferent system ing fi` erve terminal protein NT75. J Comp. Neurol., 332:198 -212. —_; a crJ Selected Invited Talks/Presentations from a total of 51 (since 1997): Making a Difference: Culture, Science and Community. Banquet Presentation. NJ6MS:Nation Jq Minority Research Symposium, New Orleans, Louisiana. October, 1997 .. Achieving Racial /Ethnic Diversity in Biomedical /Behavioral /Social Science Research. fftnel 1. Progress in Recruiting, Retaining, and Graduating Underrepresented Minorities n Regular NRSA Institutional Training Grants. Panel 2. Panelist and Presenter. National Institute of Mental Health Workshop on Minority Training Programs. Washington, D. C., October 1999. Inextricable Links: The Convergence of Diversity and Academics in Higher Education. Panel Presenter. The College Board Midwestern Regional Meeting, Chicago, Illinois, September, 2001 Community -Based Participatory Research with Tribal Communities. Featured Presentation. Montana INBRE Research Conference, Red Lodge, Montana. September 2005. Healthy Smiles Study: Community -Based Participatory Research on Oral Health of Northern Plains Indian Children Presentation, Blackfeet Community College, Browning, Montana, July, 2008 PHS 398/2590 (Rev. 06/09) Page _ Biographical Sketch Format Page D. Research Support Ongoing Research Support RFA -MD -05 -004 (Lefthand) NIH/NCMHD 10/01/08-09/30/12 Building Research Infrastructure for the Crow Community (BRICC). The NIH Research Infrastructure in Minority Institutions (RIMI) program at Little Big Horn College builds on the campus commitment to the professional, vocational and personal development of Crow Indian students in both higher education and the workplace in the health sciences and research. Role: Principal Investigator on sub - award /Consultant for evaluation. Completed Research Support (since 2004) Cooperative Agreement 1 U48DP00 1902 -01 (Nothwehr /Parker) 03/01/11- 02/28/12 CDC/National Center for Chronic Disease Prevention and Health Promotion University of Iowa Prevention Research Center for Rural Health. The focus of the PRC -RH is to improve the health of rural communities in Iowa and the Midwest through participatory research. The research themes are nutrition, physical activity, and aging. These are strongly in line with the health priorities identified by state and local entities. The PRC -RH uses a logic model which describes the activities and related outcomes of the PRC -RH consistent with the national CDC Prevention Research Center Program logic model. Role: Co- Investigator. 1 R24 MD001658 -01 (Robertson /Jaiyeola) 9/30/2005- 6/30/2010 NIH/NCMHD Using CBPR to Improve Oral Health in Northern Plains Indian Children. The overall objective is to plan and develop appropriate interventions to improve oral heal in Northern Plains (South Dakota) Indian Children using a community based participatory resch (GWR) pp ry a roach. Role: Principal Investigator on sub - award. cn RFA -RM -07 -002 (Hunninghake /Rosenthal) 09/01/20 ,q71-08/`J 1 /2qL- NIH/NCRR University of Iowa Clinical and Translational Science Program. For the Community Engagement component, establishing working relations in clinical march in partnership with Federally Qualified Community Health Centers has been a priority, including developing qualifications for Federal Wide Assurances, training in human subjects' research, HIPPA, and Institutional Review Boards approvals. Role: Co- Investigator for Community Engagement. 1 R13 HS016435 -01 (Osterberg) 06/01/2006- 05/31/2007 Agency for Health Care Research and Quality Asthma Education Conference for Tribal Health Officers Serving the Aberdeen Area. The project conducted a regional conference on asthma designed to inform representatives of Northern Plains tribal health agencies about the current state of knowledge, research and treatment of asthma, its potential environmental triggers, prevention strategies, and environmental improvement measures. Role: Co- Investigator. U90/CCU724262 -01 (Atchison) CDC 09/01/2004-08/31/2009 Upper Midwest Center for Public Health Preparedness. The Center's objective is training of the public health workforce, including tribal health personnel and emergency responders, to respond to bioterrorism and other public health emergencies. Role: Co- Investigator for tribal preparedness (2004- 2008). PHS 398/2590 (Rev. 06/09) Page — Biographical Sketch Format Page City of Iowa City r Advisory Board /Commission /Committee MiL i Vlication Form - J 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. �1 Advisory Board /Commission /Committee Name HUMM j akk, nM111j\-Q-51k34 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 AlTex's 6.klten� HOME ADDRESS 71q In�ShOICtI'i S°F A,pt 7g Is your home address (listed above) within the corporate limits of Iowa City? [A Yes ❑ No How long have you been a resident of Iowa City? Gender: Male El Female OCCUPATION Luc ,n ' /�GM�xcS t,70,r IC EMPLOYER L�L.(l il,�Ps�,y%I,, c,k Ec! 1. PHONE NUMBER: HOME GO S - aS) --Gd %O BUSINESS 31 q- 335- ot? l a3 EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: vin c-u -MG1tfq pursc4Vi , ce-ri-i `co tin, Y1- P t� c�, . . �� 1 f h/ C�( S%r&G Cx.-. 5. �1�e, be.�n n U01 i n �erCn. f- aver► Is &6 -Lf c, 41x-1 K. � Cr6oy kDclvt on aduocct oAd ofcnielvli� WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? ihe, cc "n �eCS O r �s-ts ern. � i` rK c� r��cx 1 a,C ckcca -h c� %& 1� r ou i dM ice- 0- -CA r�s +-o Abe. XOL pr`s �► t wn cL ti.-lose- L fn© ryv a.y hct L e elcV1bbe1C,Cd hrqN2-'% (�Ah +s Y2 012Zfi brks . WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)? .ice b& e� -Y1 YLLF , C-On can t b k) bv. cR, �/ �,`r- -P, k t- ,5 or1� oJoUCA;Yi'ln +o9, OF 1�(�nCm i'1�S w cue rs cam. c� co.. � ) - c�, b � •1n � q LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information reaardinp Conflict o resF IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? Yes -No ":%-) "}¢ DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD O COMMISSION? FqYes 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 answer all the questions, Council may not consider your application. Human Rights Commission Application June 2012 Page 2 of 8 BOARD, COMMISSION, & COMMITTEES BUSINESS LISTING W��.:. 0 CITY OF IOWA CITY Name of City _ Board /Commission /Committee damQo 'A1\akfs Date Name Alex i h..fx eL[ I r 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 r-3 •t✓ ���. i "� +.�zcnr.a iNj ... :r NOTE: A new form must be completed if the above information changes or an ownership interest ihs_acquired in ap.additiorlal business. Signature Address 111WRIFS 11 Misrepresentations on this application will constitute just cause for removal of an appointee. II you fail to answer all the questions, Council may not consider your application. Human Rights Commission Application June 2012 Page 3 of 8 TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective February 9, 2012 Household Size 30% Median Income (Poverty Level) 50% Median Income 60% Median Income 80% Median Income (low income) Median Income 1 $16,900 $28,150 $33,780 $45,000 $56,300 2 19,300 32,150 38,850 51,400 64,300 3 21,700 36,150 43,380 57,850 72,300 4 24,100 40,150 48,180 64,250 80,300 5 26,050 43,400 52,080 69,400 86,800 6 28,000 46,600 55,920 74,550 93,200 7 29,900 49,800 59,760 79,700 99,600 8 31,850 53,000 63,600 84,850 106,000 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. '.- rZILU/ 11 Gender Income (see table) illcpN ►� Sexual Orientation Other (Please explain below) Human Rights Commission Application June 2012 page 4 of 8 ' ' Religion Disability Lo Race, color or ethnic group National origin t.j Q , �. cs, _v iwJ J _ x NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMITTEE: PUBLIC ART ADVISORY COMMITTEE One Vacancy — Three -Year Term January 1, 2013 — January 1, 2016 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 7, 2012. 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: 3 Council Announcement Date: September 18, 2012 Application Deadline: Wednesday, 5:OOp.m., November 7, 2012 Council Appointment Date: November 13, 2012 After 12/17/2012 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. PUBLIC ART ADVISORY COMMITTEE One vacancy — Three -Year Term January 1, 2013 — January 1, 2016 Term expires for Mark Seabold Gender Balance Requirement: 1 Male No applications as of Wednesday, 5:OOp.m., November 7, 2012 0 Denotes applicant completed the Confidential page of the application. 79e Z NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: SENIOR CENTER COMMISSION Three Vacancies — Three -Year Terms January 1, 2013 - December 31, 2015 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 7, 2012. 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. i zoox II m II II n u zzDDv o�3M(D� m mall . Q(3Q n ((D N Q -< v CO) 3 C 0 N n (D (CD no 00 �3 w fp 3 3� D� C (c U) K N � O_ N ai o � ° a) (A C 3 2 7C (D (D 3 fl1 (D O >v p� r- O Q 3 fD (D _ fD 3 >v O O 3 O Vl L 3 _ fQ 7 70C 3 (Q N N N N N N N w w w w w w w rn N W W N mx x i x x x CD x x x x x x m mx x x x x x CA mm x x x x x F3 x x x x x x m y Z, x x x x x x x j co x x x x x x m CD co N O O O N O -< v CO) 3 C 0 N n (D (CD no 00 �3 w fp 3 3� D� C (c U) K N � O_ N ai Spouses and relatives of City Council Members and members of comparable County Boards and Commissions are not eligible for appointment to City Boards and Commissions. This includes: spouse, child, mother, father, mother- in- law, father- in- law, brother, sister, brother- in- law, sister- in- law, step- father, step- mother, step - child, aunt, or uncle. (Resolution 85 -354) Males: 3 Females: Council Announcement Date: September 18, 2012 Application Deadline: Wednesday, 5:OOp.m., November 7, 2012 Council Appointment Date: November 13, 2012 After 12/17/2012 (3 mo from the announcement date) Council may appoint any qualified applicant without regard to gender. SENIOR CENTER COMMISSION Three vacancies — Three -Year Terms January 1, 2013 — December 31, 2015 Term expires for Charles Felling, Daniel Benton, Sarah Maiers Gender Balance Requirement: 2 Females, 1 None (M) Charles Felling EI (Currently serving 2nd full term) 825 South 7th Ave (F) Kathy Mitchell I] 722 Iowa Ave EI Denotes applicant completed the Confidential page of the application. City of Iowa City r i Advisory Board /Commission /Committee t -iplication Form CITY OF 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 1 ► 0 r ! I I ' ' 7' G) 17111 L11 s i &,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 lb '14'11'e- �`c', f �i /�c; HOME ADDRESS V ):5 Is your home address (listed above) within the corporate limits of Iowa City? � Yes No How long have you been a resident of Iowa City? 0� il!c'G Y Gender: 19I,ale Fem ?? OCCUPATION EMPLOYER PHONE NUMBER: HOME . :j / i 6 99 y BUSINESS EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITt6:k-:� y b ,.7) , y,-, 1�-4 �:• � !�,�" , �_!w (G �. � I"r 1. `f' r�C /v ; S �� �. C e: L/.J, h -i i ��- �'�'e.. �° %6i S �� WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? l)Glii/� j tv Cx ►v C' /V �� %J7�.nl f� r r3 �JI� J'� ��i ��, LJ -4• c_yG = >1i iis.isif, WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FOR APPLYING ? �� 1 / /-' '! lug Sri � / i'� � Jam, -ti �-✓ �a� �� y-�� �J -i,.�` •-er 1 �, i•'� / 1Y ,j•44 4 < < fj 2xei -v' 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 F—] No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? YesNo (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 answer all the questions, Council may not consider your application. General Application June 2012 Page 2 of 7 lel BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING b --'" Mair Lot %_W 0—W! iL4 CITY OF IOWA CITY Name of City Board /Commission /Committees j� "`j' `�'�L 3` '��� 1 Date Name (_/ " 1a ��`' S �" wxi 0C-� /v , ,.. , �2 c j� ef" 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 • V NOTE: A new form must be completed if the above i acquired in an additional "bA ,5ipess. Applicant Signature Signature of parent/guardian (Youth Address � '� :s-- r o formation changes or an ownership interest is Commission o jaw / -7 (J e k2a -e Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application June 2012 Page 3 of 7 City of Iowa City r, r 1 �_.:. ®� 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 O FOR ANY VACANCY DURING THAT THAT TIME. Advisory Board /Commission /Committee Name 6J NIQR CCNl(-Z eQMM 1 y51�%/y Term NAME KRI111 rn i HOME ADDRESS 7Z% J�QW)� 000 IC �aqo 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? 1 9715 Gender: Male F] Female OCCUPATION ^ F�1RC I Clay 3Z `��% �� EMPLOYER W AI& PHONE NUMBER: HOME ? Iq � � � - n 150 BUSINESS NONC -- EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: I- RAA A r ne T "F f w- loP cwag . 1 iqm m li',c-m fjLlp, o m� 0uTR6Pq Commirr( -6 AND UlcZ- -C1-mg or -ri* 5Fu-R1WQ C0MmIt7zt- ( &CCz9 j3op�)• NIT �eaR, S w1u Nc; clmR or VK 5W11\1G 'Cnmmirrcz _� WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?. WeU A5 ] SC�vIU� CC�IIZ� 17fRC -�Ta� T� -,j-� y�- C)o K A5 o ff, Ts r/)v iti E5, WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FCUq APPLNgNG ? w �L I W6W BIKE tv 4 mr Re oc -r -wi rg I CR&O r>I poocl &s r lac -Nc-FI cl n2 f nt Ct� r&9 t- W 1 me rn pcgs 1� i M LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Con _iei=of Interesfl,- J; IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? [n Yes F-1 No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? DYes gNo (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 October 2012 Page 2 of 7 BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING Name of City Board /Commission /Committee 5 IOR C-e�AR bnrn155)QV Name � r CITY OF IOWA CITY Date I I— T Z- Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached (see page 7). List all businesses in which you, or your spouse /domestic partner, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS NOTE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business. Applicar Address Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council may not consider your application. General Application October 2012 Page 3 of 7