HomeMy WebLinkAbout2014-11-04 Appointment10a
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD:
BOARD OF ADJUSTMENT
One Vacancy — Five — year term
January 1, 2015 — Ending January 1, 2020
Duties: In appropriate cases and subject to appropriate conditions and safeguards, the Board
may make special exceptions to the terms of the Zoning Chapter in harmony with the general purpose and
intent of the ordinance and in accordance with general or specific rules contained therein. The Board may
grant variances to the Zoning Chapter only in the case of "unnecessary hardship." The hardship must be
substantial, serious, real, and of compelling force, as distinguished from reasons of convenience,
maximization of profit or caprice. The Board may also hear and decide appeals where it is alleged there is
an error in any order, requirement, decision, or determination made by a City official in the enforcement of
the Zoning Chapter.
Iowa City appointed members of boards and commissions must be eligible electors of the City of
Iowa City. The Board meets the second Wednesday of each month at 5:00 p.m.
Applications must be received by 5:00 p.m., Wednesday October 22, 2014. 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: 3
Females:
Council Announcement Date: September 16, 2014
Application Deadline: Wednesday, 5:00 p.m., October 22, 2014
Council Appointment Date: November 4, 2014
After 12/15/2014 (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, 2015 - January 1, 2020
Term expires for Constance Goeb
Gender Balance Requirement: 1 Female
No Applications as of Wednesday, 5:OOp.m., October 22, 2014
El Denotes applicant completed tOhe Confidential page of the application.
11 -04 -14
10b
a
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD:
CITIZENS' POLICE REVIEW BOARD
One Vacancy — Unexpired Term
Effective Upon Appointment — September 1, 2015
Duties of the Citizens' Police Review Board include reviewing Police Department investigations into
allegations of misconduct lodged against police officers, conducting further investigation of the complaint
when the Board deems it necessary, and issuing a public report which explains why and the extent to
which the complaint is sustained or not sustained; maintaining a central registry of complaints against
sworn police officers and issuing annual reports regarding the disposition of the complaints to the City
Council; reviewing police policies and practices from time -to -time and recommending changes to the City
Council when the Board deems it appropriate.
Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa
City. However, the City Council reserves the right to waive the residency requirement for good cause
shown. The City Council also reserves the right, for good cause shown, to waive the requirement that the
Board include one current or former "peace officer" as that term is defined by State law.
Applications must be received by 5:00 p.m., Wednesday, October 22, 2014. 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 Police Citizens' Review Board should be directed to Marian Karr or
Kellie Tuttle at 356 -5041.
10/28/2014
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 16, 2014
Application Deadline: Wednesday, 5:00 p.m., October 22, 2014
Council Appointment Date: November 4, 2014
After 12/15/2014 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
** Appointments to the Board shall include one current or former "peace officer"
as that term is defined by State law. The City Council reserves the right, for
good cause shown, to waive the requirement that the Board include one
current or former peace officer.
** The City Council also reserves the right to waive the residency requirement for
good cause shown.
CITIZENS' POLICE REVIEW BOARD
One Vacancy - Unexpired Term
Effective Upon Appointment — September 1, 2015
Maxime Tremblay resigned(see attachment)
Gender Balance Requirement: 1 Male
(M) Cody J Shafer [H]
2109 Davis St.
(M) Fidencio Martinez Perez rx-1
905 W. Benton St., Apt 26
(M) Donald King 0
2374 Kristian St.
El Denotes applicant completed the Confidential page of the application.
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 Citizens Police Review Board Term Available
NAME Cody J. Shafer
HOME ADDRESS 2109 Davis Street, Iowa City 52240
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 Months Gender: Male F6/1 Female
OCCUPATION Health Educator
PHONE NUMBER: HOME 319- 325 -1883
EMPLOYER Johnson Coun
BUSINESS 319 - 688 -5890
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
(hile a student at UI, I served on the executive team of the Gay, Lesbian, Bisexual, Trans & Allied Union, The
iversity Chairperson of UI Student Government, and the founder of the Cross Cultural Center Coordinating Council.
irice then I have worked in HIV prevention and education - working with various popualtions from disproportionately
ipacted minorities to HIV - positive injection drug users. I have a personal interest in current events, local politics,
id police activity that has kept me informed and engaged in the current climate /perception of the local police
7aartment.
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
citizen's police review board meets to discuss complaints against the Iowa City Police Department and to make
)mendations on policy and procedure issues as they relate to the operations of the ICPD. In recent months the
rd has been discussing the documentation of police stops not resulting in the issuance of citations as well as the
sibility of unfavorable scrutiny of minority populations.
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)?
I believe that my broad experience, which spans many populations, would be a value to the review board. As a
recent resident of the south side of Iowa City, I've become increasingly aware of a police presence and my interest in
police activity has increased as well. I fundamentally respect the work that the police do in our community but believe
that we have to work together as a community to find balance and protect the rights of our citizens.
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest
None.
r--.a
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? Yes y`p 'lo 7
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMIWION -?- s W1 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 ofian,appointee�f you fail
to answer all the questions, Council may not consider your application.
General Application
May 2014 Page 2 of 7
BOARD, COMMISSION AND COMMITTEES
BUSINESS LISTING
Name of City
Board /Commission /Committee Citizens Police Review Board
Name Cody J. Shafer
► r
CITY OF IOWA CITY
Date 09/19/2014
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of
a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached
(see page 7).
List all businesses in which you, or your spouse /domestic partner, have an ownership interest
(for example, sole proprietor, partner, 5% or more of corporation's stockholdings).
Please indicate if there are none.
BUSINESS NAME
BUSINESS ADDRESS
None.
S-2
-ssor
cn
NOTE: A new form must be completed if the above information changes or an ownership interest is
acquired in an additional business.
Applicant Signature 6 '
Address 2109 Davis Street, loV9 City 52240
Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail
to answer all the questions, Council may not consider your application.
General Application
May 2014 Page 3 of 7
Cody J. Shafer
2109 Davis Street
Iowa City, Iowa 52240
319 - 325 -1883 1 cody.j.shafer @gmail.com
09/19/2014
To Whom It May Concern:
Please find enclosed my application form for the Citizen's Police Review Board.
Thank you, in advance, for your consideration of my application. Please do not hesitate to
contact me at your convenience should you have any questions or require clarification on
any of the answers that I have provided.
I look forward to hearing from you.
In Service,
Cody JtSafer
r',
C7
Marian Karr
From: Cody Shafer <cody.j.shafer @gmail.com>
Sent: Saturday, September 20, 2014 10:10 AM
'o: Council
Subject: Citizens Police Review Board Applicant
Attachments: Citizens Police Review Board Application - Cody Shafer.pdf
Good Morning Council Members -
My name is Cody Shafer and I am writing to you today as a follow up to the application that I have submitted
for your consideration to fill the vacancy on the Citizens Police Review Board. I've attached a PDF copy of my
the application that I submitted to the City Clerk on 9/19/14 for your review.
I originally moved to Iowa City in 2005 to attend the University of Iowa where I studied political science.
During my time in school I was a leader of the University's Gay, Lesbian, Bisexual, Trans and Allied Union, the
Diversity Chairperson of UI Student Government, I managed media relations for the 10,000 Show volunteer
project and led efforts to unite the UI culture centers. I also worked with the Belin -Blank center to provide high
level education to talented and gifted primary and secondary school students and volunteered with the local HIV
program through the Johnson County Public Health Department.
My volunteerism eventually led to a career in the field of HIV education, prevention and testing. I left Iowa
City in 2011 to work with an AIDS Service Organization (ASO) in Denver, Colorado. Upon my return to the
Iowa City area in 2012, I became the Health Educator for HIV and Hepatitis programs with the health
department and resided in Coralville.
his past July I returned to Iowa City proper - where I rent a duplex on the Southeast side of Iowa City. As a
resident of this area I've become increasingly aware of the great work that the Iowa City Police Department and
the City is doing in this area. I'm familiar with the challenges that the police face in my own neighborhood and
appreciative of the work that they do.
As someone with a strong history of public service and volunteerism, it would be an honor and a pleasure to
serve my community in this capacity. I realize that the application is a vague document - so I welcome your
inquiries should you desire any additional information.
Thank you, in advance, for your consideration in regards to this appointment. I look forward to hearing from
you in the future.
In Service,
Cody J. Shafer
Cody J. Shafer
"The smallest good deed is better than the greatest intention."
City of Iowa City 1 r 1
Advisory Board /Commission /Committee;
nplication 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 Citizens Police Review Board Term Nov. "4- Sept. '15
NAME Fidencio Martinez Perez HOME ADDRESS 905W. Benton St. Apt 26
Is your home address (listed above) within the corporate limits of Iowa City? W Yes ❑ No
How long have you been a resident of Iowa City? 1 year Gender: Male Q Female
OCCUPATION Graduate Student, Instructor, Artist EMPLOYER The University of Iowa
PHONE NUMBER: HOME (910) 442 -7836 BUSINESS ----------
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
Since I moved to Iowa City I have been an active member of the Center for Worker Justice. All through -out high school I h
participated in volunteer groups, whether it be raising money for the Special Olympics, volunteering for Junior Civitans, H
Society volunteering, Relay for Life and so on.
r
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? `rt'
I don't know much but would love to learn as much as possible. I want to be an active member of tfTiaea tful c;W6nity an
my part --{
to try and make it better.
4 vJ
� \� _•Ar
I bring many unique perspectives to the board. I am brown, gay and young so I think all of these things have shaped who I am today, yet, I
know that many times things are are not just black or white. I think all of my experiences have shown me that even though sometimes
we think we know something or someone, the reality is much more complex.
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 ❑ No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? F-] Yes ❑✓ No
(it' s 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
May 2014 Page 2 of 7
BOARD, COMMISSION AND COMMITTEES.,""��
IR
BUSINESS LISTING,,
CITY OF IOWA CITY
Name of City
Board /Commission /Committee Citizens Police Review Board Date October 20, 2014
Name Fidencio Martinez Perez
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of
a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached
(see page 7).
List all businesses in which you, or your spouse /domestic partner, have an ownership interest
(for example, sole proprietor, partner, 5% or more of corporation's stockholdings).
Please indicate if there are none.
BUSINESS NAME
BUSINESS ADDRESS
None
P
NOTE: A new form must be completed if the above information changes or an ownership interest is
acquired in an additional.business.
Applicant Signaturef' ,fit
Address 905 West Benton St. Apt. 26
,iisrepresentations 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
May 2014 Page 3 of 7
City of Iowa City I r
m6Z-4,
Advisory Board /Commission /Committee �; -��� t
%
®,
1pplication 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 c r Term / -/
NAME A L' l` ~� w , HOME ADDRESS-,} 7 y ,q
Is your home address (listed above) within the corporate limits of Iowa City? Yes Fj No
How long have you been a resident of Iowa City? _u.c. --;�Jf> 1 Gender: Male /2 Female
OCCUPATION S��►�� EMPLOYER
PHONE NUMBER: HOME 31 Ct EN L(-'% L-Ac�0 BUSINESS
EMAIL ADDRESS: F {1A W Sty •/: s 5 q P YA- ". 0, co"',
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD ?'� �-
t _C3
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)?
/11A Imo--
_4 l ( iM c=F-� . 5
; k
�-L. rl �� w..s T a-, V % z
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? Z/ Yes r-] No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes KrNo
(It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.)
Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail I
to answer all the questions, Council may not consider your application.
General Application
May 2014 Page 2 of 7
1 l i
BOARD, COMMISSION AND COMMITTEES•,`10�'�
Mom
BUSINESS LISTING
CITY OF IOWA CITY
Name of City p
Board /Commission /Committee C Date
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, 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.
Applicant Signature
Address C;Mv
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
May 2014 Page 3 of 7
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10C
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
HUMAN RIGHTS COMMISSION
Three Vacancies — Three -Year Term
January 1, 2015 - January 1, 2018
Duties of the Commission include: 1) disseminating information to educate the public on
illegal discrimination and civil rights, such as organizing and facilitating educational public
forums that address one or more of the broad range of topics included within the rubric of
human rights; 2) making recommendations to the City Council for such further legislation
concerning discrimination as it may deem necessary and desirable; 3) cooperating within the
limits of any appropriations made for its operation with other agencies or organizations both
public and private whose purposes are not inconsistent with those of Title 2 of the City Code
(Human Rights Ordinance) and; 4) planning programs and activities designed to eliminate
racial, religious, cultural and other intergroup tensions including but not limited to sex, color,
creed, disability, gender identity, sexual orientation, marital status, age, and national origin.
Iowa City- appointed members of boards and commissions must be eligible electors of the
City of Iowa City. The Human Rights Commission meets the third Tuesday of each month at
6:00 p.m. in the Lobby Conference Room at City Hall, 410 E. Washington Street.
Applications must be received by 5:00 p.m., Wednesday, October 22, 2014. 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.
Spouses and relatives of City Council Members and members of comparable
County Boards and Commissions are not eligible for appointment to City Boards
and Commissions. This includes: spouse, child, mother, father, mother- in- law,
father- in- law, brother, sister, brother- in- law, sister- in- law, step- father, step-
mother, step - child, aunt, or uncle. (Resolution 85 -354)
Males: 5
Females: 1
Council Announcement Date: September 16, 2014
Application Deadline: Wednesday, 5:00 p.m., October 22, 2014
Council Appointment Date: November 4, 2014
After 12/15/2014 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
HUMAN RIGHTS COMMISSION
Three Vacancies — Three Year Term
January 1, 2015 - January 1, 2018
Term expires for Kim Hanrahan, Shams Ghoneim, and Stella Hart
Gender Balance Requirement: 3 Females
(M) Richard Bartlett 121
228 Raven St.
(F) Shams M. Ghoneim
1104 Wylde Green Rd.
(F) Stella Hart
608 Normandy Dr.
(F) Latisha Nichole McDaniel
331 Willow Wind Place
(M) Douglas Korty
250 Morgan Court
(F) Megan Schwalm
2834 Whispering Meadow Dr.
(F) Sarah Witry
816 Dover St.
0(Currently serving 1gt 3 year term)
0(Currently serving an unexpired term)
a
(F) Kim Hanrahan 0(Currently serving 1gt 3 year term)
435 Grant St.
0 Denotes applicant completed the Confidential page of the application.
Marian Karr
From:
Harry Olmstead <HarryO3 @aol.com>
Sent:
Wednesday, October 29, 2014 8:02 PM
To:
Council
Cc:
Stefanie Bowers
Subject:
Human Rights Commission Applicants
This correspondence will become a public record.
Dear Mayor and Council Members: I am the current chairperson of the Iowa City Human Rights Commission, but I'm not
writing on the commission's behalf because this was not discussed with them. I feel compelled to write in support of the
three current commissioners whose terms expire at the end of this year and all three have re- applied to be reappointed
to the Iowa City Human Rights Commission. Having worked with each of these commissioner during their term on the
commission I can unequivocally attest to their hard work, keen insights, dedicated involvement, and willingness to serve
has made for a Human Rights Commission that has been able to offer many outstanding programs for our city which we
are all proud of. The three commissioners I'm referring to are: Shame Ghoneim who brings vast knowledge, diversity,
and involvement in many community organizations including being on the Iowa City Press Citizen editorial board and
president of the ACLU, Kim Hanrahan who came right on board and accepted responsibilities of our immigrants
committee and led the way for the city to have first -hand knowledge of the need to make our city multilingual in its
signage by organizing a group of immigrants to take a tour of city hall, library, and Robert E. Lee recreational center, she
also has brought her knowledge of working with youth from her social worker position at United Action for Youth to our
commission to direct us in better relationship building with the youth of our city, and Stella Hart our newest member
who came to her first meeting and volunteered to be at an educational booth promoting Iowa City Human Rights
Commission, she has gone on outside of the commission to organize very successfully a group of local residents from all
age groups and sexes to recognize the concerns primarily women have of street hackleing, Stella has only been on the
commission a short time finishing an unexpired term of a previous commissioner.
I hope you share with me the need for consistency on the commission and are moved to re- appoint these three
outstanding women commissioners. If you wish to speak to me about any of these commissioners don't hesitate to
contact me at 319- 338 -2931.
Sincerely,
Harry Olmstead
City of Iowa City I r 1
Advisory Board /Commission /Committee i "' 110%
4T
Application Application Form -�-�-
CITY OF IOWA CITY
THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLI
WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED
FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME,
Advisory Board /Commission /Committee Name Human Rights Commission Term
NAME Richard Bartlett HOME ADDRESS 228 Raven Street, Iowa City, IA 52245
Is your home address (listed above) within the corporate limits of Iowa City? I / Yes No
How long have you been a resident of Iowa City? 4year 9months Gender: Male ✓ Female ❑
OCCUPATION IT EMPLOYER Codesta Tech
PHONE NUMBER: HOME 319- 431 -2902 BUSINESS
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
- I have worked with international organizations such as the Uganda Orphans Rural Development Programme, which
is dedicated to aiding children orphaned due to AIDS, as well as other humanitarian organzations througout Africa
and the Middle East.
- I offer experience working with the Vermont Refugee Rescue Association working with Somali- refugees, as well as
experience dealing with Human Rights violations among my own Bedouin tribal family in Morocco and Egypt who
� -e been /are persecuted based on their cultural beliefs and ethicity.
- As stated within the Experience section of this application, I contribute experience, knowledge of Human Rights
violations and how it affects it's citizens, as well as a desire to stand for those very Human Rights being violated.
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? n,/Yes ❑ No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ❑ Yes r,—/]No
(It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.)
Aisrepresentations 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 2014 Page 2 of 8
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
-? —"
o
- Simply, my understanding is exactly as the Commission's mission states:
1) Educate, 2) Recommend, 3) Cooperate, and 4) Plan
CD
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLYING)?
- As stated within the Experience section of this application, I contribute experience, knowledge of Human Rights
violations and how it affects it's citizens, as well as a desire to stand for those very Human Rights being violated.
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? n,/Yes ❑ No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ❑ Yes r,—/]No
(It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.)
Aisrepresentations 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 2014 Page 2 of 8
TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY
Effective March -15, 2013
Household
Size
30% Median Income
(Poverty Level)
50% Median
Income
60% Median
Income
80% Median Income
(low income)
Median
Income
1
$16,060
$26,750
$32,100
$42,750
$53,500
2
18,350
30,550
36,660
48,850
61,100
3
20,650
34,350
41,220
54,950
68,700
4
22,900
38,150
45,780
61,050
76,300
5
24,750
41,250
49,500
65,950
82,500
6
26,600
44,300
53,160
70,850
88,600
7
28,400
47,350
56,820
75,750
94,700
8
30,250
50,400
60,480
80,600
100,800
ATTACHMENT TO APPLICATION FOR THE
HUMAN RIGHTS COMMISSION
It is the mission of the Iowa City Human Rights Commission to protect residents of the city from
discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city
strives to ensure that the Human Rights Commission is representative of the community.
Therefore, "appointments shall take into consideration men and women of various racial,
religious, cultural, social and economic groups in the city." (Ord. 94 -3647, 11 -8 -94)
OPTIONAL:
PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN
CHOOSING AN APPLICANT.
Age
Gender
Income (see table)
Sexual Orientation
Other (Please explain below)
Human Rights Commission Application
January 2014 page 4 of 8
Religion
Disability
Race, color
or ethnic group
National origin
<g�
BOARD, COMMISSION, & COMMITTEES
BUSINESS LISTING
Name of City
Board /Commission /Committee Human Rights Commission
Name Richard Bartlett
�Wame �l
CITY OF IOWA CITY
Date 09/22/2014
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
Codesta, LLC
228 Raven Street, Iowa City, IA 52245
Pq
<"
NOTE: A new form must be completed if the above information changes or an ownership interest
is acquired in an additional business.
Signature
Address 228 Raven Street, 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 2014 Page 3 of 8
City of Iowa City ii r Iii
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 PUBLIi
WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED
FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME.
Advisory Board /Commission /Committee Name Human Rights Commission Term 3 nears
NAME Shams M. Ghoneim HOME ADDRESS 1104 Wylde Green Rd.lowa City,IA.52246
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? 45 Years Gender: Male ❑ Female ❑✓
OCCUPATION Uiniversity of Iowa Retiree EMPLOYER University of Iowa
PHONE NUMBER: HOME 319 - 351 -5045 BUSINESS None
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
am former president ¤t V.President of ACLU -IA board of Directors, serve on the UI Center for Human Rights
advisory board , and a current member of the Iowa City Human Rights Commission. I am the Iowa Coordinator of the
Muslim Public Affairs Council and an EXC member of the Iowa City Mosque and Islamic Center. I am the former
President and current member of the Johnson County Consultation of Religiuos communities and heavily involved in
interfaith dialogue and activities. Serving for the last 3 years on the Iowa City HRC has been a most rewarding
erience for me culminating last year in the joint conference addressing dispropotionate incarceration of Minorities
and addressing racial justice issues. I serve on the Iowa City Press Citizen editorial board allowing me to be a
bridge between the HRC and the local media. Former Chair /Co -Chair of UI Council on Disabiabitt Awareness.
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVI50KY 13OAKU-." P
am current member and my term will expire January 2015.
v '
-s.21 - <
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FOR APPLYiN6 ?
I would like to continue serving Iowa City community in this very important capacity.
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest
None.
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? U Yes U No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? [—]Yes [Z]No
(it has been Council policy not to permit an individual to serve on two Boards or 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
BOARD, COMMISSION, & COMMITTEES
BUSINESS LISTING
Name of City
Board /Commission /Committee Human Rights Commission
Name Shams M. Ghoneim
� r
-NOV .am
CITY OF IOWA CITY
Date 10/01/2014
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. lvo /V
BUSINESS NAME
BUSINESS ADDRESS
i
f+
NOTE: A new form must be completed if the above information changes or an ownership interest
is acquired in an additional business.
Signature �...s /11 G
Address ! I a W y- r-�-�' G-rt4,. ��Q :�T ��1A � S�T�z
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
TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY
Effective March 15, 2013
Household
Size
30% Median Income
(Poverty Level)
50% Median
Income
60% Median
Income
80% Median Income
(low income)
Median
Income
1
$16,060
$26,750
$32,100
$42,750
$53,500
2
18,350
30,550
36,660
48,850
61,100
3
20,650
34,350
41,220
54,950
68,700
4
22,900
38,150
45,780
61,050
76,300
5
24,750
41,250
49,500
65,950
82,500
6
26,600
44,300
53,160
70,850
88,600
7
28,400
47,350
56,820
75,750
94,700
8
1 30,250
50,400
60,480
80,600
100,800
ATTACHMENT TO APPLICATION FOR THE
HUMAN RIGHTS COMMISSION
It is the mission of the Iowa City Human Rights Commission to protect residents of the city from
discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city
strives to ensure that the Human Rights Commission is representative of the community.
Therefore, "appointments shall take into consideration men and women of v�ious racial,
religious, cultural, social and economic groups in the city." (Ord. 94 -3647, 1 1n8 94)x:
8
i'«:+ ➢-� '�"'' ;.rases
OPTIONAL:
PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHfTO
CHOOSING AN APPLICANT. -
FE-70-M
Female Gender
A-boft M � 1 Income (see table)
Sexual Orientation
Other (Please explain below)
Human Rights Commission Application
Muslim Religion
Disability
Race, color
or ethnic group
Egyptian American National origin
City of Iowa City 1, i
®4
Advisory Board /Commission /Committee #; "' -
=1
�ipplication Form -�-m--
CITY OF IOWA CITY
THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC,
WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED
FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME.
Advisory Board /Commission /Committee Name Human Rights Commission Term 2015
NAME Stella Hart HOME ADDRESS 608 Normandy Dr. Iowa City, IA 52246
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? 3 years Gender: Male ❑ Female 0
OCCUPATION Shelter Services Coordinator
PHONE NUMBER: HOME 319 - 899 -8215
EMPLOYER Domestic Violence Intervention Program
BUSINESS
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
- Graduated cum laude from Drake University in Dec. 2011 with a bachelor of arts in English and music
- As a sheter services coordinator at DVIP, I provide legal, housing and employment advocacy to survivors of
domestic violence and their children
- I have served as a crisis line volunteer with the Johnson County Crisis Center since Spring 2014
I have served as a Medical Consultant at the Patient Education Institute for 3 years, writing,,healthzinformation for
,w literacy audiences
- I have served as a direct support professional with Systems Unlimited for 2 years '� --►
O
VVHA1 15 YUUK F'KtStN 1 KI ILMLtIOUL UI- I NIZi AUVIJUKT MJAKU !
have served on the Human Rights Commission since June 2014. The Human Rights Commission -advocafes for
social equality and the end of discrimination through the education and protection of the public, makii g
recommendations to the City Council as needed.
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FOR APPLYING ?
I think that it's important for young, working people to be represented in city government. I will take the concerns of
the public seriously and keep an open mind to all perspectives. I will strive to offer a thoughtful opinion and
collaborate with fellow commissioners to best serve the interests of our community.
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 ❑ No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ❑ Yes F,/]No
(It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.)
Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail
to answer all the questions, Council may not consider your application.
Human Rights Commission Application
January 2014 Page 2 of 8
BOARD, COMMISSION, & COMMITTEES
BUSINESS LISTING
Name of City
Board /Commission /Committee Human Rights Commission
Name Stella Hart
I k 1
4�
- �►a.as._
CITY OF IOWA CITY
Date 10/06/2014
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
CO
09
NOTE: A new form must be completed
is acquAd in an additional bust
Signature
Address 608 Normandy Dr. Iowa City, IA 52246
ab ,qve information changes or an ownership interest
Misrepresentations on this application will constitute just cause for removal of an appointee.
If you fail to answer all the questions, Council may not consider your application.
Human Rights Commission Application
January 2014 Page 3 of 8
TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY
Effective March 15, 2013
Household
Size
30% Median Income
(Poverty Level)
50% Median
Income
60% Median
Income
80% Median Income
(low income)
Median
Income
1
$16,060
$26,750
$32,100
$42,750
$53,500
2
18,350
30,550
36,660
48,850
61,100
3
20,650
34,350
41,220
54,950
68,700
4
22,900
38,150
45,780
61,050
76,300
5
24,750
41,250
49,500
65,950
82,500
6
26,600
44,300
53,160
70,850
88,600
7
28,400
47,350
56,820
75,750
94,700
8
30,250
50,400
60,480
80,600
100,800
ATTACHMENT TO APPLICATION FOR THE
HUMAN RIGHTS COMMISSION
It is the mission of the Iowa City Human Rights Commission to protect residents of the city from
discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city
strives to ensure that the Human Rights Commission is representative of the community.
Therefore, "appointments shall take into consideration men and women of various racial,
religious, cultural, social and economic groups in the city." (Ord. 94 -3647, 11 -8 -94)
nPTInIMAI
PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN
CHOOSING AN APPLICANT.
24 Age
Female Gender
I 32,000 Income (see table)
Sexual Orientation
F-10ther (Please explain below)
Unaffiliated Religion
None Disability
White Race, color
or ethnic group
American .,National origin
Human Rights Commission Application
January 2014 page 4 of 8
10/16/2014 09:46 FAX 3193533003 UIHC IA 003/007
City of Iowa City _ I r
Advisory Board /Commission /Committee Azi- IAM ,
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 CONSIDEFED
FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME.
Advisory Board /Commission /Committee Name -liYY an 1h) M 111ISS1 nTerm
NAME l a '1 C1 l h ennr -I)a Ce.1HOMEADDRESS 331 v� X60 wino P C1?
Is your home address (listed above) within the corporate limits of Iowa City? 2Yes No
How long have you been a resident of Iowa City? Gender: Male ❑ Female ET
OCCUPATION eSes— tc( h—IQCy C :b a EMPLOYER U"'j JQ12Sj I�_(J�Ot
PHONE NUMBER: HOME 2t-q - (03'Z —30( _.1 BUSINESS a9- -Sg g — ,�JLLA _
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
J �1ays? be,rcrl a Go rn mu n i o r �a n i PX' �i n CQ, 2 c� r O t�
)n 1XIkas cts an C;dvccC'a�2 r he e crime Vk(A whc� ulA3
-!ar Wed -(or bel ng �". SpnGe t-ha t , .L have dv -9cLr isec' arogvAd
I.S N-eS wch as I"f r-r ca v " U\, ; mrru,g i- on r&rra, WAat OASc u
plo - abor -t on r t5VI15 and rOL -OCL ( ' u �l i C� , T had Ok -10 vii
'1, �ormrl�
:reVGI(JCCgh, Mf) 164 rr1OULlo1'1�-�1 r%irinr -ifiv uitovkan,4 A. IAaciAbr7rD. ouDni-
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
No p(Qsen4 >�� (edge. o� 4te, t V-, CovnmisAo h
2 ww-A 4.0 4-ake- aL( o� the 4-hof Vve Vtad w4h OrgQMirl -,
ard W (nydj-e d +-1' a 6 ) (eve.IY 7 ` irir m� VWWO, cjou W p6179 �.
mucb-geeded,
LIST POTENTIAL CONFLICTS OF INTEREST: See page 7 for information renardina Conflict of Interest
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? 12Yes ❑ No w?
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSI6--;E' ' Re es` ` _No
(It has been Council policy not to permit an individual to serve on two Boards or Commissionis-�t,tlle tirne,)
Misrepresentations on this application will constitute just cause for removal of anaap. intee. If j�o4 fail
to answer all the questions, Council may not consider your application.
. -%I.— , •rr...,........
January 2014 Page 2 of 8�
10/16/2014 09:46 FAX 3193533003 UIHC Z 004/007
Name of Citv
Board
Name
� r
BOARD, COMMISSION, & COMMITTEES
BUSINESS LISTING 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.!i
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 I BUSINESS ADDRESS
c
NOTE: A new form must be completed if the above information changes or an� 6yvnershiP inters t
is acquired in an additional business.. -� -
Signature
Address �� I �NI ho W1Y\oI ���CI`�a 522.1
Misrepresentations on this application will constitute just cause for removal of an appointee.
If you fail to answer all the questions, Council may not consider your application,
Human Rights Commission Application
January 2014 Page 3 of 8
10/16/2014 09:46 FAX 3193533003 UIHC
0005/007
TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CIS �
Effective March 15, 2013
Household
Size
30% Median Income
(Poverty Level)
50% Median
Income
609 Median
Income
80% Median Inco.me�
(low income)
"' Meq(an
=.Y Income%
1
$16,060
$26,750
$32.100
$42,750
2
3
18,350
20,650
30,550
34.350
36,660
41,220
48,850
54,950
61,100
68,700
4
22,900
38,150
45,780
61,050
76,300
5
24,750
41,250
49,500
65,950
82,500
6
26.600
44,300
53,160
70,850
88,600
7
28,400
47,350
56,820
75,750
94,700
8
30,250
50,400 1
60,480
80,600
100,800
ATTACHMENT TO APPLICATION FOR THE
HUMAN RIGHTS COMMISSION
It is the mission of the Iowa City Human Rights Commission to protect residents of the city from
discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city
strives to ensure that the Human Rights Commission is representative of the community.
Therefore, "appointments shall take into consideration man and women of various racial,
religious, cultural, social and economic groups in the city." (Ord. 94 -3647, 11 -8 -94)
OPTIONAL:
PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN
CHOOSING AN APPLICANT.
Age
Gender
d Q Income (see table)
L?A)4eWCfl I Sexual Orientation
Other (Please explain below)
Human Rights Commission Application
January 2014 page 4 of 8
� �� M I M � 0 - M.
Disability
Race, color
or ethnic group
4i'11RX 1 C,QfN
National origin
City of Iowa City
Advisory Board/Commission/Committee,.'
Application Form CITY O
CITY OF IOWA CITY
THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC,
WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED
FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME.
Advisory Board /Commission /Committee Name Human Rights Term
NAME Douglas Korty HOME ADDRESS 250 Morgan Court
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? 11 Months Gender: Male ❑✓ Female ❑
OCCUPATION Research EMPLOYER Self Employed
PHONE NUMBER: HOME 319 - 333 -1488 BUSINESS 319 - 333 -1488
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
I worked in the civil rights movement in 1964 and 1965 in Mississippi and Tennessee. I have supported civil rights
and cvil liberties organizations. I have worked in government at local, state and federal levels. I once worked for a
congressional commission headed by Neslon Rockefeller and Edmund Muskie. I have done research on health care
policy for government agencies and nonprofits. I have done research during my career on many related issues and
have created educational websites. For example, I have websites on Race, Humanism, Affordable Housing,
Corruption, Equal Opportunity, Labor Movement, Social Democracy, Eldercare, Mental Health, Human Rights,
Refugees, Womens Rights, Finding Work, Abortion Debate, Democracy, Indigenous Americans, Law, Non Profit
Organizations, Progressives, Sociology and Violence.
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
I understand that the Board resolves complaints involving discrimination in Iowa City and provides public outreach on
the issue. Discrimination is unlawful and the complaint process continues until resolved.
MAKE TO THIS
I have expertise in research and statistical analysis and a great deal of experience in related sGbjec� I haVgbeen
interested in and committed to civil rights and human rights throughout my life.
ro
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict -6ll lnter�st =
None
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? [Z ]Yes "No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ❑Yes ZNo
(It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.)
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 2014 Page 2 of 8
BOARD, COMMISSION, & COMMITTEES
BUSINESS LISTING
Name of City
Board /Commission /Committee Human Rights
Name Douglas Korty
� C
Al
CITY OF IOWA CITY
Date 10/20/2014
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
NOTE: A new form must be completed if the above information changes or an ownership interest
is acquired in an additional business.
Signature
Address 250 Morgan Court, IowaJCity, IA 52240
Misrepresentations on this application will constitute just cause for removal of an appointee.
If you fail to answer all the questions, Council may not consider your application.
Human Rights Commission Application
January 2014 Page 3 of 8
TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY
Effective March 15, 2013
Household
Size
30% Median Income
(Poverty Level)
50% Median
Income
60% Median
Income
80% Median Income
(low income)
Median
Income
1
$16,060
$26,750
$32,100
$42,750
$53,500
2
18,350
30,550
36,660
48,850
61,100
3
20,650
34,350
41,220
54,950
68,700
4
22,900
38,150
45,780
61,050
76,300
5
24,750
41,250
49,500
65;950
82,500
6
26,600
44,300
53,160
70,850
88,600
7
28,400
47,350
56,820
75,750
94,700
8
30,250
50,400
1 60,480 1
80,600 1
100,800
ATTACHMENT TO APPLICATION FOR THE
HUMAN RIGHTS COMMISSION
It is the mission of the Iowa City Human Rights Commission to protect residents of the city from
discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city
strives to ensure that the Human Rights Commission is representative of the community.
Therefore, "appointments shall take into consideration men and women of various racial,
religious, cultural, social and economic groups in the city." (Ord. 94 -3647, 11 -8 -94)
OPTIONAL:
PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN
CHOOSING AN APPLICANT.
71 Age
male Gender
3 Income (see table)
hetero Sexual Orientation
F1Other (Please explain below)
Human Rights Commission Application
January 2014 page 4 of 8
no formal religion Religion
none Disability
1white
Race, color
or ethnic group
US
National origin
7
City of Iowa City r i
Advisory Board /Commission /Committee;,-- "';
Npplication Form
CITY OF IOWA CITY
THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC,
WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED
FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME.
Advisory Board /Commission /Committee Name Human Rights Commission Term 1/15 -1/18
NAME
Megan Schwalm HOME ADDRESS 2834 Whispering Meadow Drive
Is your home address (listed above) within the corporate limits of Iowa City? �/❑ Yes ❑ No
How long have you been a resident of Iowa City? 5 years Gender: Male ❑ Female k/
OCCUPATION Diversity Consultant and Trainer EMPLOYER Self- Employed
PHONE NUMBER: HOME 319- 936 -8656 BUSINESS 319 - 936 -8656
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
The majority of my work experience has focused on human rights and social justice, including my work as Diversity
Coordinator for the University of Iowa. I currently provide independent consulting and training relating to diversity
and cultural competency. I was Chair of the Coalition for Racial Justice and am heavily involved in the community,
specifically relating to issues of social justice. I have a great deal of experience facilitating educational forums that
address human rights issues, both at the University and in the community. Much of my work experience has
icluded planning programs and activities designed to eliminate racial, religious, cultural and other intergroup
.ansions. In addition, I am a single mother of a child with special needs. Parenting a child with special needs has
increased my awareness and advocacy skills around issues of ability.
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
I am very familiar with the Commission as I have done community work with Stefanie Bowers and other members of
the commission. I read the monthly meeting minutes from the Commission so I am aware of issues they are
currently addressing, including amending the Human Rights ordinance, planning of the Human Rights Breakfast, and
representing the Commission at a plethora of local events.
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FORAPPLYING)?
Through my PhD coursework and research, my community work, and my professional work, I have gained a great
deal of knowlege about discrimination and human rights and have also had the opportunity to hone my public
speaking skills. I am an experienced trainer and educator and can use those skills to enhance the current work of
the Commission. In addition, I will bring a younger perspective to the Commission.
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest
None
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? 0 Yes
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISS19pi? l i sj V]No
(it has been Council policy not to permit an individual to serve on two Boards or Comm issi hni -_bt the same - time.)
Misrepresentations on this application will constitute just cause for removal of 6h appointee. If you fail
to answer all the questions, Council may not consider your application.
Human Rights Commission Application
January 2014 Page 2 of 8
BOARD, COMMISSION, & COMMITTEES
BUSINESS LISTING
Name of City
Board /Commission /Committee Human Rights Commission
Name Megan Schwalm
� r
"m`' "
CITY OF IOWA CITY
Date
9/29/2014
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 2834 Wh
Meadow Drive, Iowa City, IA 52240
Misrepresentations on this application will constitute just cause for removal of an appointee.
if you fail to answer all the questions, Council may not consider your application.
Human Rights Commission Application
January 2014 Page 3 of 8
TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY
Effective March 15, 2013
Household
Size
30% Median Income
(Poverty Level)
50% Median
Income
60% Median
Income
80% Median Income
(low income)
Median
Income
1
$16,060
$26,750
$32,100
$42,750
$53,500
2
18,350
30,550
36,660
48,850
61,100
3
20,650
34,350
41,220
54,950
68,700
4
22,900
38,150
45,780
61,050
76,300
5
24,750
41,250
49,500
65,950
82,500
6
1 26,600
44,300
53,160
70,850
88,600
7
28,400
47,350
56,820
75,750
94,700
8
30,250
50,400
60,480
80,600
100,800
ATTACHMENT TO APPLICATION FOR THE
HUMAN RIGHTS COMMISSION
It is the mission of the Iowa City Human Rights Commission to protect residents of the city from
discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city
strives to ensure that the Human Rights Commission is representative of the community.
Therefore, "appointments shall take into consideration men and women of various racial,
religious, cultural, social and economic groups in the city." (Ord. 94 -3647, 11 -8 -94)
nPTInNAI
PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN
CHOOSING AN APPLICANT.
34 Age
Woman Gender
30% Median Inc.
Heterosexual
Income (see table)
Sexual Orientation
® Other (Please explain below)
None Religion
CD
e�
None - ~�isabili
White - -Race .-color
or ethnic group
US National origin
am a single parent of children of color, one of whom has disabilities. Parenting children of color, especially one with
disabilites, certainly shapes my experience as I move in the world. I acutely aware of discrimination and its impact on
people in our communtiy..
Human Rights Commission Application
January 2014 page 4 of 8
City of Iowa City I r
Advisory Board /Commission /Committee;,- "'�
,Application Form
CITY OF IOWA CITY
THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC,
WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED
FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME.
Advisory Board /Commission /Committee Name Human Rights Commission Term Jan 2015
NAME Sarah Witry HOME ADDRESS 816 Dover Street
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? 11 years Gender: Male ❑ Female ❑✓
OCCUPATION Food Bank & Emergency Assistance Director EMPLOYER The Crisis Center of Johnson County
PHONE NUMBER: HOME (cell) 319- 936 -2232 BUSINESS 319- 351 -2726 ext. 118
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
I have my Master's in Social Work and my coursework included several courses on diversity, oppression, and social
justice. The Food Bank program serves a diverse population, and in my six years as the program's Director I have
come to a deeper realization of the many ways that different groups are oppressed, ostracized, and otherwise
excluded from the opportunities afforded to privileged groups. I am also part of the Local Homeless Coordinating
.'oard and serving on the Advocacy Committee, which is tasked with understanding how the community views
persons experiencing homelessness and developing an advocacy campaign to help our efforts to improve the lives
of persons experiencing homelessness. It is clear to me that the people I serve in these roles are often in vulnerable
and impoverished situations because of the disadvantages they face as a result of oppression.
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
I have not interacted with the Human Rights Commission in the past, but I understand the role of engaging the public
in advocacy and awareness activities and collaborating with other organizations with the goal of efMinating
discrimination.
WHAT CONTRIBUTIONS CAN YOU (MAKE TO THIS ADVISORY BOARD (REASON FmAPP44NG) -,'—
My connection to the social service community will allow me to network with other organiz-aons Pat can s „partner with
the Commission on projects; my background in Social Work has provided me training in gra4p fac�'ilitationbachd
community organizing, which I am excited to put to use.
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest
If the Commission ever had an opportunity to make a recommendation that would impact the funding of social
service agencies, then my work at The Crisis Center would pose a conflict of interest.
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? 0 Yes ❑ No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? ❑ Yes WlNo
(It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.)
Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail
to answer all the questions, Council may not consider your application.
Human Rights Commission Application
January 2014 Page 2 of 8
BOARD, COMMISSION, & COMMITTEES
BUSINESS LISTING
Name of City
Board /Commission /Committee Human Rights Commission
Name Sarah Witry
tlr
CITY OF IOWA CITY
Date 10/21/2014
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
4�
�w, 7
NOTE: A new form must be completed if the above information changes or an ownership interest
is acquired in an additional business.
Signature
Address 816 Dover Street, Iowa City, IA
Misrepresentations on this application will constitute just cause for removal of an appointee.
If you fail to answer all the questions, Council may not consider your application.
Human Rights Commission Application
January 2014 Page 3 of 8
TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY
Effective March 15, 2013
Household
Size
30% Median Income
(Poverty Level)
50% Median
Income
60% Median
Income
80% Median Income
(low income)
Median
Income
1
$16,060
$26,750
$32,100
$42,750
$53,500
2
18,350
30,550
36,660
48,850
61,100
3
20,650
34,350
41,220
54,950
68,700
4
22,900
38,150
45,780
61,050
76,300
5
24,750
41,250
49,500
65,950
82,500
6
26,600
44,300
53,160
70,850
88,600
7
28,400
47,350
1 56,820
75,750
94,700
8 1
30,250
50,400 1
60,480
80,600
100,800
ATTACHMENT TO APPLICATION FOR THE
HUMAN RIGHTS COMMISSION
It is the mission of the Iowa City Human Rights Commission to protect residents of the city from
discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city
strives to ensure that the Human Rights Commission is representative of the community.
Therefore, "appointments shall take into consideration men and women of various racial,
religious, cultural, social and economic groups in the city." (Ord. 94 -3647, 11 -8 -94)
OPTIONAL-
PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CON R WHEO
CHOOSING AN APPLICANT. - r.
30 Age
I Female Gender
>100% median Income (see table)
Sexual Orientation
F� Other (Please explain below)
Human Rights Commission Application
January 2014 page 4 of 8
Religion r'
h�
Disability
White Race, color
or ethnic group
National origin
City of Iowa City r I
Advisory Board/Commission/Committee ;~ h
��
Xpplication Form --
CITY OF IOWA CITY
THIS APPLICATION IS A PUBLIC DOCUMENT AND AS SUCH CAN BE REPRODUCED AND DISTRIBUTED FOR THE PUBLIC,
WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED
FOR THREE MONTHS ONLY AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME.
Advisory Board /Commission /Committee Name Iowa City Human Rights Commission Term 1/1/2015
NAME Kim Hanrahan HOME ADDRESS 435 Grant St.
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? 56 years Gender: Male ❑ Female ❑✓
OCCUPATION Liscensed Master Social Worker EMPLOYER United Action for Youth
PHONE NUMBER: HOME 319.530.9339 BUSINESS 319.338.7518
EXPERIENCE AND /OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
have been a social worker in and around Johnson County and Iowa City for the last thirty years. I have experience
working with individuals, families and children from a variety of cultures and in many different capacities. I have also
served on various social services boards and committees. Because of these opportunities I have a realisitic
understanding of what people are experiencing while living in Iowa City and what the barriers and challanges are
espcially for those from a lower socioeconomic status or from different cultures or countries.
r."
r�
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? �, '
I have served one term on the Human Rights Commission and would like to serve anothegerm sWA am TaMiliar with
the expectations and time commitment.
r7i
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD (REASON FOR APPLYING)?
During our recent goal planning session it was decided that the HR Commission should provide more outreach
services, perhaps through listening posts or community /neighborhood meeting attendance. I believe that one of my
strongest skill sets is the ability to connect with people form a wide variety of backgrounds and cultures and would be
able to support, organize and conttribute to the success of this goal. I was the chair of the sub - committee on
Immigration through the HR Commission and was able to reach out to the immigrant community by attending faith!;�(t
-tIS P MLeONFt:le'T"F-INTE Tarr egar onffiet of lnternest _
Lid -i
4- ivi.t � 1
- (_L_ Cet�r��i' L.�
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? [,—/] Yes ❑ No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? —]Yes ❑✓ No
(It has been Council policy not to permit an individual to serve on two Boards or Commissions at the same time.)
Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail
to answer all the questions, Council may not consider your application.
Human Rights Commission Application
January 2014 Page 2 of 8
BOARD, COMMISSION, & COMMITTEES
BUSINESS LISTING
Name of City
Board /Commission /Committee
Name Kim Hanrahan
Iowa City Human Rights Commission
► r 1
CITY OF IOWA CITY
Date
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member
of a city Board or Commission from having an interest in a city contract. A copy of Section 362.5
is attached (see page 8).
List all businesses in which you or your spouse /domestic partner have an ownership interest (for
example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please indicate if there
are none.
BUSINESS NAME
BUSINESS ADDRESS
NONE
_ Iv .�
- cn
NOTE: A new form must be completed if the above information changes or an ownership interest
is acquired in an additional business.
Signature
Address
Misrepresentations on this application will constitute just cause for removal of an appointee.
If you fail to answer all the questions, Council may not consider your application.
Human Rights Commission Application
January 2014 Page 3 of 8
TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY
Effective March 15, 2013
Household
Size
30% Median Income
(Poverty Level)
50% Median
Income
60% Median
Income
80% Median Income
(low income)
Median
Income
1
$16,060
$26,750
$32,100
$42,750
$53,500
2
18,350
30,550
36,660
48,850
61,100
3
20,650
34,350
41,220
54,950
68,700
4
22,900
38,150
45,780
61,050
76,300
5
24,750
41,250
49,500
65,950
82,500
6
26,600
44,300
53,160
70,850
88,600
7
28,400
47,350
56,820
75,750
94,700
8
30,250
50,400
60,480
80,600
100,800
ATTACHMENT TO APPLICATION FOR THE
HUMAN RIGHTS COMMISSION
It is the mission of the Iowa City Human Rights Commission to protect residents of the city from
discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city
strives to ensure that the Human Rights Commission is representative of the community.
Therefore, "appointments shall take into consideration men and women of various racial,
religious, cultural, social and economic groups in the city." (Ord. 94 -3647, 11 -8 -94)
OPTIONAL:
PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN
CHOOSING AN APPLICANT.
Age
r�ieligion
Gender
-1 ty
�1
Income (see table)
� Race, color
or ethnic group
Sexual Orientation
National origin
F-1 Other (Please explain below)
Human Rights Commission Application
January 2014 page 4 of 8
Human Rights Commission
ATTENDANCE RECORD
YEAR 2013/2014
tm"tina notnl
NAME
TERM
EXP.
9/17/
13
10/15/
13
11/19/
13
121171
13
1/21/
14
2118/
14
31181
14
4/29/
14
51201
14
6117/
14
71151
14
8/19/
14
9/16/
14
All Ahmed
1/1/17
-
-
-
-
X
X
O/E
O/E
O/E
X
X
X
Orville
Townsend, Sr.
1/1/17
X
X
X
X
X
X
X
O/E
X
X
X
X
Paul Retish
1/1/17
-
X
X
X
X
X
O/E
X
X
X
O/E
X
Kim
Hanrahan
111115
X
X
O/E
X
X
X
X
X
O/E
O/E
X
X
Shams
Ghoneim
111115
X
X
X
X
O/E
X
X
X
X
X
X
X
Stella Hart
111115
-
-
-
-
-
-
-
-
-
X
X
X
Jewell Amos
111115
X
X
O/E
X
X
X
O/E
R
R
R
R
R
Joe D. Coulter
1/1/16
X
X
X
X
X
X
X
X
X
X
O/E
X
Harry
Olmstead
1/1/16
X
X
X
X
X
X
X
X
X
X
X
X
Andrea Cohen
1/1/16
X
X
X
X
X
X
O/E
X
X
X
X
X
KEY: X = Present
O = Absent
O/E – Absent/Excused
NM = No meeting
— = No longer a member
R = Resignation
10d
IIII mII
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
PARKS AND RECREATION COMMISSION
Two Vacancies — Four -Year Terms
January 1, 2015 - January 1, 2019
The duties of the members of the Parks and Recreation Commission are to recommend and review
policies, rules, regulations, ordinances, and budgets relating to parks, playgrounds, recreation centers,
and cultural functions of the City and make such reports to the City Council as the Commission deems in
the public interest; to exercise broad responsibility for the development of parks, recreation centers,
playgrounds, and cultural facilities to serve the City -- including the creation and appointment of advisory
groups to make studies.
Iowa City- appointed members of boards and commissions must be eligible electors of the City of Iowa
City. The Parks and Recreation Commission meets the second Wednesday of each month at 5:00 p.m.
Applications must be received by 5:00 p.m., Wednesday, October 22, 2014. 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.
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: 4
Council Announcement Date: Sept. 16, 2014
Application Deadline: Wednesday, 5:00 p.m., October 22, 2014
Council Appointment Date: November 4, 2014
After 12/15/2014 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
PARKS AND RECREATION COMMISSION
Two Vacancies — Four -Year Terms
January 1, 2015 — January 1, 2019
Term expires for David Bourgeois and Lucie Laurian
Gender Balance Requirement: 1 Male, 1 None
No Applications as of Wednesday, 5:OOp.m., October 22, 2014
0 Denotes applicant completed the confidential page of the application.
1Oe
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMITTEE:
PUBLIC ART ADVISORY COMMITTEE
Two Vacancies — Three Year -Term
January 1, 2015 — January 1, 2018
Duties of the Public Art Advisory Committee include developing by -laws and procedures for the Iowa
City Public Art Program; administering the Public Art Program by determining the placement of public art,
the type of art to be used in a specific project, and the artist to be engaged; overseeing the acceptance of
gifts of art; overseeing the maintenance and disposition of public art; and overseeing expenditures of the
Public Art Program budget.
Iowa City appointed members of boards and commissions must be eligible electors of the City of Iowa
City. The Public Art Advisory Committee meets the first Thursday of each month at 3:30 p.m.
Applications must be received by 5:00 p.m., Wednesday, October 22, 2014. 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: 2
Females: 1
Council Announcement Date: September 16, 2014
Application Deadline: Wednesday, 5:00 p.m., October 22, 2014
Council Appointment Date: November 4, 2014
After 12/15/2014 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
PUBLIC ART ADVISORY COMMITTEE
Two Vacancies — Three Year Term
January 1, 2015 - January 1, 2018
Term expires for Elizabeth Marilla Pusak and John Engelbrecht
Gender Balance Requirement: 1 Female, 1 None
No Applications as of Wednesday, 5:OOp.m., October 22, 2014
ODenotes applicant completed the Confidential page of the application.
T-
10f
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING
COMMISSION:
SENIOR CENTER COMMISSION
Two Vacancies — Three -Year Term
January 1, 2015 - December 31, 2018
The duties of members of the Senior Center Commission are to:
Serve in an advisory role to the City Council with regard to needs of the Senior Center.
Make recommendations with regard to policies and programs at the Senior Center.
Join staff and other interested persons in seeking adequate financial resources for
operation of the Senior Center.
Encourage full participation by senior citizens in the programs of the Senior Center.
Ensure that the Senior Center is effectively integrated into the community and cooperates
with organizations with common goals in meeting the needs of senior citizens.
Serves in an advocacy role with regard to the needs of senior citizens in Iowa City.
Iowa City- appointed members of boards and commissions must be eligible electors of the
City of Iowa City. The Senior Center Commission meets the third Tuesday of each month
at 3:00 p.m.
Applications must be received by 5:00 p.m., Wednesday, October 22, 2014. The City of
Iowa City encourages diversity in the appointment of citizens to boards and commissions.
Persons interested in being considered should contact the City Clerk at City Hall, 410 E.
Washington Street. Application forms are available from the Clerk's office upon request or
on the City website at www.icgov.org.
Questions about the Iowa City Senior Center Commission should be directed to Linda
Kopping, Senior Center Coordinator at 356 -5225.
Spouses and relatives of City Council Members and members of comparable
County Boards and Commissions are not eligible for appointment to City Boards
and Commissions. This includes: spouse, child, mother, father, mother- in- law,
father- in- law, brother, sister, brother- in- law, sister- in- law, step- father, step-
mother, step - child, aunt, or uncle. (Resolution 85 -354)
Males: 3
Females: 2
Council Announcement Date: September 16, 2014
Application Deadline: Wednesday, October 22, 2014
Council Appointment Date: November 4, 2014
After 12/15/2014 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
SENIOR CENTER COMMISSION
Two vacancies — Three Year Term
January 1, 2015- December 31, 2018
Term expires for Rosamond Hanson and Mark Holbrook
Gender Balance Requirement: 1 Female, 1 None
(F) Cheryll Clamon M
1023 Village Green Blvd.
❑x 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.
Advisory Board /Commission /Committee Name Senior Center Commission Term 1/15 to 12/17
NAME Cheryll Clamon HOME ADDRESS 1023 Village Green Blvd., IC
Is your home address (listed above) within the corporate limits of Iowa City? R./ Yes FJ No
How long have you been a resident of Iowa City? 38 years Gender: Male F� FemaleQ
OCCUPATION Retired Social Worker, Legal Assistant EMPLOYER Univ. of Iowa Hospitals & Clinics
PHONE NUMBER: HOME 319 - 338 -3729 BUSINESS cell 319 - 331 -9086
EXPERIENCE AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
ince 1976, worked and raised a family in Iowa City and active in various community activities (public library,
Mediator- in small claims court, children's school organization, social service agencies, etc)
en plus years volunteer and participant in Senior Center classes, activities and music programs.
erved on several Senior Center committees mostly having to do with New Horizons band and band camps.
IaIueT M vn"o cR =cGtiT WMnwl Fnr,F nF THIS ADVISORY BOARD?
Served on Iowa City Housing and Community Development Commission and Johnson Counly Judicial Magistrate
Appointment so have knowledge of this process
Read agendas and minutes of Senior Center Commission and Senior Services Ad Hoc corn - ,tee,,
t- - M
WHAT CONTRIBUTIONS CAN YOU MAKE TO THIS ADVISORY BOARD REASON FORAPPLYIIUG ?
1 have considerable experience and knowledge working in various community activities. I am a supporter of Senior
Center activities and would like to assist as the Center continues its mission of service to Seniors. This includes
making changes for future development, particularly in expanding its services to an even more diverse population of
seniors. I firmly believe the Center is and will continue to be an important service to the community.
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for infonnation regarding Conflict of Interest
none
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? 0 Yes U No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? nYes 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.
General Application
May 2014 Page 2 of 7
BOARD, COMMISSION AND COMMITTEES
BUSINESS LISTING
Name of City
Board /Commission /Committee Senior Center Commission
_,! r
CITY OF IOWA CITY
Date 10/03/2014
Name Cheryll Clamon
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
CD
.r
NOTE: A new form must be completed if the above information changes or an ownership interest is
acquired in an additional business.
Applicant Signatu
Address 1023 Village Green Blvd., IC
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
May 2014 Page 3 of 7
Approved Minutes
May 15, 2014
Senior Center Commission
Attendance Record
Year 2014
Name
Term Expires
8/15
9/19
10/24
11/21
12/19
1/16
1130
2/6
2120
3/3
3120
5/15
Chuck Felling
12/31/15
NM
X
X
NM
X
X
X
X
X
X
X
X
Rose Hanson
12/31/14
NM
O/E
O/E
NM
X
O/E
X
X
X
X
X
X
Jack Hobbs
12/31/16
—
—
—
—
--
X
X
X
O/E
X
X
X
Mark Holbrook
12131114
NM
X
X
NM
X
X
X
X
X
O/E
X
X
Jay Honohan
12/31/16
NM
X
X
NM
X
X
X
X
X
X
X
X
Michael Lensing
12/31/13
NM
—
—
--
—
--
--
—
—
—
—
—
Kathy Mitchell
12/31/15
NM
X
X
NM
X
X
X
X
X
X
X
X
Margaret Reese
12/31/15
--
X
X
NM
X
X
X
O/E
T X
X
X
X
Key: X = Present
O = Absent
O/E = Absent/Excused
NM= No meeting
— = Not a member
11f
Marian Karr -
From:
Stefanie Bowers
Sent:
Wednesday, October 29, 2014 3:28 PM
To:
Marian Karr
Subject:
FW: Resignation
From: Andrea Cohen [mailto:andreacoh @gmail.com]
Sent: Tuesday, October 28, 2014 2:18 PM
To: Stefanie Bowers
Subject: Resignation
Dear Stefanie,
It is with regret that I inform you and the Commission of my resignation effective 12/31/2014. For family
reasons I will be out of the country for much of 2015.1 feel it is best for the Commission and the community so
that others have the opportunity to participate in the civic process.
I will be reapplying in the Fall of 2015 as I feel I still have much to contribute to (and learn from) the
Commission and the community.
With kind regards,
Andrea Cohen
http : / /whererightsbegin.weebly.com /