HomeMy WebLinkAbout2016-11-01 Appointments13a
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD:
BOARD OF APPEALS
One Vacancy— Five Year term
January 1, 2017 - December 31, 2021
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.
The Board meets the first Monday of each month or at the call of the Building Official.
City -appointed members of boards and commissions must be at least 18 years old and reside in the
City of Iowa City. The City of Iowa City encourages diversity in the appointment to boards and
commissions.
Applications must be received by 5:00 p.m., Wednesday, October 26, 2016. An application can be
completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the
Clerk's office.
Questions regarding the Board of Appeals should be directed to Tim Hennes, Sr Building Inspector at
356-5122.
A Council Member's spouse, domestic partner or partner by cohabitation, children, step-
children, children for whom the Council Member assumes parental responsibility, mother,
father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother,
sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and
grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons
who are parents of the same child, and persons with whom the employee is in an intimate
relationship. A current member of a City Board or Commission, unless dual or joint
memberships are provided for in the resolution, ordinance, or statute which creates the
Board or Commission to which appointment is being made. A current member of a
comparable County Board or Commission, unless dual or joint memberships are provided
for in the resolution, ordinance, or statute which creates the Board or Commission to
which appointment is being made.
It is hereby established, as a formal policy of the City Council of Iowa City, that each
application for reappointment to a City Board or Commission will be considered without
regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
BOARD OF APPEALS
One vacancy - Five-year Term
Jauary 1, 2017 — December 31, 2021
Term expired for Scott McDonough
Council Announcement Date: September 20, 2016
Application Deadline: Wednesday, 5:00 p.m., October 26, 2016
Council Appointment Date: November 1, 2016
After 12/1912016 (3 mo from the announcement date) Council may appoint any
qualified applicant without regard to gender.
Gender Balance Requirement: 1 female Males: 3
Females: 1
No Applications as of Wednesday, 5:OOp.m., October 26, 2016
❑x Denotes applicant completed the Confidential page of the application.
MTMrTr-
13b
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD:
BOARD OF ADJUSTMENT
One Vacancy — Five — year term
January 1, 2017 — Ending January 1, 2022
• Duties: The Board of Adjustment is a citizen panel that reviews requests for special
exceptions and variances.
• The Board also considers appeals when there is a disagreement about an administrative
decision made by the City.
• Members of the board act like judges, making decisions about individual properties and
uses that may have difficulty meeting a specific zoning regulation or to resolve disputes
about administrative zoning decisions.
• The Board is assisted in its work by planning staff and the City Attorney's office. Decisions
made by the Board of Adjustment are binding upon all parties unless overturned upon
appeal to District Court.
• The Board meets the second Wednesday of each month at 5:15 p.m.
Iowa City appointed members of boards and commissions must be 18 years of age and live in
Iowa City. The City of Iowa City encourages diversity in the appointment to boards and
commissions.
Applications must be received by 5:00 p.m., Wednesday, October 26, 2016. An application can
be completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting
the Clerk's office.
Questions about the Iowa City Board of Adjustment Commission should be directed to Sarah
Walz, Associate Planner at 356-5239.
A Council Member's spouse, domestic partner or partner by cohabitation, children, step-
children, children for whom the Council Member assumes parental responsibility, mother,
father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother,
sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and
grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons
who are parents of the same child, and persons with whom the employee is in an intimate
relationship. A current member of a City Board or Commission, unless dual or joint
memberships are provided for in the resolution, ordinance, or statute which creates the
Board or Commission to which appointment is being made. A current member of a
comparable County Board or Commission, unless dual or joint memberships are provided
for in the resolution, ordinance, or statute which creates the Board or Commission to
which appointment is being made.
It is hereby established, as a formal policy of the City Council of Iowa City, that each
application for reappointment to a City Board or Commission will be considered without
regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
BOARD OF ADJUSTMENT
One vacancy — Five Year Term
January 1, 2017 - January 1, 2022
Term expires for Larry Baker
Council Announcement Date: September 20, 2016
Application Deadline: Wednesday, 5:00 p.m., October 26, 2016
Council Appointment Date: November 1, 2016
After 12/19/2016 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
Gender Balance Requirement: None
(M) Bryce B. Parker ❑x
517 S. Governor St.
❑x Denotes applicant completed the Confidential page of the application.
Males: 2
Females: 2
City of Iowa City I r ,
Advisory Board/Commission/CommitteeII'�
®�
C, CITY Form clv of IOWA CITY
THIS APPLICATION IS A PUBLIC DOCUMENT WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL:' THIS
APPLICATION WILL BE CONSIDERED FOR TWELVE MONTHS AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY
DURING THAT TIME.
Advisory Board/Commission/Committee Name Board of Adjustment Term 2017-2022
NAME Bryce B. Parker -t o .m,ag,n:a HOME ADDRESS 517 S. Governor Street
Is your home address within the corporate limits of Iowa City? ❑✓ Yes F� No
How long have you lived in Iowa City? 11 years Gender: Male[Z] Female El
Contact # 712-490-7899 1 Email Address bryprkr@gmail.com
CONTRIBUTION AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION:
rban and Regional Planning graduate student 2014-2016, 'Project Manager for the Department of Defense
12-2013, 'Contract Representative for Department of Defense 2011-2016, 'Company Commander for US Army,
15-2016, Current Rank- Captain US Army Reserve. Current Assistant Director at Tippie College of Business's
ughan Institute of Risk Management and Insurance. Also, Univercity homeowner in a conservation district.
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest
None that I know of.
IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? ❑✓ Yes ❑ No
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? FYes QNo
(If yes, please indicate which board would be your first choice to serve on.)
Misrepresentations on this application will constitute just cause for removal of -ah appointee. If you fail
to answer all the questions, Council may not consider your application.
Uenerdi rippucduun - w j „
April 2015 Page 2 of 7 -
BOARD, COMMISSION AND COMMITTEES �. L_r0'ti
BUSINESS LISTING
®�9
CITY OF IOWA CITY
Name of City
Board/Commission/Committee Board of Adjustment Date 10/03/2016
Name Bryce B. Parker
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.
I BUSINESS NAME I BUSINESS ADDRESS I
I NONE I NONE 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
517 S. Governor Street
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. cn
General Application
April 2015 Page 3 of 7
BOARD OF ADJUSTMENT
ATTENDANCE RECORD
NAME
TERM EXP.
9114
10114
12116
1113
2117
319
4113
6116
7113
8110
BAKER, LARRY
1/1/2017
X
X
X
X
O/E
X
X
X
X
X
GOER, CONNIE
1/1/2020
X
X
X
X
X
X
X
X
X
X
GRENIS, BROCK
1/12016
X
O/E
X
—
—
—
—
—
—
—
CHRISCHILLES, T. GENE
1/1/2019
X
X
X
X
X
X
X
O/E
X
X
SOGLIN, BECKY
1/1/2018
X
X
X
X
X
X
O/E
X
X
X
WEITZEL, TIM
1/1/2021
—
—
—
—
X
X
X
X
X
X
KEY: X = Present
0 = Absent
01E = Absent/Excused
— = Not a Member
11-0
13c
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
HUMAN RIGHTS COMMISSION
One Vacancy —Three -Year Term
January 1, 2017 - January 1, 2020
Duties of the Commission include:
• 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;
making recommendations to the City Council for such further legislation concerning
discrimination as it may deem necessary and desirable;
• 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)
• 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 at least 18 years of age
and reside in the City of Iowa City. The City of Iowa City encourages diversity in the
appointment to boards and commissions.
Applications must be received by 5:00 p.m., Wednesday, October 26, 2016. An application can be
completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the
Clerk's office.
Questions about the Human Rights Commission should be directed to Stefanie Bowers,
Human Rights Coordinator at 356-5022 or stefanie-bower(a)iowa-city.org.
A Council Member's spouse, domestic partner or partner by cohabitation, children, step-
children, children for whom the Council Member assumes parental responsibility, mother,
father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother,
sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and
grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons
who are parents of the same child, and persons with whom the employee is in an intimate
relationship. A current member of a City Board or Commission, unless dual or joint
memberships are provided for in the resolution, ordinance, or statute which creates the
Board or Commission to which appointment is being made. A current member of a
comparable County Board or Commission, unless dual or joint memberships are provided
for in the resolution, ordinance, or statute which creates the Board or Commission to
which appointment is being made.
It is hereby established, as a formal policy of the City Council of Iowa City, that each
application for reappointment to a City Board or Commission will be considered without
regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
HUMAN RIGHTS COMMISSION
One Vacancy — Three -Year Terms
January 1, 2017 - January 1, 2020
Term expires for Paul Retish
Council Announcement Date: September 20, 2016
Application Deadline: October 26, 2016
Council Appointment Date: November 1, 2016
After 12/19/2016 (3 mo from the announcement date) Council may appoint any
qualified applicant without regard to gender.
Gender Balance Requirement:
1 Male,
Males: 3
Females: 5
(F)
Jessica Lynn Ferdig
❑O
(F) Julie Christensen ❑O
18 Dunuggan Ct.
254 Black Springs Circle
(F)
Heather Young
❑O
(F) Damita Brown ❑O
5023 rd Ave.
216 E. Bloomington St.
(F)
Erin Michelle Noon
❑x
1513 McCleary Lane
(F)
Nicole "AX Richard
❑O
2801 Hwy 6 E. Lot 421
(F)
Sarah Maxwell Leckband
rXi
134 Ashford PI.
(F)
Angel Taylor
❑O
2247 Plaen View Dr.
(M)
Nidal Besher
O
2604 Bartelt Rd. Apt 1A
0 Denotes applicant completed the Confidential page of the application.
City of Iowa City
Advisory Board/Commission/Committee "
Application Form
2016 SEP 28 AIS 7: 5,'
1 nib AFFLIUAI ION IS A PUBLIC DOC IJJ::E! T WITH THE EXCEPTION OF T11E LAST PAGE
MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDEJLQ, FOA-TdVTif!Y.E
AION'IIIS AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAI' TI\]E.
AdvisoryBoazd/Commission/Committee Name}�UMa,I'� R- !� k{
7'erm.�s"¢S.ls�..�o.n 1. 2020
NAME ,gip 0, (4Zr rev , HOME ADDRESS l U
J
Is your home address within the corporate limits of Iowa City? Yes X No
How long have you lived in Iowa City?_ dip [.1--5 Gender. Male__ Female _ )(_
Contactl/ 3(9_�1J `)$(L Email Address S.F-�.r�
S�c�IICo✓,l . c.om
CONTRIBUTION AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS
POSITION:
COM,pIt%LOV\ of K)v WLktn 6ws CIN La%crw h.eclA"
heaj,�h dS?0_k- tt_%, � socCcLi cf njK- oma- KtCjlam,
C.vvrJ�r Zk4-vr of La\J .5 lx ukz T0jtKer, a UINC research s
{veur itN5 00 obe c ( KXt- t Dr\ �c 1 our �n ceev� e aeS vis / ld�-r�
A k -h r~� VP ll I CH 's b.i e tS Qrco r ea r.��ex.c e�
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
Lti5kci auktrs, /ori n &� ta-e ,S._ A.$ G. u l o u
Gly tu,ck>�o�c as clSW95ed t dk Joe 1Di> UQL ; ore
vl' tv.q ere-vibus ProGt6sor5
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of
Interest
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes
,Z(
No (If yes, please indicate which board would be your first choice to serve on.) —
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.
June 2016 —D--;.
tr
BOARD, COMMISSION AND COMMITTEES
BUSINESS LISTING
CITY Or IOWA CITY
Name of City
BoardlCommission/Committeelumpx. R�% A- s Date
Name ,1rcc, rn tro.--1. _
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of
a city Board or Commission from having an interest in a city contract. A copy of Section 362.5 is attached
(see page 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 I 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 Sig
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
April 2015
Page 3 of 7
V
TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY
Effective May 1, 2014
Household
Size
30% Median Income
(Poverty Level)
50% Median
Income
or ethnic group
jl�ap4lncome
`low Income)
Madlan
Income
1
$16,700
$27,850_$44,550
$55,700
2
19,100
31,800,
TM
. 50,900
63,600
3
21,500
35,80057,250
71,600
_4
23,850
39,75063,600
79,500
5
25,800
42,950
51,540
68,700
85,900
6
27,700
46,150
55,380
73,800
92,300
7
29,600
49,300
59,160
78,900
98,600
8
31,50052,500
63,000
84,000
105,000
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.
Zq Age
F Le Gender
1�� Income (see table)
-e A -u-0 Sexual Orientation
F1Other (Please explain below)
Human Rights Commission Application
1 February 2015 page 4 of 8
O 2 Religion
Disability
Race, color
or ethnic group
USA
National origin
City of Iowa City
Advisory Board/Commission/Committee
Application Form
THIS APPLICATION IS A PUBLIC DOCUMENT WITH THE EXCEPTION OF THE LAST PAGE
MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR TWELVE
MONTHS AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME.
Advisory Board--/rrC��l1ommission/Commince Name t.(AA^E4�„ {2; grwa (OATerm
NAME QI 441,✓ _ HOME ADDRESS �O 3 �� iQMo . d 0 "0
Is your home address within the corporate limits of Iowa City? Yes No 5 � ,
How long have you lived in Iowa City? C
U Gender: Male _ Female
Contactll /g
CONTRIBUTION AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS
pnerrrnN.
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
LIST POTENTIAL CONFLICTS OF INTEREST: See page I for information regarding Conflict of
interest
l%--)O-7-Q -
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? _Yes
-?�io (If yes, please indicate which board would be your first choice to serve on.)
misrepresentations on this application will constitute just cause for removal of an appointm
fail to answer all the questions, Council may not consider your application.
2016
R
Psge2
Powered by MachForm
BOARD, COMMISSION AND COMMITTEES +`� a
BUSINESS LISTING
CITY OF IOWA CITY
Name of City ' I ?
Board/Commission/Committee k U"`\ C'e)MM!y5i� /`t /16
Namefir'^ ,, ,^ Date
tV�`'"/r��
Section 362.5 of the Code of loo 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.
NOTE: A new form must be completed if the above information changes or an ownership interest is
acquired in an additional business.
Applicant
Misrepresentations on this application will constitute just cause for removal of8n appatee. If you fail
to answer all the questions, Council may not consider your application.
7� n m
General Application -'qn C�
April 2015 Page 3 of 7 �r*i ;t-
2 2 w
TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY
Effective May 1, 2014
Household
Size
30% Median Income
(Poverty Level)
50% Median
Income
60% Median
Income
80% Median Income
(low income)
Median
Income
1
$16,700
$27,850
$33,420
$44,550
$55,700
2
19,100
31,800
38,160
50,900
63,600
3
21,500
35,800
42,960
57,250
71,600
4
23,850
39,750
47,700
63,600
79,500
5
25,800
42,950
51,540
68,700
85,900
6
27,700
'N55380
73,800
92,300
7
29,600
49,300
59,160
78,900
98,600
8
31,500
52,500 1
63,000
84,000
105,000
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.
® Age
Gender
YN-kA(6Tti Income (see table)
N ° Sexual Orientation
Other (Please explain below)
Human Rights Commission Application
February 2015 page 4 of 8
/✓4"v^¢- Religion
N �9- Disability
N
O
n
Race, color
.-fir
or ethnic group
S
National origin
N
O
n
Cc tl
.-fir
p
M
-
w
�n
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.
t Human Rights Commission Application
February 2015 Page 1 8
City of Iowa City
Advisory Board/Commission/Committee
Application Form
THIS APPLICATION IS A PUBLIC DOCUMENT WITH THE EXCEPTION OF THE LAST PAGE
MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR TWELVE
MONTHS AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME.
Advisory Board/Commission/Committee Name: Human Rights
NAME Erin Michelle Noon
HOME ADDRESS 1513 McCleary Lane Iowa City. IA 52245
Is your home address within the corporate limits of Iowa City? XYes No-.
How long have you lived in Iowa City? 1 YR Gender: Male X Female
Contact#Email Address
Enoon25Agmail.com
CONTRIBUTION AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR rms
POSITION:
• Active Disabilities Advocate
• Disabilities Blogger-Social Justice/Lack of Representation in the Workforce
• Active Advocate for Other Disenfranchised groups
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
Duties of the Commission involve educating the public on civil and human rights, including planning
programs and activities to eliminate unlawful discrimination. The Commission also makes
recommendations to the City Council for Social Justice and Racial Equity Grant funding, as well as for
, -additional local legislation as it relates to discrimination.
Ln
C , � LET POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of
�+ ht%rest'
1iAUX�
.,�...,. N >—r_�
DD -d "CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? _Yes
�Vo gI yes, please indicate which board would be your first choice to serve on.)
Osrepresentations 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.
r
June 2016 Paget of 7
BOARD, COMMISSION AND
COMMITTEES BUSINESS
LISTING
Name of City
Board/Commission/Committee Human Rights
Name Erin Michelle Noon
> y�CPcii
CITY OF IOWA CITY
Date 9.21.2016
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
N/A
cy
P
NOTE: A new form must be completed if the above information changes or an ownership interest is acquired
in an additional business.
6Ti
Applicant Signature Eltt n, / I LLriWA -MO-M
Misrepresentations on this application will constitute just
fail to answer all the questions, Council may not consider
General Application
April 2015 Page 3 7
removal of an appointee. If you
u�
ly _
LJ J.
. GI7
0
cam+
removal of an appointee. If you
THANK YOU FOR YOUR PARTICIPATION IN THIS SURVEY.
TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA
CITY
Effective May 1, 2014
Household 30% Median Income
(Poverty Level)
Median
Income
Median
Income
80% Median
Income
(low income)
Median
Income
1 $16,700
$27,850
$33,420
$44,550
$55,700
2 19,100
31,800
38,160
50,900
63,600
3 21,500
35,800
42,960
57,250
711600
4 23,850
39,750
47,700
63,600
79,500
5 25,800
42,950
51,540
68,700
85,900
6 27,700
46,150
55,380
73,800
92,300
7 29,600
49,300
59,160
78,900
98,600
8 1 31 ,500
52,500
63,000
84,000
105,000
ATTACHMENT TO APPLICATION FOR THE
HUMAN RIGHTS COMMISSION
-It is the mtission of the Iowa City Human Rights Commission to protect residents of the city from
discrimiggtion as defined in the Human Rights Ordinance. In order to further this goal, the city strives
to'ensui5gthat the Human Rights Commission is representative of the community. Therefore,
appointments sfiill take into consideration men and women of various racial, religious, cultural,
social and economic groups in the city." (Ord. 94-3647, 1 1-8-94)
OPTIONAL:
PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO
CONSIDER WHEN CHOOSING AN APPLICANT.
27 Age
Female
Gender
Income (see table)
2
Sexual Orientation
Other (Please explain below)
Religion
Cerebral Palsy -Physical
Disability
White
Race, color or
ethnic group
National origin
1 In a committed relationship
of 8
r
C
City of Iowa City
Advisory Board/Commission/Committee
Application Form
. •. " .0 n r UDUL, VUUUA1tN'1' WITH THE EXCE
MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CON
MONTHS AND AUTOMATICALLY CONSIDERED FOR ANY V
2016 SEP 26 ANI1.3`
AT TIME.
Advisory Board/Commission/CommitteeName i tTerm
ri
NAME /yt1r2 la- 'Aart f]t.4ft4OA-1EADDRESS I H(a/, (o
Is your home address within the corporate limits of Iowa City? Yes /`YYNo
Since June — How long have you lived in Iowa City? �(}I_K p nom/ „ Gender. A4ale _ Female
C14x I-0JI- 2
b t 4ot'6,
ContactN3fq-4A__ - � Email Address Qt r�� l�9 Lo�%mQ j �r cem
CONTRIBUTION AND/OR ACTIVITIES Wmrm vnrt imvr A% ._
POSITION - -- "� "'•'+ +va. rvrc tris
Seg- �-F�ache�
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
See. "acll e ,-
LIST POTENTIAL CONFLICTS OF INTEREST; See page 1 for information regarding Conflict of
Interest
Se4e_ LLA4CLt
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? _Yes
XNo (If yes, please indicate which board would be your first choice to serve on.)
Misrepresentations on this application will constitute lust cause for removal of an appointee. If you
fail to answer all the questions, Council may not consider your application.
City of Iowa City
Advisory Board/Commission/Committee
Application Form
Name: Nicole Jeanette "AJ" Richard 2016 SEP 26 V + 11: S
Address: 2801 Hwy. 6 E, Lot 421, Iowa City, IA 52240
I have lived in Iowa City since June 2015. I lived in Iowa City previously between 2006 and 2009. I
returned to Iowa City because I love the city.
Contact: 319-480-8673
Email: airichard999@mail.com
CONTRIBUTION AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS
POSITION:
Camp Fire USA member, 1976-1982
YMCA basketball coach, 1989
Founder and President HURT (Humans Unlearning Racism Together), Des Moines, IA 1992-1995
Volunteer community radio talk show host, KUCB 89.3FM Des Moines, IA 1992-1995
YMCA Downtown Teen Program working with at -risk youth, Des Moines, IA 1992-1995
Des Moines Educational Equaity Committee, IA 1993-1994
Very Important Partners volunteer with Polk County Juvenile Court, 1993-1994
Volunteered leading therapeutic poetry group for adjudicated teen girls, Des Moines, IA 1996-1998
Gender Inclusion organization, Univ. of Northern Iowa, 2001-2004
LGBTQA organization, Univ. of Northern Iowa, 2001-2004
President Club SOLE (Student Outdoor Leadership Education), Univ. of Northern IA, 2003-2004
Special Olympics volunteer, 2004
Foster parent, IA 2008-2009
Baseball For All Nationals Committee member (creating opportunities for girls to play baseball in a
traditionally all-male sport, 2015 -Present
Professional working with individuals with disabilities including as a summer camp counselor,
Communications Director, and Services Coordinator, 1999 -Present
Diversity Awareness Facilitator (volunteer), 1992 -Present
National Youth Sports Coaches Association, 2016
BA from Univ. of Northern Iowa in Leisure/Youth/Human Services, 2004
Awarded: Dean's List, Educational Excellence Award
WHAT IS YOUR PRESENT KNOWLEDGE OF THE ADVISORY BOARD?
The Human Rights Advisory Board works to protect all residents of Iowa City from discrimination.
Members are volunteers. The Board meets monthly. The Board works to educate and public about civil
and human rights. The Board plans programs and activities to eliminate unlawful discrimination. The
Board also recommends funding for Social Justice and Racial Equity grants to the City Council of Iowa
City.
r
Nicole "AJ" Richard continued
Human Rights Advisory Commission Application
LIST POTENTIAL CONFLICTS OF INTEREST
2015 SE? 26
I work for Reach For Your Potential.
My previous employer was Camp Courageous in Monticello, IA. I was terminated fromV'position
there after many years and filed a complaint with the Iowa Civil Rights Commission wWch is still
being investigated.
I do not own property.
I am not on any other boards.
I volunteer with Baseball For All and plan to coach baseball in the Iowa City area beginning in 2017.
RESUME AND
PROVIDED UPON REQUEST
BOARD, COMMISSION AND COMMITTEES
BUSINESS LISTING--'
Name of City
Boa rd/Commission-/C ommittee
Name
G S`:P 26 Rx I I - T
/f A
r
CITY OF IOWA CITY
Date 9-:214— /(a
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 Signatu
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
April 2015
Page 3 of 7
I
TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY
Effective May 1, 2014
Household
Size
30% Median Income
(Poverty Level)
50% Median
Income
60% Median
Income
80% Median Income
�l9 'ncotn' 1 `:1i.
Median
Income
1
$16,700
$27,850
$33,420
4 $44,550
$55,700
2
19,100
31,800
38,160
. -50,900!
63,600
3
21,500
35,800
42,960
57,250 `
71,600
4
23,850
39,750
47,700
63,600
79,500
5
25,800
42,950 1
51,540
68,700
85,900
6
27,700::::�H
46,150
55,380
73,800
92,300
7
29,600
49,300
59,160
78,900
98,600
8
31,500
52,500
63,000
84,000
105,000
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.
ern Gender
600onqdulp Income (see table)
3 , V0
Sexual Orientation
Other (Please explain below)
N�1
nan Rights Commission Application
February 2015 page 4 of 8
Religion
Disability
A -lisrn-fibrCCAYA i[
i Race, color
or ethnic group
National origin
hjas (perrngo -c l- rE.s(den+
6-P Girlge�CL ,.
City of Iowa City
Advisory Board/Commission/Committee
Application Form
THIS APPLICATION IS A PUBLIC DOCUMENT WITH THE EXCEPTION OF THE LAST PAGE
MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR TWELVE
MONTHS AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME.
Advisory Board/Commission/Committee Name tk~ Pi C, k 7 IN'T M
In -
NAME &i VGl I✓I MOI j( W i U L e HaADDRESS f 3 K k kov^e( pl
Is your home address within the corporate limits of Iowa Cit}l Yes No
) (176-` G tlS— pYtieti _
How long have you lived in Iowa City? I 1 p y 2 Gi�✓�.S' ender: Male _ Female x
Contact# 5(5-9 I'I3-035ZEmailAddress
CONTRIBUTION AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS
POSITTOly-
I am a V► a.tb Ir vlev), CVurr,e,-� _
%V11 -e W-ZVYI o f L ba
k? tN`lc�r
} e ul d ,(JCt-
S 6"v,\
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
k"r-G V'Q.OZ,(•-Ur� "--p- ",,5,y , ,`-ni rvl i s
C -C
Sii<,aS we�(� rtis r4 -1e-
C-� vv.� s
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of
Interest
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? 4'ss
'&_No (If yes, please indicate which board would be your fust choice to serve on.)
Misrepresentations on this application will constitute just cause for removal of an appointee If
fail to answer all the questions, Council may not consider your application.
t
June 2016
Page2 of 7
BOARD, COMMISSION AND COMMITTEESx"10 m
BUSINESS LISTING 'MY1A°���
CITY OF IOWA CITY
Name of City
Board/Commission/Committee _ 1jyUw&A-4n P-4' of �-3 wl/t�Wn Date 9 -R o I C
Name SP1 Y N✓ I MA�"-W 4 VIL�±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 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
Misrepresentations on this application will constitute just cause for removal of an appointee. Ifyqu fail
to answer all the questions, Council may not consider your application. ; s
General Application
April 2015
Page 3 of 7
0
0
C']
Misrepresentations on this application will constitute just cause for removal of an appointee. Ifyqu fail
to answer all the questions, Council may not consider your application. ; s
General Application
April 2015
Page 3 of 7
0
0
TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY
Effective May 1, 2014
Household
% Median
60% Median
80% Median Income
Median
Size
Income
Income
(low Income)
Income
1
7iu
27,850
$33,420
$44,550
$55,700
2
31,800
38,160
50,900
63,600
3
35,800
42,960
57,250
71,600
4
39,750
47,700
63,600
79,500
5
25,800
42,950
51,540
68,700
85,900
6
27,700
46,150
55,380
73,800
92,300
7
29,600
49,300
59,160
78,900
98,600
8
31,500
52,500
63,000
84,000
105,000
ATTACHMENT TO APPLICATION FOR THE
HUMAN RIGHTS COMMISSION
It is the mission of the Iowa City Human Rights Commission to protect residents of the city from
discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city
strives to ensure that the Human Rights Commission is representative of the community.
Therefore, "appointments shall take into consideration men and women of various racial,
religious, cultural, social and economic groups in the city." (Ord. 94-3647, 11-8-94)
OPTIONAL:
PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN
CHOOSING AN APPLICANT.
F201 ] Age
®Gender
I'D 6 Income (see table)
l� ?i{2✓! ✓ exual Orientation
Other (Please explain below)
CGS r i G i Religion
Disability
CTu. Ga,$�&-v� Race, color
or ethnic group
S National origin
N
O
0
C'.)
,
Human Rights Commission Application
February 2015 page 4 of 8
r
N
City of Iowa City
Advisory Board/Commission/CommitteeF I L E D
Application Form
2016 OCT -7 PFI 4: 17
IRIS APPLICATION IS A PUBLIC DOCUMENT WITH THE EX(MgTl OF�HE LAST PAGE
MARKED "CONFIDENTIAL." THIS APPLICATION WILL BFIg(I, 6R.,TWELVE
MONTHS AND AUTOMATICALLY CONSIDERED FOR ANj �Y VA bUING THAT TIME.
Advisory Board/Commission/Committee Name 4 �N Term �QL
n
NAME r1,� I (� I () HOME ADDRESS(I i iij ISA .
Is your home address within the corporate limits of Iowa City? Yesl No
How long have you lived in Iowa City?MUGender: Male _ FemalecE�_
Contactfi Nq-5 f 1( -) y n I Email Address (1�, � 1 TJ14At �g q g 00l rl 13't t, �_Crv)
CONTRIBUTION AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS
hvz�)L bUA-) nn '4�(JC a _ PUL
�fywd-)
( 4 Lo l6l hnu 4_ c 4 C L r'1 EJ1 S
s rn tv 2
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
rht Y�)dr,�
6VIJ L
s 1wJ 0`'
1
LIST POTENTIAL CONFLICTS OF INTEREST:
Interest
1 for information regarding Conflict of
DO�YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? _Yes
o (If yes, please indicate which board would be your fust choice to serve on.)
Misrepresentations on this application will constitute just cause for removal of an appointee. It you
fail to answer all the questions, Council may not consider your application.
June 2016 Page2 of 7
5
k
r.
C
t
BOARD, COMMISSION AND COMMITTEES —„ ^°
BUSINESS LISTING +ft®1®�
Name of City
Board/Commission/Committee
Name
rd,1;ITY OFJOWA CITY
ate,
JT y
Section 362.5 of the Code of Iowa generally prohibits, with certain important excep".ft6ns, a -member of
a city Board or Commission from having an interest in a city contract. A copy of SJ ion 315-2'.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.
NOTE: A new form must be mpleted if the above information changes or an ownership interest is
acquired in an addition us' ess. 1.1
Applicant
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
April 2015
Page 3 of 7
TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY
Effective May 1, 2014
Household
Size
30% Median Income
(Poverty Level)
50% Median
Income
60% Median
Income
80% Median Income
(low income)
Median
Income
1
$16,700
$27,850
$33,420
$44,550
$55,700
2
19,100
31,800
38,160
50,900
63,600
3
21,500
35,800
42,960
57,250 0
71,600
4
23,850
39,750
47,700
63, _ ^a o
7M500
5
25,800
42,950
51,540
68,7-00-3 °
mff8900
6
27,700
46,150
1 55,380
73,81t�! J
92,300
7
29,600
49,300
59,160
78,90Qr o
98 00
8
31,500
52,500
63,000
84,0Og =2
$Mow
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
1 P7 Gender
Income (see table)
Sexual Orientation
Other (Please explain below)
(-HumanRights Commission Application
February 2015 page 4 of 8
Religion
Disability
Race, color
or ethnic group
National origin
City of Iowa City
Advisory Board/Commission/Committee
( Application Form
THIS APPLICATION IS A PUBLIC DOCUMENT WITH THE EXCEPTION OF THE LAST PAGE
MARKED "CONFIDENTIAL:' THIS APPLICATION WILL BE CONSIDERED FOR TWELVE
MONTHS AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURING THAT TIME.
Advisory Board/Commission/Co\m^mittec Name _VN U NA 4A ��a�N5 CQ!MZZ jferm W et'W J 6, jj
NAME 1 &AK e 51\QY HOME ADDRESS 2 6
Is your home address within the corpora(e limits of Iowa City? Yes No
How long have you lived in Iowa city? 0,\ cl 2. \\ em5 Gender. Male 1j _ Female
Contactfi $ F% ' `��� -O$ 6Q Email Address
CONTRIBUTION AND/OR ACTIVITIES WnTryi vnri PPET nT7 A T Tc %7i.
POSITION: -- --' " r .. .�' avv rvrc ILLS
'YAv er t, l ow.ev� Y�`��n4s , greed°tr , wSahuri�te1-• -
(P act�Ve \V\%uvvl4h ks �n \N1Mt_e01u,VAj/W ea
6
k S i(� wY6VVvi �Vpoy
WuNnAN n36 avtj' gt✓4lrf -
WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
:kms aPafk C>f 0\e (:AY boArdS �^�. o,�e �� )�j�O►�V1�c°rtwisc
dna vhavr qC4\ ✓Ik ��✓ \ C3 �-j A
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of
Interest
i✓a�n�f0.ckS WM1 V0Wy\kWffl"tTfS�\Eersor6-Wk ae�e1�S�Volun{
� cmiCy�ts ,� b ��u�o cigl {1Qt�P�r.
Jtbet Ar\ o Y `/, Pr\ kwurf3(ln -Jbo
DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes
_No (If yes, please indicate which board would be your first choice to serve on.)
ti
0
Misrepresentations on this application wlll constitute just cause for removal of an app - ge, If gh
fail to answer all the questions, Council may not consider your application.
June 2016 Paget of 7
C��
r
BOARD, COMMISSION AND COMMITTEES
TEES ��^ �
BUSINESS LISTING S �p6i°�
CITY OF IOWA CITY
Name of City oo��
Board/Commission/Committee Date w • 2a -�
1
Name
R3
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.
❑CW wrrn rnusi oe completed if the above information changes or an ingrsl intergst is
acquired in an additional business. -
v f
Applicant Signature tJ t
Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail
to answer all the questions, Council may not consider your application.
General Application
April 2015
Page 3 of 7
TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY
Effective May 1, 2014
Household
Size
30% Medlan Income
(Poverty Level)
50% Median
Income
60% Median
Income
80% Median IncIt
(low income
1
$16,700
$27,850
$33,420
$44,550
2
19,100
31,800
38,160
50,900
3
21,500
35,800
42,960
57,250
4
23,850
39,750
47,700
63,60025,800
42,950
51,540
68,70027,700
46,150
55,380
73,800
7
29,600
49,300
59,160
78,900
98,600
8
31,500
52,500
63,000
84,000
105,000
ATTACHMENT TO APPLICATION FOR THE o
HUMAN RIGHTS COMMISSION 3E o
_i -.r
It is the mission of the Iowa City Human Rights Commission to protect residentR6(-thcity f ohm
discrimination as defined in the Human Rights Ordinance. In order to further tI�I-)yoal,,thepin
strives to ensure that the Human Rights Commission is representative of:tN�' community)
Therefore, "appointments shall take into consideration men and women oC:'Various racYal,
religious, cultural, social and economic groups in the city." (Ord. 94-3647, 11-844)
OPTIONAL:
PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN
CHOOSING AN APPLICANT.
Ft�y Age
V%Nc, Gender
Income (see table)
yNor""A, 7 Sexual Orientation
Other (Please explain below)
1.._,man Rights Commission Application
February 2015 page 4 of 8
N\! lTL w� Religion
Disability
AiflCsvli�VeByleu�esanSd� Race, color
or ethnic group
National origin
City of Iowa City
Advisory Board/Commission/Committee FILED
Application Form 2016 OCT 26 AN 10 23
THIS APPLICATION IS AL.:, THIS
DOC' Ft la T WWF TBE EXCEPTTO 1► ii .ASp�iAGE
MARKED "CONFTDENTIAL:'HLS ,1PPLICAIION MLL DE CONSIqVA lgTjl�'1
MONTHS AND AUTOMATICALLY CONSH) V'/ D FOR,W( JYl�VACANCY DURING T1LAT TIME.
Advisory Doard/Conmdssion/Commiitee Name V1 1 145 Term_,i�N�t''I
Ni1IEjJij ( ' mf I ►)Yl.' Sal HOMEADDRE,S8_7— B, Ie�ele rte_ N Ci e(� ID ✓•r CX
f
Is your home address within the corporate limits of Iowa City? Yes /N,
..
How long have you lived in Iowa Cit5•7 IS Gender: Male _ Female ✓�-
Email Address_ ty_Vl �3�D �` f`/zyt �l"vi��o � �— fa
Ltt l tJ- �{
COVTMUTION AND/OR ACTIVITIES WHICH Y017FE"t QUALIFY? e"' el THIS
q ed.,
POSYr1f)N•
sez .1lr,Lw d
WHAT 1S YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD?
- -I
LIST POTENTIAL CONFLICTS OF INTEREST: See page i for Information regarding Conflict of
Interest
DO OU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? _Yea
VNO (If yes, please indicate which board would be your first choice to serve on.)
Misrepresentations on this application will consdtute just cause foc removal of an
fall to amwer all the questions, Council may not consider your application:
IED
Addendum to application — Human Rights Commission, City of (ovifa cit
Applicant: Julie J. Christensen 7516V OCT 26 Nr 10: 23
CIT`f CLE ` �
•.
rnntrihutinn anri/nr artivitipc which vnu fppl nualifv vnu fnr tivs�n'ncitc,,J 1, I0 t
In full transparency, I am new to Iowa City, having moved to the area just 5 months ago from
Upstate NY. However, one of the first things that I did when I arrived was look for opportunities
to get involved in the community. Due to my deep commitment to social justice issues, I quickly
found the Iowa City Human Rights Commission's web page, and was able to connect with
Stefanie Bowers early in the summer. The intent was just to get a sense of what is happening in
the community as I look for ways to get involved and give back as a new Iowa City resident.
Perhaps 1 should be a resident longer before throwing my name into consideration for a
vacancy on the Commission, but I thought it worth noting some of my background and
experience— which I offer as a potential Commission member, or simply as a resident who
supports the work of the Commission.
I am a social worker by training, and have focused about a decade of my career on working with
academically and behaviorally at -risk students in Rochester, NY. Working in a district where
over 90% of students were living at or below poverty, I because quickly immersed in community
coalition building to support struggling families. I also worked at a teen runaway and homeless
youth shelter as a part-time counselor for 8.5 years, where I provided crisis support counseling,
and worked within a community consortium that focused on combating chronic homelessness,
as well as serving the unique transition needs needs of families impacted by such issues as
mental health, gender identity, and resettlement (refugee and asylum families).
In the past 8 years, I worked at the University of Rochester focusing on creating inclusive
communities —and specifically addressing the needs of individuals with intellectual and
developmental disabilities. It is in this capacity that I was recruited to come to the University of
Iowa to work at the Center for Disabilities and Development, where I am engaged in public
policy, research & evaluation, and technical assistance and training.
This provides a brief snapshot of my experiences and interests. In my short time in Iowa City, I
see many of the same systemic and community issues faced here as were areas of concern in
Rochester. I believe strongly in coalition building, and that the community has a responsibility
to care for all of its members. In this respect, I am excited to get involved as a community
member in Iowa City to work towards inclusive communities for all citizens.
What is your present knowledge of this advisory board?
In my meeting with Stefanie Bowers, she provided an overview of the work of the Commission,
Including a history of the many events and programs that the Commission has sponsored over
the years. I also had an opportunity to read past meeting minutes from the past 2 years, which
gave me a good sense of some of the discussions and issues on the forefront. I am particularly
attracted to the Commission's focus on civil rights, social justicF anlelin�ating discrimination
of all kinds in our community. I also had the honor of attending the Awards Breakfast this
morning, and was thrilled and moved by the great work thjtuW%p,,7cp,8ni�O IS66icommunity.
CITY CLERii
List of Potential Conflicts of Interest: CWA CITY,
None
L
BOARD, COMMISSION AND COMWPdEC— �^ 9
r BUSINESS LISTING
t016 OCT 26 Al i-1 IOWA CITY
Name of City i I 4� �� I -uITY C!—E-5
Board/Commis``sionfC``ommii`tl�e�e HUMP, Cl 75 IyML55q/J,,.tf JTY'!` iw t0�2G 1(0
Name _i �1.I1lC A WIv19-4EOSe41 _
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.
NOTE: A new form must be completed if the above information changes or an ownership interest is
acquired in an additional business.
Applicant
Misrepresentations on this application will constitute just cause for removal of an appointee. If you fait
to answer all the questions, Council may not consider your application.
General Application
April 2015 Page 3 of 7
f!
r
TABLE OF INCOME GUIDELINES AND DEFINITIONS-FbD 104NA ITY
Effective May 1, 2014 11
Household
Size
30% Median Income
(Poverty Level)
50% Median
Income
60% Media
Income
}
6 , n t#2tia Idc'ome
(low incofne),r
Median
income
1
$16,700
$27,850
$33,420
�.�'
p ,•r
$55704
2
19,100
31,800
38,160
Obb'
3600
3
21,50035,800
42,960
57,250 71,600
4 _.
_ _ 23,850
39,750
47,700
63,600
79,500
5
25,800
42,950
_ 51,54068,700
85,900
6
27,700
46,150
55,38_0
73,800
92300
_ 7
29,600
49.300
59,160
i
78,900
98,600
_8_
31,500
52.500
F3 nnn
ATTACHMENT TO APPLICATION FOR THE
HUMAN RIGHTS COMMISSION
It is the mission of the Iowa City Human Rights Commission to protect residents of the city from
discrimination as defined in the Human Rights Ordinance. In order to further this goal, the city
strives to ensure that the Human Rights Commission is representative of the community.
Therefore, "appointments shall take Into consideration men and women of various racial,
religious, cultural, social and economic groups in the city." (Ord. 94-3647, 11-8-94)
OPTIONAL:
PLEASE PROVIDE ADDITIONAL INFORMATION FOR THE COUNCIL TO CONSIDER WHEN
CHOOSING AN APPLICANT.
M'Z. Age
QLvtc� Gender
i� rwrt Income (see table)
Save Sexual Orientation
n h Other (Please explain beiowl
Human Rights Commission Application
February 2015 page 4 of 8
N•}Gstl, o '� Religion
11o" Disability
GIJCws'�an Race, color
or ethnic group
National origin
J/
City of Iowa City
Advisory Board/Commission/Committee
Application Form EEt
0
8.
THIS APPLICATION IS A PUBLIC DOCUMENT WITH THE EXCEPTION OF IHBEAST P' V E
MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR±LVE�a
MONTHS AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURI&
p¢'H$q' TDV)
Advisory Bcard/COmmission/Committee Name/J,1
,
`�n1
� Tectn:;.�-- tV
NAME }x I 1-U (y3 v) HOAIE ADDRESS 2 I (o C • 9 1 0 d yxr M o 0
Is your home address within the corporate limits of Iowa City? Yes k No
How long have you lived in Iowa City?I x 10 r/tB `. Gender: Male _ Female
Contact# 31 3 s9 SS
Email Address AG 'I. c D vr\
CONTRIBUTION AND/OR ACTIVITIES
POSITION: WHICH YOU FEEL QUALIFY YOU FOR THIS
f
oMe- Cc�t'u-�-1 �,`e�a,hej., 2s rv� �nLv ���► 6���U�
ba+e, as c,� underor�(d as a rcdoc4t_ 3+v kqK{;
s}vd�ed -xial�Jt�-s-fic�� F►-,e�Uwwer eve
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o+kQ_r- cGu a � Fi` C_ a -H a h g
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WHAT IS YOUR PRESENT KNOWLEDGE THIS ADVISORY RY BOARn;'3'r S
ctwt
lowo� Ul-A
5
te4s�P_ see C +k"j
LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Contiict of
Interest
4t.e l opo, CLA-� 'Ri1d LI �i 6-a+ry,
xDO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? _Yes
No (If yes, please indicate which board would be your first choice to serve on.)
i. "cprCsenrarmus on this application will constitute just cause for removal of an appointee. Ifyou
fail to answer all the questions, Council may not consider your application.
June 2016 Paget of 7
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BOARD, COMMISSION AND COMMITTEES
.,,ift
wS�
BUSINESS LISTING " e�
C?rClT,rOF IbWA CITY
Name of City ev
r"n 8
Board/Commission/Committee _L+U VI, ci,K 919 �i s
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Name_�vrv�wat+ti.y
�� ►-ds (,�u.�•n, i � � a cr.`s �
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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
n
NOTE: A new form must be completed if the above
acquired,in ara-edditlnal business.
Applicant
information changes or an ownership interest is
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
April 2015 Page 3 of 7
TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY
Effective May 1, 2014
Household
Size
30% Median Income
(Poverty Level)
50% Median
Income
60% Median
Income
80% Median Income
(low income)
Median
Income
1
$16,700
$27,850
$33,420
$44,550
$55,700
2
19,100
31,800
38,160
50,900
63,600
3
21,500
35,800
42,960
57,250
71,600
4
23,850
39,750
47,700
63,600
79,500
5
25,800
42,950
51,540
68,700
85,900
6
27,700
46,150
55,380
73,800
92,300
7
29,600
49,300
59,160
78,900
98,600
8
31,500
52,500
63,000
84,000
105,o00
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
3�Jlp Income (see table)
cSexual Orientation
Other (Please explain below)
✓����5 Religion
iJ o Disability
Race, color
or ethnic group
S National origin
Human Rights Commission Application :<� �-�
February 2015 page 4 of 8 0
y
r �a
0
Human Rights Commission
Attendance Record
NAME
TERM
EXP.
9/16
15
10/20
15
11/17
15
12115
15
1/19
16
2/16
16
3/15
16
4/18
16
5/17
16
6/21
16
7/7
16
7119
16
8/16
16
Joe D. Coulter
1/1/2019
X
X
X
X
X
X
X
X
O/E
X
X
O/E
X
Adil D.
Adams
1/1/2019
—
—
--
—
O/E
0
O/E
O
X
X
X
X
X
Eliza Jane
Willis
1/1/2019
--
—
--
—
X
O/E
X
X
X
X
X
X
X
Paul Retish
1/12017
X
X
X
X
O/E
X
X
X
X
X
X
X
X
Orville
Townsend, Sr.
1112017
X
X
X
X
X
X
X
X
X
X
X
X
R
Karol Krotz
1/1/2017
—
—
--
—
—
—
—
O
0
0
R
R
Andrea Cohen
1/1/2018
—
—
—
—
X
X
X
X
X
X
X
X
X
Kim
Hanrahan
1/12018
X
X
X
X
X
X
0/E
X
X
X
X
X
O
Shams
Ghoneim
1/12018
X
O/E
X
X
O/E
X
X
X
X
X
X
I X
X
Key
X = Present
0 = Absent
O/E= Absent/Excused
R - Resigned
— = Vacant
13d
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING
PARKS AND RECREATION COMMISSION
Two Vacancies — Four -Year Terms
January 1, 2017 - January 1, 2021
The duties of the members of the Parks and Recreation Commission are.
• to recommend and review policies, rules, regulations, ordinances, CIP (Capital Improvement
Program) funds 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.
The Parks and Recreation Commission meet the second Wednesday of each month.
Iowa City -appointed members of boards and commissions must be 18 years of age and live in Iowa
City. The City of Iowa City encourages diversity in the appointment to boards and commissions.
Applications must be received by 5:00 p.m., Wednesday, October 26, 2016. An application can be
completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the
Clerk's office.
Questions about the Iowa City Parks and Recreation Commission should be directed to Mike Moran,
Parks & Recreation Director at 356-5110.
A Council Member's spouse, domestic partner or partner by cohabitation, children, step-
children, children for whom the Council Member assumes parental responsibility, mother,
father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother,
sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and
grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons
who are parents of the same child, and persons with whom the employee is in an intimate
relationship. A current member of a City Board or Commission, unless dual or joint
memberships are provided for in the resolution, ordinance, or statute which creates the
Board or Commission to which appointment is being made. A current member of a
comparable County Board or Commission, unless dual or joint memberships are provided
for in the resolution, ordinance, or statute which creates the Board or Commission to
which appointment is being made.
It is hereby established, as a formal policy of the City Council of Iowa City, that each
application for reappointment to a City Board or Commission will be considered without
regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
PARKS AND RECREATION COMMISSION
Two Vacancies — Four -Year Terms
January 1, 2017 — January 1, 2021
Term expires for Maggie Elliott and Suzanne Bentler
Council Announcement Date: September 20, 2016
Application Deadline: Wednesday, 5:00 p.m., October 26, 2016
Council Appointment Date: November 1, 2016
After 12/19/2016 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
Gender Balance Requirement: 2 Female
No Applications as of Wednesday, 5:OOp.m., October 26, 2016
❑O Denotes applicant completed the Confidential page of the application.
Males: 5
Females: 2
13e
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, 2017 — January 1, 2020
Duties of the 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;
• overseeing expenditures of the Public Art Program budget.
• overseeing the Poetry in the Public Program.
Iowa City appointed members of boards and commissions must be at least 18 years of age and
reside in the City of Iowa City. The City of Iowa City encourages diversity in the appointment to
boards and commissions.
Applications must be received by 5:00 p.m., Wednesday, October 26, 2016. An application can be
completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the
Clerk's office.
Questions about the Iowa City Public Art Advisory Committee should be directed to Marcia Bollinger,
Neighborhood Outreach Coordinator, 356-5237 or Marcia-Bollinger@Iowa-City.org.
A Council Member's spouse, domestic partner or partner by cohabitation, children, step-
children, children for whom the Council Member assumes parental responsibility, mother,
father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother,
sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and
grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons
who are parents of the same child, and persons with whom the employee is in an intimate
relationship. A current member of a City Board or Commission, unless dual or joint
memberships are provided for in the resolution, ordinance, or statute which creates the
Board or Commission to which appointment is being made. A current member of a
comparable County Board or Commission, unless dual or joint memberships are provided
for in the resolution, ordinance, or statute which creates the Board or Commission to
which appointment is being made.
It is hereby established, as a formal policy of the City Council of Iowa City, that each
application for reappointment to a City Board or Commission will be considered without
regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
PUBLIC ART ADVISORY COMMITTEE
Two Vacancies — Three year Term
January 1, 2017 - January 1, 2021
Term expires William Nusser and Brent Westphal
Council Announcement Date: September 20, 2016
Application Deadline: Wednesday, 5:00 p.m., October 26, 2016
Council Appointment Date: November 1, 2016
After 12/19/2016 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
Gender Balance Requirement: 1 Male, 1 None Males: 1
Females: 2
No Applications as of Wednesday, 5:OOp.m., October 26, 2016
❑O Denotes applicant completed the Confidential page of the application.
-
13f
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
SENIOR CENTER COMMISSION
Two vacancies — Three -Year Term
January 1, 2017 - December 31, 2020
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 at least 18 years of age and
live in Iowa City. The City of Iowa City encourages diversity in the appointment to boards
and commissions.
Applications must be received by 5:00 p.m., Wednesday, October 26, 2016. An application can be
completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the
Clerk's office.
Questions about the Iowa City Senior Center Commission should be directed to Linda
Kopping, Senior Center Coordinator at 356-5225
A Council Member's spouse, domestic partner or partner by cohabitation, children, step-
children, children for whom the Council Member assumes parental responsibility, mother,
father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother,
sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and
grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons
who are parents of the same child, and persons with whom the employee is in an intimate
relationship. A current member of a City Board or Commission, unless dual or joint
memberships are provided for in the resolution, ordinance, or statute which creates the
Board or Commission to which appointment is being made. A current member of a
comparable County Board or Commission, unless dual or joint memberships are provided
for in the resolution, ordinance, or statute which creates the Board or Commission to
which appointment is being made.
It is hereby established, as a formal policy of the City Council of Iowa City, that each
application for reappointment to a City Board or Commission will be considered without
regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
SENIOR CENTER COMMISSION
Two vacancies — Three Year Term
January 1, 2017- December 31, 2020
Term expires for Jay H Honohan and Jack R. Hobbs
Council Announcement Date: September 20, 2016
Application Deadline: Wednesday, October 26, 2016
Council Appointment Date: November 1, 2016
After 12/19/2016 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
Gender Balance Requirement: 2 Male Males: 1
Females: 3
No Applications as of Wednesday, 5:OOp.m., October 26, 2016
0 Denotes applicant completed the Confidential page of the application.
"TMT -TF -
13g
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
TELECOMMUNICATIONS COMMISSION
One Vacancy — Unexpired term
Upon appointment — July 1, 2017
• The duties of the Telecommunications Commission include serving as a review board to
resolve disputes between any subscriber or potential subscriber and the cablevision company
• reviewing and auditing reports by the cable company to the City as required by the Cable
Television Ordinance; working with the public, the media, the City, and the cablevision
company for the purpose of making recommendations on various issues;
• monitoring and promoting community programming and the use of the local access channels
by a wide range of individuals, institutions, and organizations;
• informing and educating citizens on matters related to cable TV and other communications
systems;
• and monitoring and reviewing State and Federal legislative and regulatory action or change.
Iowa City appointed members of boards and commissions must be 18 years of age and live in Iowa
City. The City of Iowa City encourages diversity in the appointment to boards and commissions.
Applications must be received by 5:00 p.m., Wednesday, October 26, 2016. An application can be
completed and submitted on the City of Iowa City website at www.icgov.org. or by contacting the
Clerk's office.
Questions about the Iowa City Telecommunications Commission should be directed to Ty Coleman,
Media Production Services Coordinator, at 356-5454.
10/25/2016
A Council Member's spouse, domestic partner or partner by cohabitation, children, step-
children, children for whom the Council Member assumes parental responsibility, mother,
father, son-in-law, daughter-in-law, mother-in-law, father-in-law, step-parent, brother,
sister, step -siblings and half -siblings, brother-in-law, sister-in-law, grandparents and
grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster child, persons
who are parents of the same child, and persons with whom the employee is in an intimate
relationship. A current member of a City Board or Commission, unless dual or joint
memberships are provided for in the resolution, ordinance, or statute which creates the
Board or Commission to which appointment is being made. A current member of a
comparable County Board or Commission, unless dual or joint memberships are provided
for in the resolution, ordinance, or statute which creates the Board or Commission to
which appointment is being made. (RES15-300)
It is hereby established, as a formal policy of the City Council of Iowa City, that each
application for reappointment to a City Board or Commission will be considered without
regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
TELECOMMUNICATIONS COMMISSION
One Vacancy - unexpired Three-year Term
Upon appointment — July 1, 2017
Alex Homewood -Weldon resigned
Council Announcement Date: September 20, 2016
Application Deadline: Wednesday, 5:00 p.m., October 26, 2016
Council Appointment Date: November 1, 2016
After 12/19/2016 (3 mo from the announcement date) Council may appoint any qualified
applicant without regard to gender.
Males: 3
Females: 1
Gender Balance Requirement: 1 Female
No Applications as of Wednesday, 5:OOp.m., October 26, 2016
❑x Denotes applicant completed the Confidential page of the application.