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Home My WebLink About2016-12-06 AppointmentLa" 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, November 30, 2016. An application can be completed and submitted on the City of Iowa City website at www.lcgov.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. Board/Commission Application Cover Board/Commission: Board of Appeals - At -Large One vacancy five year term 1/1/2017-12/31/2021 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. Council Announcement Date: 11/1/2016 Application Deadline: 11/30/2016 Council Appointment Date: 11/1/2016 Date of Non -Gender Appointment: 12/19/2016 After date above Council may appoint without regard to gender Gender Balance Requirement: 1 Female Current Gender Balance: Female:1 Male: 3 Gender Name and Address None None 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, November 30, 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. Board/Commission Application Cover Board/Commission: Adjustment, Board of One vacancy five year term 11112017- 11112022 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. Council Announcement Date: 11/1/2016 Application Deadline: 11/30/2016 Council Appointment Date: 11/1/2016 Date of Non -Gender Appointment: 12/19/2016 After date above Council may appoint without regard to gender Gender Balance Requirement: None Current Gender Balance: Female: 2 Male: 2 Gender Name and Address Male Falk, Jeff 7 Princeton Ct Male =PV_ke_r, Bryce Governor St. Advisory Board/Commission Application Form 'Rdtt'EE l This application is a public document and as such can be reproduced and distributed for -nam ' the public. This application Will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CITY OF UTERATURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 11/21/2016 First Name Jeff Last Name* Falk Home Address* 7 Princeton Ct City IOWA CITY State IA Zip Code* 52245 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-800-9869 Email Address* joanieff@centurylink.net Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission Select a Board or Commission you are interested in:* Adjustment, Board of 2. How long have you been a resident of Iowa City? 1 & 3/4 years 3. Occupation:* retired statistician 4. Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* Moved to Iowa City from Fountain City, WI, to be near grandchildren. Been interested in and actively kept abreast of human rights issues for over 50 years. Worked for over a year as the domestic assault men's program coordinator for the Winona (Mn) Women's Resource Center. Volunteered for over 5 years at the Winona Volunteer Services Food Shelf. Tutored and provided an enrichment math program at the Cochrane - Fountain City Elementary School. Currently a volunteer tutor at the Kirkwood Learning Center. Have spent a short time in a prison cell and known people who have done time. Have attended many city council meetings, county board meetings, school board meetings, and Board of Adjustment meetings while living in Wisconsin. 6. What is your present knowledge of each advisory board you are interested in?* Attended the "Building and Crossing Bridges Together" program Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describea some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision-making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a Citycontract. City Council Resolution # 15-300 established a policythal the following persons shall not be appointment to Boards and Commissions: A Council Members 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-irrlaw, 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 Res. #15-300 states 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. Council policy is rat to permit an incMdual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. 7. Do you currently have a conflict of Interest?* Klo 8. Do you currently serve on another Iowa City board or commission?* Kb Demographic Information The City Council values all types of diversity on its Boards and Commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the Board and Commission is representative of the community and the groups(s) which it serves, please provide your information for the following: S. Age 72 10. Country of Origin USA 11. Sexual Orientation heterosexual 12. Religion none 13. Do you have a disability? No 14. Ethnicity Jewish 'NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. City of Iowa City —11 , Advisory Board/Commission/Committee ,'-Application Form-,....� CITY 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 !-`a-i_x per" """""" HOME ADDRESS 517 S. Governor Street Is your home address within the corporate limits of Iowa City? 0✓ Yes ❑ No How long have you lived in Iowa City? 11 years Gender: MaleW Female D Contact # 712-490-7899 ' Email Address bryprkr@gmail.com CONTRIBUTION AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: *Urban and Regional Planning graduate student 2014-2016, *Project Manager for the Department of Defense 2012-2013, *Contract Representative for Department of Defense 2011-2016, *Company Commander for US Army, 2015-2016, Current Rank- Captain US Army Reserve. Current Assistant Director at Tippie College of Business's Vaughan Institute of Risk Management and Insurance. Also, Univemity homeowner in a conservation district. WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? I LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest that I know of. IF YOU ARE NOT SELECTED, DO YOU WANT TO BE NOTIFIED? P Yes Q No DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? 0Yes M,/No (If yes, please indicate which board would be your first choice to serve on.) A Misrepresentations on this application will constitute just cause for removal of an appbtntee. If you fail ffI to answer all the questions, Council may not consider your application. CD I General Application April 2015 Page 2 of 7 l � t BOARD, COMMISSION AND COMMITTEES h BUSINESS LISTING 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. BUSINESS NAME I 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 rl Digital�siq�yn d bit (1 � •. . � � f PARK�k.1Ef�1MM47 Applicant Signature —7 ' �� r Date:2©%2M0B.d&S6t2s;0sIno' 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.Ln C-> General Application April 2015 Page 3 of 7 BOARD OF ADJUSTMENT ATTENDANCE RECORD NAME TERM EXP. 8112 9114 10114 12116 1113 2117 3/9 4113 6115 7113 BAKER, LARRY 1/1/2017 X X X X X O/E X X X X GOER, CONNIE 1/1/2020 X X X X X X X X X X GRENIS, BROCK 1/1/2016 X X O/E X — — -- — — — CHRISCHILLES, T. GENE 1/1/2019 X X X X X X X X O/E X SOGLIN, BECKY 1/1/2018 X X X X X X X O/E X X WEITZEL, TIM 1/1/2021 — — — — — X X X X X KEY: X = Present O = Absent O/E = Absent/Excused — = Not a Member 17c 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, November 30, 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-citv.org. Board/Commission Application Cover Board/Commission: Human Rights Commission One vacancy -three year term 1/1/2017 -1/1/2022 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. Council Announcement Date: 11/1/2016 Application Deadline: 11/30/2016 Council Appointment Date: 11/1/2016 Date of Non -Gender Appointment: 12/19/2016 After date above Council may appoint without regard to gender Gender Balance Requirement: Current Gender Balance: Gender Male Female Female 1 Male Female:5 Male:3 Name and Address Besher, Nidal 2604 Bartelt Rd, Apt 1A Brown, Damita 216 E. Bloomington St. Christensen, Julie 254 Black Springs Circle Female Davidovic, Jovana 630 Fairchild St Male Falk, Jeff 7 Princeton Ct Female Ferdig, Jessica 18 Dunuggan Ct. Female Maxwell Leckband, Sarah 134 Ashford Pl. Female Noon, Erin Michelle 1513 McCleary Lane Male Retish, Paul serving unexpired term 66 Pen Fro Dr Female Female Female Richard, Nicole "AJ" 2801 Hwy 6 E. Taylor, Angel 2247 Plaen View Dr. Young, Heather 502 3rd Ave. - i Adviso Board/Commission lication Form ry ApP - J% t w Ems' This application is a public document and as such can be reproduced and distributed for the public. This application will be considered for twelve months only and automatically CITY OF IOWA CIN considered for any vacancy during that time. UNESCO CITY OF UIEMEURE NOTE: Must be 18 years of age and live Within city limits of Iowa City to apply Date of Application 11/29/2016 First Name Nidal Last Name* Besher Home Address* 2604 Bartell Rd City IOWA CRY State IA Lp Code" 52246 1. Is your home address (listed above) within the corporate limits of Iowa Clty?* Yes Contact Phone Number* 6822180860 Email Address* n id a (free 15@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City?* 2.5 years 3. Occupation:* employee at Reach of Potential company 4. Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* I am active in human rights and writer about issues related to human rights like democracy, civil rights, discrimination , privacy , women rights.. and i think i have abilities to make change and helping other people and do positivist actions . 6. What is your present knowledge of each advisory board you are interested in?* human rights Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describea some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision-making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any contract, subcontract, or agreement with respect to a federally -assisted acfivity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate family lies, during their tenure or for one year thereafter. Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for appointment to Boards and Commissions: 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-ir-law, step-parent, brother, sister, step -siblings and half -siblings, brother-ir-law, sister-ir-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 Res. #15-300 states 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. Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission? W Demographic Information The City Council values all types of diversity on its Boards and Commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the Board and Commission is representative of the communityand the groups(s) which it serves, please provide your information for the following: 9. Age 45 10. Country of Origin Sudan 11. Sexual Orientation hetrosexual 12. Religion muslem 13. Do you have a disability? No 14. Ethnicity 'NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall lake into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. City of Iowa City f' Advisory Board/Commission/Committee y Application Form THIS APPLICATION 1S A PUBLIC DOCUMENT W11Ti THE FXCEPTION OF ENTIAL." THIS APPLICATION WILL BE CONSIDERED TR9:9 T P E MONTHS AND AUTOMATICALLY CONSIDERED FOR ANY VACANCY DURIIVt,. LVE g�q� paaag TIM. ° Advisory Hoard/Commission/Conunittee Name aon,A t NAME.}S 3 rU 4] v,. HOASEADD o RESSZ i (o G• B I o d rxt� , Is your home address within the corporate limits of Iowa City? Yes -k No How long have you lived in Iowa Citylxt. 10 11 Gender-. Male Female Conl 30 TS 37 Email Address �• Y'Ge t �-` ,�tl• �C•rn CONTRIBUTION AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS POSITION: � j� ` tt l7 tiQ_ Q1t:CUA� 1`L�i h aNi iDy �2f�aS � �fr fk� �4 CtS 0. �r �'S)vrarPe Xi r�Ua4-t. S3vt lwfg 1 Svc. t�14 of or a y C, 2eAs �s (ead�cis aka�ss C�nclrr z rte ICQ o'Y10 �ccttu +V SS nk eacG,; t yt, of r hJmar. 5 WHAT IS YUR PRESENT KNOWLEDGE OF THIS ADVISORY BOA i e%.VN w,a�aa ort 4 u4t, V -N -oz' S 1 ie. . LIST POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of Interest L WtL( So6h �_ e� tipAe4--Kr"- -ewplovt= %DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? _Yes S (If yes, please indicate which hoard would be your fust choice to serve on.) MlsreptucnIII dol s on this application wID constitute just cense for removal of an appointee. If you fail to annver all the questions, Council may not consider your application. June 2016 ..___. .. C. Sze. n+4ecj Q4. O U f r+k�- vj,C c rs f A ctve. bee o �o (a..... ,, 7 fn✓o��n.o�i- ;n one waj or ana+)vr,. ✓✓kef-Atr-oaf klLta;js ycrv;n9 0�b ct;n 04 'c2,r a /ocAl c,'v i rt'j•hts DrgAni2n��Ori Or— MOGk-f',l j 6'1 ddurS' 4o k-,q'SQ a wit 2v>ess �. be,ca i ! �106�anJJ-t Sc7C�j`ri,� i's 5v{'S' , l S �L LA+ VV-ci-v--l Vl2Dt y- S S 4-v Ay i` rt3 SUrn e � +-I— rvt 0 51- Pre- ssi 5 i s5Q-e-s i rnpa C, f '`�j hvrmon r;Sk-VS GL c� �I�nis w o C k In ag � � k G c. W e.lc A, .-\ a.x a Yv.acvo o„d m c-cro ctf-rr y"k cs sciejr(i po l; Eca ( avrrk -ec-0r.um;c. i�u�ti�-� on huvv, A� r�S►,}s. (�e�l li�� 1n�asL,t,��r o ndL %n Uis4h,^„j o� rOYISU'OV5455 q� fL,n,v�rs; (�1 oar CaL 1: �C)rvt;c, rc VK -R- rkd 5er�e. b yl 4-1-s rncj t SU) K +S 44G),C a�5D ici�c�k� `ts> E--kr-)\'c S-Noi��s �� 15 �a11 Pad a n ( ss" 2s j 2�gii rim an Qi`S�.fS . �J N O CJ a` C7 ^G N • '„a9 v O BOARD, COMMISSION AND COMMITTEES BUSINESS LISTING C" Cl1VOF 15WA CITY Name of City Board/Commission/Committee vrsa (Zi 1„ j -Safe r.LO 13 l Name r e&� -) oV-0 n 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 acquiredjn.aft-edditipnal business. 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 6D% Median Income 80% Median Income (low income) Median Income 1 $16,700 $27,850 $33,420 $44,550 $55700 2 19,100 31,800 38,160 50,900 63600 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 68,700 859 00 6 27,700 46,150 55,380 73,800 , 92,300 7 29,600 49,300 59,160 78,900 98,6600 8 31,500 52,500 63,000 84,000 105,00 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. I J � Age ® Gender 6 2v Income (see table) Sexual Orientation Other (Please explain below) Human Rights Commission Application February 2015 page 4 of 8 i�)u,.4 ni S Religion N o Disability qL� Race, color or ethnic group Qt National origin �-i v Co ,5 City of Iowa City FILED R L E D Advisory Board/Commission/Committee ° '" Application Form 2016 CBCT 25 ?M.10:213 TARAPPLICATIONN I PUBLTC➢OCUb1F�1TWITHTHtiEXCEPTIO1�i: q Q��}hS ,PY'— MARKED "CONb'1DENTIAL." THIS APPLICATION WILL 13E CONSlgfl LF)1?� MONTHS AND AUTOMATICALLV CONSIDfREDF04ANYVACANCY DURING TILAT TIME. Advisory Board/Commissioa/Comainec N.21chwA ?_ Tenn i�.N�l+) Jar, ZceD NAME I 1Yf" SQI� HOME ADDI7,FmS91 l 51 _ZSYf 131aC(<n_ Is your home address within the corpomtc limits of Iowa City? Yes How long have you lived in Iowa City? W1p46 Gender: Malt Female V'r on N (i 1 s'-5�3 t{ Email Address_ 1 LN ✓i �A tv (A't"11��v111L��" •— f — CONTRIBUTION AND/OR ACTTVIT(ES winen YodtTEL QUALIFY YOU Fop TRIS d. et%s,r Pn.qrrrnN.- SRZ. n&C(q j WHAT IS YOUR PRL'SENT KNOWLEDGE OF THIS ADVISORY BOARD? Som- n &r—tt.e j LIST POTENTIAL CONFLICTS OF INTEREST: See page I for Information regarding Conflict of Interest DO ,YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? _Yeo o (If yes, please indicate which board would be your fust choice to serve on.) lt7iorepresentations onthis applieaGon WID titn eonste jurt mase for removal of an appointee. H yon fail to answer all the question, Council may not consider your application. f Addendum to application — Human Rights Commission, City of I Ja ity D Applicant: Julie J. Christensen t016OCT 2G Ai; 10; 23 CITY CLE.",*��A fnnhrihi rtinn nn,i/nr �r-Yivitioe urhir6 �rnn4nol nr mlifir �rnrr fnr tk�nn'cittnn•Yr r � "r � in full transparency, I am new to Iowa City, having moved to the area just 5 months ago frorn Upstate NY. However, one of the first things that I did when 1 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 I 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 1 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 1 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 justice a d,:elih�iin xg 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 thjt WSiTCpSnI�q0 ja t@eicommunity. CITY C,ER,i List of Potential Conflicts of Interest: iC CIT Y, None a� r BOARD, COMMISSION AND COM ` " I:.a BUSINESS LISTING a"®" 2415 0CT 26 HPl {OWbF IOttirA CITY Name of City F BoardlCommission/Committea qh" �'' T . + W , // tt 1 UVilll h rpt tYI lS�'!l2rt f 11 `t3ate" t D/ 2 G I Name c Itllie V li!rvr54Prncvin 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 fail to answer all the questions, Council may not consider your application. General Application April 2015 Page 3 of 7 r� L_- TABLE OF INCOME GUIDELINES AND DEFINITION h"0D� &rITY Effective May 1, 2014 ° Hcusohold Size 30°,6 Median Income (Poverty Level) 60% rJledian Income 60°% MediartjQ income °., .., ,. J wgod` ridome Medial) pow inccm ,; Income 1 $16,700 $27850 $33,420 i'_•6l ' 2 3 1%100 _ 21 500 31,800 35,8D0 - 38,160 42,960 10 tif. ,gib" 57Y250 3600 71,600 4 23,860 $9,750 47,700_ 63,60D 79,500 5 25,80042,950 61,540 _ �fi8,7D0 6 27,700 46,150 55380 73,800 _85,900 92,300 7 29,60049,300 59,160 ' 78,900 98,600 8 I_ 31,500 1 52.500 Fe3 nnn I GA MA enc nn.. 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. "12 Age Qmp Gender 1`l 1A✓1 Income (see table) gL1(vA Sexual Orientation n r., Other (Please explain below) Human Rights Commission Application February 2015 page 4 of 8 Religion Y10N•C. Disability fit/CtiSLGLi1 Race, color or ethnic group f t National origin 0 I I Advisory Board/Commission Application Form 1� iI 7r �4gi1'f E ' This application is a public document and as such can be reproduced and distributed for the public. This application vill be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESCO OT OF UTERATURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 11/16/2016 First Name Jovana Last Name* Davidovic Home Address* 630 Fairchild St City IOWA CITY State IA Zip Code IF 52245 1. Is your home address (listed above) within the corporate limits of Iowa City? Yes Contact Phone Number* 319-321-4573 Email Address* lovana-davidovic@uiovva.edu Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City? 4.5 years 3. Occupation:* Philosophy Professor 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I am a professor of philosophy %hose primary teaching duty is teaching undergo and grad classes on human rights at the University of lova. I also write extensively on conceptual and practical issues related to the human rights, like issues of transitional justice, international law, humanitarian military intervention, terrorism, etc. I have also years of experience Working as the Global Links Coordinator- putting on informative cultural programs at University of Maine. 6. What Is your present knowledge of each advisory board you are interested in?* I have read through the recent agendas and have seen this board present or participate in a number of events I have been a part of. It seems to me its primary roles are promotion of human rights and prevention of violations of human rights, through publicizing human rights issues (for promotion) and through affecting local ordinances and advising the city council on issues that might relate to human rights. ft seems to me that today ft is more than ever important for this board to remain active and vocal- which is why I am hoping to be a part of f. Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describes some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decisiort-making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally -assisted activity, or have a financial interest in arty contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of ft federalty-assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. Section 362.5 of the Code of lowagenerilly prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Member's spouse, domestic partner or partner by cohabitation, children, stepchildren, 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 Res. #15-300 states that each application for reappointment to a City Board or Commission will be considered without regard to incumbency If reappointed, an indhAdual would be limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve. Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information The City Council values all types of diversity on its Boards and Commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the Board and Commission is representative of the community and the groups(s) which it serves, please provide your information for the following: 9. Age 38 10. Country of Origin Yugoslavia 11. Sexual Orientation Heterosexual 12. Religion Atheist 13. Do you have a disability? No 14. Ethnicity Serbian 'NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Advisory Board/Commission Application Form This application is a public document and as such can be reproduced and distributed for the public. This application Will be considered for twelve months only and automatically CITY Of IOWA CITY considered for any vacancy during that time. UNESCO CITY OF LITERATURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 11/21/2016 First Name Jeff Last Name Falk Home Address* 7 Princeton Ct City IOWA CITY State IA Zip Code* 52245 1. Is your home address (listed above) within the corporate limits of Iowa City?" Yes Contact Phone Number* 319-800-9869 Email Address* loanjeff@centurylink.net Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission Select a Board or Commission you are interested in:* Adjustment, Board of 2. How long have you been a resident of Iowa City?* 1 & 3/4 years 3. Occupation:* retired statistician 4. Gender:* Male 5. Experience andlor activities which you feel qualify you for this position:* Moved to Iowa City from Fountain City, WI, to be near grandchildren. Been interested in and actively kept abreast of human rights issues for over 50 years. Worked for over a year as the domestic assault men's program coordinator for the Winona (Mn) Women's Resource Center. Volunteered for over 5 years at the Winona Volunteer Services Food Shelf. Tutored and provided an enrichment math program at the Cochrane - Fountain City Elementary School. Currently a volunteer tutor at the Kirkwood Learning Center. Have spent a short time in a prison cell and known people who have done time. Have attended many city council meetings, county board meetings, school board greetings, and Board of Adjustment meetings while living in Wisconsin. 6. What is your present knowledge of each advisory board you are Interested in?* Attended the "Building and Crossing Bridges Together" program Please contact the City Attorney at 356.5030 to discuss questions or concerns regarding a potential conflict of interest. The following describes some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision-making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally -assisted activity, or have a financial interest in any contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate family fies, during their tenure or for one year thereafter. Section 362.5 of the Code of lowagenerelly, prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: 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-in4aw, 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 Res. #15-300 states 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. Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. 7. Do you currently have a conflict of Interest?* Kb 6. Do you currentiyserve on another Iowa City board or commission?* IJo Demographic Information The City Council values all types of diversity on its Boards and Commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the Board and Commission is representative of the community and the groups(s) which it serves, please provide your information for the following: 9. Age 72 10. Country of Origin USA 11. Sexual Orientation heterosexual 12. Religion none 13. Do you have a disability? No 14. Ethnicity Jewish 'NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* �T�W Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Gty of Iowa Oty advisory Board/iContimission/Comm itee ; Application Form 2016 SEP 28 ru,"II 7: 5: anis ArrL1cA"LION IS A PUBLIC DOCUMENT R'ITH T1IH F,XCEPTIOI�,'OF'tIIE LAST�PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDFREq FUR;TW; r PA D'ION'II-LS AND AUTOMATICALLY CONSiilERVE ED FOR ANY VACANCY DURING TIJAT TjDIg, Advisory Board/Commission/Committee Namc ay r,No n & �,{s Tern,L..p�3h_,�� lr Z02� u NAME fir' CSic h�A. 1 }� HOME ADDRESS I ..U 'ar7(La._ Is your home address within the corporate limits of lows City? Yes 'X No _ _ HOW long have you lived in Iowa City?__ h_4iG.CS_ Gender: Male_ _ Female _X_ Contact#/ f (� _ �,ejj._LY. —" ( Email Address _ _y ! �Vn MALJ . cn M CONTRIBUTION AND/OR ACTIVITIES WI3IUCH POSITION; YOU FEEL QUALH7Y YOU FOR 77115 T, Cot,,plelkton of Npkf G.Icvi\ �ows on La{tt.o ltieal — heew I kh cuS�ox�k er, , � SUCict� de.i-u-tvu�txn:is Cvvrti�r�akor QF Liut1-t WetL Ioc��}i.¢a 0. U14C reSent�it s't�P�j {ocUCUM5 M 6kst� ot-N 6t tow-�t�ctxmc_ MZLU_s /cl�ld»ex� 'AI k_hf% UGi t5 t,Ncxti�S QFCbr f -or, CLS II WHAT IS YOUR PRESENT fagOWi,EDGE OF THIS ADVISORY BOARD? J 4K1tL1 o u}tYs� /pt�n dry t km8 aS eb��trc SSe cT on n C, otu w Gly WCb?0-% , as Clls(.tysSed w N� Jbe aCosi ore Ok LYa.1 previovS ?rokrsot-5 I 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 XNo (If yes, please indicate which board would be your first choice to serve on.) fall t answer the on this ns, Council will constitute just cause for removal of an appointee. If you fall to answer all the questions, CouncJ may not consider your application. BOARD, COMMISSION AND COMIkO1TTEES BUSINESS LISTING Name of City Board/Commission/Committee ._JAUvYyo_r. 1weh�S ,gip i CITY OF IOWA CITY Date 9 / 21 I o. Name -- C54, f a VP,A,, 4 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 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 FOR10WA CITY Effective llWay 1, 2014 Household Size 30% Median income (Poverty Level) 60%Median Income 60% M rad'E'.L7,�1%iVldiiipneome 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 63600 3 21,500 35,800 _ 42,960 57,250 71,600 `r I 23 850 39,750 47,700 63,600 79,500 5 25,800 42,950 51,540 68,700 85,900 fi 27,700 46,15D 55,380 73,800 7 29,600 49,300 59,160 78,900 _92,300 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. ? LIAge �4 mn lei Gender Income (see table) I l2 i t t p Sexual Orientation Other (Please explain below) Human Rights Commission Application February 2016 page 4 of 8 Religion No(1,e_: � Disability U-3 k- EC Race, color or ethnic group USA National origin City of Iowa City T Advisory Bard/Commiss1on/CoMn,1tte16 Ai pheaiion Form TIIIS APPLICATION IS A PUBLIC DOCUMENT WITH THE EXCEPTION OF THE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BE CONSIDERED FOR TWELVE MONTHS AND AUTOM1ATTCZ.LT Y C'ONSIDERED'FOR y1ANY IV,A�CANC�Y DURING THAT T31VIG: Advisory Beard/l_OMMission/CornmitteeName � n KIIk , ca NAME SaI VA l� MA 2(w LI Le HO MEAODREss 13in K lizr g kjsy^ i pl. Is your home address within the corporate limits o£ Iowa City !(es—X-No (t70-ras HOW long long have you lived in Iowa City? l q � e a r s, er. Male _ FmW c X Contact#(515_11�3-0357—EmailAddress Si'V1GlnWetlDl jWta+1•uly, CONTRIBUTION AND/OR ACT`VITIES WHICH yoU FEEL QUALIFY YOU FOIL I= POSITION: Gi Vh 6M q -tD r vit%v) t cvt Vyp-�J StA l� GLf— ho vYl.e m -z vvI o f eNn iVx l 61,rA C; WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? 1 ka lr-G r'¢,oe4.,i d 1--k� d -c,364---+ p --i, dr A-4. of � c� w- - s (; tom, a-VItvl S s s, Si.K t OL S w e,lil 0. 5 e p rR >3 S r-4- e- S� S re--Ck+r4 I -D LIST POTENTIAL EONFLICTS OF INTEREST: See page 1 for information regarding Coaflict of Interest DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? �Yk s '&-No (If yes, Please indicate which board would be your first choice to serve on.) rn 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 2016cn Pagel of 7 BOARD, COMMISSION AND COMMITTEES MMc�1■ � BUSINESS LISTING """"�� C -nAk CITY OF IOWA CITY Name of City BoardlCommissionfCommittee f o"-O� K { of k -f3 %cywt-✓1 - Date 9 , o w Name ka/" MAA T,4Lo Section 362.5 of the Code of Iowa generally prohibits, ,wwith 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 spouseldomestic partner, have an ownership interest (for example, sole proprietor, partner, 5% or more of corporation's stockholdings). Please Indicate if there are none. 140TE: A new form must be completed if the above information changes or an ownership interest is acquired in an additional business, Applicant o L epresentations on this application will constitute just cause for removal orr ahappointee. If ygu fail nswer all the questions, Council may not consider your application. Gene ral Application April 2015 Page 3 of 7 W TABLE OF INCOME GUIDELINES AND DEFINITIONS. FOR IOWA CITY Effective may i, 2014 Household Size 30% Median Income (Poverty Level) 50% Median Income 60116 Median Income 50% Median Income (low income) Median income 1 $16,700 $27,850 $33,420 $44,550 $55,700 2 1g,100 31,800 38,160 50,900 63,600 3 21,500 35,800 42,960 57,250 71,600 4 23,650 39,750 47,700 63,600 79,500 5 25,800 42,950 51,540 68,70D 85,900 6 27,700 46,150 55,380 73,800 92,300 7 29,600 49,300 59,160 78,900 98,600 B 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 W14EN CHOOSING AN APPLICANT. Age ® Gender 19 0 1� 'F I Income (see table) V`erE exualOrientation Other (Please explain below) I Cy� rr S 1ly, Religion Disability G 4L c a- s -i r`.v1 Race, color or ethnic group 1A S tv National origin N 0 rn C n Human Rights Commission Application `- February 2015 page 4 of 8 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 February 2015 Page 18 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" TIES 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 Enoon25(@gmail.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 TIES 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 [Hakes recommendations to the City Council for Social Justice and Racial Equity Grant funding, as well as for i' additional local legislation as it relates to discrimination. LRT POTENTIAL CONFLICTS OF INTEREST: See page 1 for information regarding Conflict of R; f Interestcli - y DDIYQ'-CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? _Yes 5$io 41yeS, please indicate which board would be your first choice to serve on.) lWsrepresentations 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 Paget of 7 �: c BOARD, COMMISSION AND ;*' '' COMMITTEES BUSINESS LISTING CITY OF IOWA CITY Name of City Board/Commission/Committee Human Rights Date 9.21.2016 Name Erin Michelle Noon 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 O N NOTE: A new, form mustbe completed if the above information changcs or an ownership interest is acquired H1 m auumunai ousmess. of Applicant Signature LR�.YL 7nLrXLe& -aa-0-ti, 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 7 e . r, N .. LJ _ 0 N Page 3 7 THANK YOU FOR YOUR PARTICIPATION IN THIS SURVEY. TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective Mav L 2014 Household 1 30%Median Income (Poverty Level) $16,700 Median Income $27,850 Median 80% Median Income Income (low income) $33,420 $44,550 Median Income $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 31,500 52,500 63,000 84,000 105,000 x t I x�fitvl�ly I I U APPLICATION FOR THE HUMAN RIGHTS COMMISSION It is the emission of the Iowa City Human Rights Commission to protect residents of the city from discrimi fation as defined in the Human Rights Ordinance. In order to further this goal, the city strives to bnsu Othat 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, 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 Religion Cerebral Palsy -Physical Disability White Race, color or ethnic group National oriein FOther (Please explain below) In a committed relationship of 8 �A LX-M-V� CITY OF IOWA CITY UNESCO CITY OF U1 ERATURE Advisory Board/Commission/Committee Application Form This application is a public document and as such can be reproduced and distributed for the public. This application will be considered for twelve months only and automatically considered for any vacancy during that time. Advisory Board/Commission/Committee Name t / t, ( 1 ! / (S (�y, 7„ I J s - t--- - Date of Application Name l �CFn_�_� ✓--JL �--/ �` P�� Home Address Contact phone number3/y fs'(_ .,1_vJ jEmail Address /'(D -t'o i Co t](0- ei Your home address must be within the corporate limits of Iowa City? How long have you lived in Iowa City?? Occupation: ��y-_I vN� -----Pro. JS Gender: Male V/ Female Experiences and/or activities which you feel qualify� you for this position: / -7-ka N.,+. i,�(1Slr'� "t �` l'Er iL��/ .�. y/ .� /S l ) Pa. What is your present knowledge o�f� qthis advisory board? F' T'ti'` (s� v 4 � � NAY✓ q -Y. � G L (C ! .J/y �•�/[�'� .—(J W�y,le vr.e� �i e�s/t p-e�ICYJ . '� i ;;J ZZ 1 J0 3102 Please contact the city attorney at 319-356-5030 to discuss questions or concerns regarding a potential conflict of interest. Potential Conflict of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision—making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally -assisted activity, or have a financial interest in any contract, subcontract, agreement with respect to the proceeds of the federally—assisted activity, either for themselves or those with whom they have business or immediate family lies, during their tenure or for one year thereafter. 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. Section 362.5 City Council Resolution 415-300 established a policy that the following persons shall not be eligible for appointments to Boards and Commissions. A council member's spouse, domestic partner or partner in cohabitation, children, step children, children for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law, sister-in-law, grandparents, and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, poster child, persons who are parents of the same child, and persons whom the employee is in an intimate relationship. Res. 415-300 states 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. Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. Do you currently have a conflict of interest? YES_ NOZ Do you currently serve on another Iowa City board or commission? YES NO If so which one do you prefer? ,U :I ;':d GG 'iiia'JIU The City Council values all types of diversity on its boards and commissions. Your responses on this page provide valuable information to the Council in achieving that goal. i In order to ensure that the board and commission is represenlalive of the community and the groups(s) which it serves, please provide your information for the following: Age _/ Country of Origin 1) S 74— . _ - _ Sexual Orientation __ r(t �c ✓ 0 S V Religwn Do you have a disability? YES_ NO Y__ Race, Color or Ethnic Group LV Ar *Note: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise finance and one person who receives rental assistance. (Resolution) Signature of Applicant* Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, Council will not consider your application, You are encouraged Ao contact individual Council Members to express your interest in serving. Contact information is attached. 011 t;, Z' e—, 4`101i9'doz Marian Karr From: Retish, Paul M <paul-retish@uiowa.edu> Sent: Sunday, November 20, 2016 2:14 PM To: Council Dear council members. I hope you will consider my reapplication to the Human Rights Commission in a favorable manner. I am committed to the projects the Commission has started and is continuing. I still want to continue with the Building Blocks job fair as well as the education of the community and myself on human rights. Thank you Paul Retish Sent from my iPad City of Iowa City Advisory Board/Comlmission/Cola mitgee Application Form nm ArrL1UjfV11ON IS A PUBLIC DOCUMENT WITH THE EX( MARKED "CONFIDENTIAL.' THIS APPLICATION WILL 13 CC MONTHS AND AUTOMATICALLY CONSIDERED FOR ANY Advisory1Board/Commission/Committee Name NAME /Vi r,.rJ, _ "A. -r" Q .. L.. __A.,,. Z016 SEP 26 Term Azo/ rl Is your home address within the corporate limits of Iowa City'/ YOSA No 1 How long have you lived in Iowa City? S i n e e J-ia ne, -- yt21 Gender: Male _ Female ContacW3f9- 4 6e_}orN� -- --____��' do Finail Address CONTRIBUTION AND/OR ACTIVITIES WHI POSITION: CH YOUFEEL QUALIFYYOU FOR THIS Sir F- AACLC-h-e.tk WHAT IS YOUR PRESENT KNOWLEDGE OF TM.S ADVISORY BOARD? St r, CL41 ach e aC 0016 Cr+y l-�rHz f (, Com LIST POTENTIAL CONFLICTS OF INTEREST: See page I for information regarding ConRtct of Interest S to CLAN itch -P Off. ADO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY ]BOARD OR COMMISSION? _yes NO (If yes, please indicate which board would be your fust choice to serve on.) MdisreprmFutanons 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. City of Iowa City Advisory Board/Commission/Committee Application Form Name: Nicole Jeanette "AJ" Richard 2016 SEP 26 A;', I ! : 2 - 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@gmail.com CONTRH3UTION 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/Youtb/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. Nicole "AJ" Richard continued Human Rights Advisory Commission Application LIST POTENTIAL CONFLICTS OF INTEREST t„ I work for Reach For Your Potential. My previous employer was Camp Courageous in Monticello, IA. I was terminated from myposition there after many years and filed a complaint with the Iowa Civil Rights Commission wVnch 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 REFERENCES PROVIDED UPON REQUEST BOARD, CQMUSSiON AND COFAM17'PEEs0 01 CITY OF IOWA CITY Name of City Board/Commission/Committee I& hiig n,- Date q•-,2- Name Q 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 It there ars 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 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 110% Median Income ! ncaSnel1,: 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 71600 4 23,850 39,750 47,700 63,60p 79,500 5 25,800 42,950 51,540 68,700 85,900 8 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. © Age ern Gender x,,��0-01 Income (see table) jT 1 CC) 00 nJ Sexual Orientation Other (Please explain below) N�4 nan Rights Commission Application February 2015 page 4 of 9 Religion 114t'ahXI AA r4c r-31 Disability a '4isrn -'r bra rnyAtj_OL� Race, color or ethnic group i National origin h/CIS p ermp n 1✓r4 res ra(-en+ Q F 6M a City of Iowa City _ Advisory Board/Commission/Committee' d g E D Application Form 2016 OCT -7 PM 4:17 11115 APPLICATION IS A PUBLIC DOCUMENT WITH TIIE EX(RFJ .HE LAST PAGE MARKED "CONFIDENTIAL." THIS APPLICATION WILL BFy�4iII1S 1•k•d76,13 TWELVE MONTHS AND AUTOMATICALLY CONSIDERED FOR ANY VA� DURING THAT TIME. Advisory Board/Commission/Committee Name Term I NAME TO LI t— HOME ADDRESS�� f f �� (%(�W JSOJ Is your home address within the corporate 'limits 'of Iowa City? Yes 'y _No How long have you lived in Iowa City? U IL,) Gender: Male _ Female,' Contacttl3 - 9Y-Lqi?i Email Addresse% 'r_ A Gq o0jyrl13 it L+C(�) CONTRIBUTION AND/OR ACTIVITIES WHICH YOU FEEL QUALIFY YOU FOR THIS Tll(.tmi�� h� bL213 rad, FCX- maniq (� lJlniC� hoU� ��1 nzL6L6 ,, J WHAT IS YOUR KNOWLEDGE OF THIS ADVISORY BOARD? LIST POTENTIAL CONFLICTS OF INTEREST: Interest 1 for information regarding Conflict of D9XOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? _Yes o (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 Page2 of 7 i? BOARD, COMMISSION AND COMMITTEES` ° 1� N BUSINESS LISTING ,,� �®r@ *TY OF -IOWA CITY Name of City qr, Board/Commission/Committeeatel T Name .° Section 362.5 of the Code of Iowa generally prohibits, with certain important exceplfdhs, a.memberof a city Board or Commission from having an interest in a city contract. A copy of SeCfon 363.5 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 Sig ze 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 T 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 pow 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 CE 71,600 4 23,850 39,750 47,700 63, ^� 0 500 5 25,800 42,950 51,540 68,740-t "', I "89'900 6 27,700 46,150 55,380 73,85-6 t 92,300 7 29,6D0 49,300 59,160 78,90@x- 1-6*00 8 31,500 52,500 63,000 84,000 �.; 10, 00 r 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 L-- Gender 40 1 Income (see table) Sexual Orientation = Other (Please explain below) Human Rights 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 i" Application Form PHIS A)'PLICATION IS A PUBLIC DOCUMEM' 1VITH 7'HH EXCF,PTION OF Ti" LAST PAGE MARKED "'CONFIDENTIAL." THIS APPLICATION WII,L BE CONSIDERED FOR TWELVE MONTHS AND AUTOTiATICALLY CONSED ERF,D FOR ANY VACANCY DURING TIIA•r MIE. Advisory Bcard/Commissioa/Committec Name 9 t•(♦'y`RA, f2• i'p/ erm NAME. d`W.I.�/ 4t1 t_1,Y HOME ADDRESS y�p�{..m '-�+ar Is your home address within thecorporatelimits of Iowa City7 Yes_ No HOW long have you lived in Iowa City? 5 CNi.? • . Gender. Male_.._�1� Female Comactl/_��Q.jSfS'i3°o�EmaiimdmssQ a °S� ems,/rte• d/P 1� CONTRIBUTION AND/OR ACTIVITIES WHICH YOU FEEL POSr1r1ONe QUALIFY YOU FOR THIS I,— WHAT IS YOUR PRESENT KNOWLEDGE OF THIS ADVISORY BOARD? r � t LIST POTENTIAL CONFLICTS OF INTEREST; See page I for information regarding Conflict of Interest �DO YOU CURRENTLY SERVE ON ANOTHER IOWA CITY BOARD OR COMMISSION? Yes No (If yes, Please indicate which board would be your fust choice to Serve on.) ` INisrepresentations on this application will constitute just cause for removal of an appointee. If yRq fail to answer all the questions, Council may not consider your application. e+ Tune 2 116 __ B �' C") 1 E{r 74f7 CO 1 m � ca 1 •1 Powered by MachPorm 1 � i BOARD, COMMISSION AND COMMITTEESSIOAN 's (� BUSINESS LISTING CITY OF IOWA CITY Name of City Board/Commission/Committee r�UVV v� �'R` �OmyYji55i Date F/1/16 Name t "W" __ t Mit Section 362.5 of the Code of lo�rua genevrally 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 spouseldomesticpartner, 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 ofd appMtee. If you fail to answer all the questions, Council may not consider your application. n v,rri .� General Application -` ' F f - April 2015 Page 3 of 7 r- c z - V W .7 V, TABLE OF INCOME GUIDELINES AND DEFINITIONS FOR IOWA CITY Effective May 1, 2014 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 17=`=J Gender Income (see table) E'� Sexual Orientation Other (Please explain below) Human Rights Commiss(on Application February 2015 page 4 of 8 Religion N Disability GJ Median Income Level) Incomeome) 50°,6 MedC60%M78.9008 or ethnic group Income Medlanverty Income16,700 $27,8550 $55,70019,100 R50$25,800 31,8000 63,60021,500 35,8050 71,60023,850 39,75000 79,500 42,9500 85,900 27,700 46,150 55,38000 92,300 7 29,600 49,300 59,1600 98,6008 31500 52,500 63,0000 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 17=`=J Gender Income (see table) E'� Sexual Orientation Other (Please explain below) Human Rights Commiss(on Application February 2015 page 4 of 8 Religion N Disability GJ Race, color L'� or ethnic group 5 National origin art L'� Human Rights Commission Attendance Record NAME TERM EXP. 10/20 IS 11/17 IS 12/15 15 1/19 16 2116 16 3115 16 4118 16 51176/21 16 I6 717 16 7/19 16 8116 Ifi 9120 I6 Joe D. Coulter 1112019 X X X X X X X O/E X X O/E X O/E Adil D. Adams 1/12019 — — — O/E O O/E O X X X X X X Eliza Jane Willis 1112019 -- — — X O/E X X X X X X X X Paul Relish 1/12017 X X X O/E X X X X X X X X X Orville Townsend, Sr. 1/12017 X X X X X X X X X X X R R Karol Krotz 1/1/2017 — — — — — — — O O O R R R Andrea Cohen 1/12018 — — — X X X X X X X X X X Kim Hanrahan 1/12018 X X X X X O/E X X X X X O X Shams Ghoncim 1/12018 O/E X X O/E X X X X X X X X X Key X = Present O - Absent O/E- Absent/Excused R = Resigned — = Vacant 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, 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, November 30, 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. Board/Commission Application Cover Board/Commission: Parks and Recreation Commission Two vacancies four year term 11112017- 11112021 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. Council Announcement Date: Application Deadline: Council Appointment Date: Date of Non -Gender Appointment Gender Balance Requirement: Current Gender Balance: Gender Female Male Female 11/1/2016 11/30/2016 11/1/2016 12/19/2016 After date above Council may appoint without regard to gender 2 Female Female:2 Male:5 Name and Address Bentler, Suzanne 201 Black Springs Circle Russell, Ben 907 Canton St Venzon, Jamie 763 Mission Point Rd serving unexpired term +t� �E ' w� CITY Of IOWA CITY UNESCO OW OE ME"OURE Advisory Board/Cortrnission Application Form This application is a public document and as such can be reproduced and distributed for the public. This application will be considered for twelve months only and automatically considered for any vacancy during that time. NOTE: Must be 18 years of age and live within city limits of lows City to apply Date of Application 11/10/2016 First Name Suzanne Last Name Bentler Home Address* 201 Black Springs Circle City IOWA CRY State IA Zip Code 52246 1. Is your home address (listed above) within the corporate limits of Iowa City? Yes Contact Phone Number* 3193215157 Email Address* su-bent@hotmail.com Boards & Commissions Select a Board or Commission you are interested in:* Parks and Recreation Commission 2. How long have you been a resident of Iowa City? 23 years 3. Occupation:* Assistant Research Scientist 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I am an active user of many of the parks in lova City and have been for many years. 1 hike, bike, kayak, walk dogs, cross country ski, and gather with friends and family in those parks. As a P&R commission member for the past several years, I have torte to understand and appreciate the recreation part of the department as well and have many friends who use the services provided by our recreation center and other facilities. I am thoughtful, respectful, enjoy people, love nature, and have a cooperative spirit which I hope has made rte a good commission member during my first term and which I think will help me to be an excellent commission member in a second term, if I am appointed. 6. What is your present knowledge of each advisory board you are interested In?* I have been an active member of the Parks & Rec Commission since 2013 and have gained a great deal of knowledge about and experience with the commission. I am applying for a second term to be able to use that knowledge in the coming years to help usher in the changes that will be headed our way. I understand that this would be my final term if I were to be appointed. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describea some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDGIHOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision-making process or gain inside inormation with regard to such activities, may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federalVassisted activity, either for themselves or those with wham they have business or immediate family lies, during their tenure or for one year thereafter. Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a Citycontract City Council Resolution # 15300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: 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, mofher-in-law, father-in-law, step-parent, brother, sister, step -siblings and hag -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 Res. #15-300 states 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. Council policy is not to peril an individual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. 7. Do you currently have a conflict of Interest?* W 8. Do you currently serve on another Iowa City board or commission?* W Demographic Information The City Council values all types of diversity on its Boards and Commissions. You responses on this page provide valuable information to the Council in achieving that goal In order to ensure that the Board and Commission is representative of the community and the groups(s) which it serves, please provide your information for the following: 9. Age 45 10. Country of Origin United Slates 11. Sexual Orientation Heterosexual 12. Religion None 13. Do you have a disability? No 14. Ethnicity Caucasian 'NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* i�27MW�/ LIr Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. I r -4 Advisory Board/CormTission Application Form M.ty This application is a public document and as such can be reproduced and distributed for �6rR'W waw the public. This application will be considered for twelve months only and automatically CITY OF IOWA CITY considered for any vacancy during that time. UNESCO CITY OF UTERATURE NOTE: Must be 16 years of age and live within city limits of Iowa City to apply Date of Application 11/30/2016 First Name Ben Last Name Russell Home Address* 907 Canton Sl City IOWA CITY State IA Zip Code 52245 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-621-2999 Email Address* be njandn. k.russell@gmail. com Boards & Commissions Select a Board or Commission you are interested in:* Parks and Recreation Commission 2. How long have you been a resident of Iowa City?* 21 years total 3. Occupation:* Commercial Banking Officer 4. Gender:* Male 5. Experience andlor activities which you feel qualify you for this position:* I grew up in Iowa City and graduated from Regina Hgh School. While growing up in Iowe City, I used many of the parks and recreational facilities such as the pools and rec center. I was a part of the rec center's summer camp program each year and went though the counselor in training program. I have lived in Iowa City for a total of approximately 21 years and recently built a house in Iowa City for long-term use. I have worked for His Bank and Trust Company for over 6 years total and love volunteering in the community that involve the City's parks and facilities. Iowa City is and always will be my home. 6. What is your present knowledge of each advisory board you are interested in?* This commission involves understanding the City's policies, rules, regulations, ordinances and budgets relating to the parks and recreation centers. Throughout one's time on this commission, people recommend and review reports to the City Council that is deemed to be in the good of the public interest. This commission works with the City to help stay on task throughout the year relating to new and existing developments/projects/plans as well as financially being responsible. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describea some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to line City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision-making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally—assisted activity, or have a financial interest in any contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted acfivity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. 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. City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for appointment to Boards and Commissions: 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 Res. #15-300 states 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. Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information The City Council values all types of diversity on its Boards and Commissions. Your responses on this page provide valuable information to the Council in achieving that goal In order to ensure that the Board and Commission is representative of the community and the groups(s) which it serves, please provide your information for the following: 9. Age 31 10. Country of Origin South Korea 11. Sexual Orientation Male 12. Religion Catholic 13. Do you have a disability? No 14. Ethnicity Asian 'NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. i t a Advisory Board/Comrrtission Application Form MT. wy� ' This application is a public document and as such can be reproduced and distributed for the public. This application will be considered for twelve months only and automatically CITY Of IOWA CIN Considered for any vacancy during that time. UNESCO CRY OF MEMMM NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 11/29/2016 First Name Jamie Last Name Venn Home Address* 763 Mlission Point Rd City IOWA CRY State IA 21p Code* 52245 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-331-9393 Email Address* ismievenzon@gmil.com I:.e , •rW: [ -e Select a Board or Commission you are Interested in:* Parks and Recreation Commission 2. How long have you been a resident of Iowa City? 28 years 3. Occupation:* Corporate Events Director, American Heart Association 4. Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* As a fife -long resident of Iowa City, and a step -mother to an active 8 -year old boy, I have had a wide range of experiences with Iowa City Parks & Recreation. As a young girl, I was involved with different activities through the parks & rec department, from Iowa City softball, to 5 -on -5 basketball, to indoor roller skating on the weekends with friends; going to the rec center was always the highlight of my weekends. As a step -mom, rve had the opportunity to share my love for the kme City parks with my stepson, who loves to discover new parks in our city. My stepson is also very active in the different opportunities available to him through the IC Parks & Rec department. He has attended summer camp for the past two summers, and has participated in boys baseball, basketball, and soccer leagues. lows City is such an important piece of who I am, and rm so proud of my city. I feel as though my own experiences as a child as well as my current experiences as a parent would bring a fresh perspective to the commission, and a point of view that may not yet be represented. 6. What Is your present knowledge of each advisory board you are Interested In?* I have found myself reading through past agendas of the parks & rec commission, and getting excited about the developments of new parks and recreation opportunities in our city. I am so invested in my hometown, and enjoy keeping in -the -know on changes happening. My current knowledge of the Parks & Rec Commission is that the responsibilities include providing recommendations and review to the different rules, regulations, policies, and budgets for the parks and rec centers of the city, as well as cultural functions. I would thoroughly enjoy joining the commission, and working with the group to take on the responsibilities for the parks, rec, playgrounds, and cultural facilities that serve our city, and would be thrilled to face the challenges and opportunities joining the commission would include. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of Interest. The following describea some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised arty functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision-making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally -assisted activity, or have a financial interest in any contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federally -assisted activity, either for themselves or those with whom they have business or immediate familylies, during their tenure or for one year thereafter. Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a Citycontract CityCouncil Resolution # 15-300 established a policy that the following persons shall not be eligible for appointment to Boards and Commissions: A Council Members 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-irt-law, mother -int -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 Res. #15-300 states 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. Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. 7. Do you currently have a conflict of Interest?* 0.. 8. Do you currently serve on another Iowa City board or commission?* No Demographic Information The City Council values all types of diversity on its Boards and Commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the Board and Commission is representative of the community and the groups(s) which it serves, please provide your information for the following: 9. Age 28 10. Country of Origin United States 11. Sexual Orientation Heterosexual 12. Religion Catholic 13. Do you have a disability? No 14. Ethnicity Caucasian 'NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. PARKS AND RECREATION COMMISSION August 10, 2016 Page 2 of 6 PARKS AND RECREATION COMMISSION ATTENDANCE RECORD NAME tn in to W TERM ao EXPIRE r S Suzanne 1/1/17 X X X O/E X X X X X X X X X Bentler David 111115 X X X X X O/E Bourgeois Larry Brown 1/1/18 X X X O/E X O/E X X O/E X X X X Clay 1/1/18 X X X X X X X X X X X X X Claussen Maggie 1/1/17 X X X X X X X X X O/E X O/E X Elliott Wayne Fett 111119 * * * * * * * X X X X X O/E Cara 1/1/16 O/E X X X X X O/E X X X X X X Hamann Lucie 1/1115 O/E O/E X X X X X O/E O/E X X X O/E Laurian Paul Roesler I/1/18 * X X X X X O/E O/E X X X X X Joe Younker 1/1/16 O/E O/E X X X X X X X X X O/E X KEY: X= Present 0= Absent O/E = Absenb%xcused NM = No meeting LQ — No meeting due to lack of quorum * = Not a member at this time 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, November 30, 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. Board/Commission Application Cover Board/Commission: Public Art Advisory Committee - At -Large Two vacancies -three year terms 1/1/2017-1/1/2020 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. Council Announcement Date: 11/1/2016 Application Deadline: 11/30/2016 Council Appointment Date: 11/1/2016 Date of Non -Gender Appointment: 12/19/2016 After date above Council may appoint without regard to gender Gender Balance Requirement: 1 Male, 1 None Current Gender Balance: Female: 2 Male: 1 Gender Name and Address None None 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, November 30, 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 Board/Commission Application Cover Board/Commission: Senior Center Commission Two vacancies -three year terms 1/1/2017 -12/31/2020 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. Council Announcement Date: 11/1/2016 Application Deadline: 11/30/2016 Council Appointment Date: 11/1/2016 Date of Non -Gender Appointment: 12/19/2016 Gender Balance Requirement Current Gender Balance: Gender After date above Council may appoint without regard to gender 2 Male Female:3 Male:1 Name and Address Male Honohan, Jay serving 6t" term 1510 Somerset Ln AdvisoryBoard/Commission Application Form App - ��i This application is a public document and as such can be reproduced and distributed for the public. This application will be considered for twelve months only and automatically CITY OF IOWA CIN considered for any vacancy during that time. UNESCO CITY Of UTERATURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 11/13/2016 First Name* Jay Last Name* Honohan Home Address* 1510 Somerset Ln City IOWA CITY State IA Zip Code 52240 1. Is your home address (listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 319 338-6990 Email Address* nroamer@aol.com IC9� 1pr-W 91111 91 Select a Board or Commission you are interested in:* Senior Center Commission 2. How long have you been a resident of Iowa City?* 66 years 3. Occupation:* attorney 4. Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* I have been commission chair for several years. I am a volunteer attorney at the Center. I attend classes and events at the Center. I am active in community affairs. 1 am the President of the Center's Foundation. I have served on the Ad Floc Committee for Seniors. I have served as police judge and City Attorney for Iowa City. I knowthe rule about serving consecutive terns but would like the Council to waive that rule in my case. This will be my last hurrah on the Commission. I went very much to serve in helping the goal of the City and the Commission to increase the non -tax funding of the Center. 6. What is your present knowledge of each advisory board you are interested in?* Having served on the Conrrission since 1998, 1 know the Commission's role and have worked well with the staff over the years. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest. The following describes some but not all potential conflicts. Potential Conflicts of Interest The Housing and Community Development Commission makes recommendations to the City Council regarding the distribution of federal CBDG/HOME funds. The general rule is that no persons who exercise or have exercised any functions or responsibilities with respect to federally funded activities, or who are in a position to participate in the decision-making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a federally -assisted activity, or have a financial interest in any contract, subcontract, or agreement with respect to a federally -assisted activity, or with respect to the proceeds of the federal"ssisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a Citycontract. City Council Resolution # 15-300 established a policy that the following persons shall rat be eligible for appointment to Boards and Commissions: 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 Res. #15-300 states 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. Council policy is rat to peril an individual to serve on two Boards or Commissions at the same time. You will be asked to resign from one if appointed to another. 7. Do you currently have a conflict of Interest?* No 8. Do you currently serve on another Iowa City board or commission?* hdo Demographic Information The City Council values all types of diversityon its Boards and Commissions. Your responses on this page provide valuable information to the Council in achieving that goal. In order to ensure that the Board and Commission is representative of the community and the groups(s) which it serves, please provide your information for the following 9. Age 86 10. Country of Origin USA 11. Sexual Orientation Married to my wife for 58 years. 12. Religion Methodist 13. Do you have a disability? No 14. Ethnicity Irish to the core. Father's side County Cork, Mother's side County Tyrone *NOTE: The Human Rights Commission strives to ensure the Commission is representative of the community. Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and economic groups in the city. (Ordinance) The Housing and Community Development Commission strives to satisfy its purpose and intent, when possible to have at least one person with expertise in construction, at least one person with expertise in finance, and one person who receives rental assistance. (Resolution) Signature of Applicant* �ay rQ,�arf�rr Misrepresentations on this application will constitute just cause for removal of an appointee. If you fail to answer all the questions, except demographics, Council will not consider your application. You are encouraged to contact individual Council Members to express your interest in serving. Approved Minutes August 18, 2016 Senior Center Commission Attendance Record Year 2016 Name Term Expires 1011511511/19/15 12/17/15 1/14/1612/18116 3/17/16 4121/16 5/I9/16 6/11/16 6116116 7/21/16 8/18/16 Joy Beadleston 12/31/19 -- — — X I X X NM O/E I X NM O/E I O/E Chmyll Clamon 12/31/18 X X NM X X X NM O/E X NM X X Chuck Felling 12/31/15 X X NM — — — — — — — — — Jack Hobbs 12/31/16 X X NM X X O/E NM X X NM X WE Mark Holbrook 12/31/18 X X NM X X X NM X O/E NM X X JayHonohsn 12/31/16 X WE NM O/E X X NM X X NM X X Kathy Mitchell 12/31/19 X X NM X X X NM X X NM O/E X Margaret Reese 12/31/17 X X NM X X X NM O/E X NM X X Key: X- Present O- Absent O/E= Absent/Excused NM— No meeting —= Nota member 12-06-16 17g 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, November 30, 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. 11/30/2016 Board/Commission Application Cover Board/Commission: Telecommunications Commission One vacancy -unexpired 3 year term Upon appointment - 7/1/2017 It is hereby established, as a formal polity 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. Council Announcement Date: 11/1/2016 Application Deadline: 11/30/2016 Council Appointment Date: 11/1/2016 Date of Non -Gender Appointment: 12/19/2016 After date above Council may appoint without regard to gender Gender Balance Requirement: 1 Female Current Gender Balance: Female: 1 Male: 3 rGender Name and Address -------- --- None None