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HomeMy WebLinkAbout2018-05-15 Appointment 1Oa NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: AIRPORT COMMISSION Two Vacancies— Four Year Term July 1, 2018—June 30, 2022 • Duties: To exercise all the powers granted to cities and towns under Chapter 330 of the Code of Iowa, except the power to sell said airport. • To annually certify the amount of taxes within the limitations of the Statutes of the State of Iowa to be levied for Airport purposes. All funds derived from taxation or otherwise for airport purposes shall be under the full and absolute control of the Airport Commission, deposited with the City Treasurer, and disbursed only on the written warrants or order of the Airport Commission. • The Airport Commission meets the third Thursday of each month at 6:00 p.m. Iowa City appointed members of the 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., Tuesday, May 8, 2018.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 Airport Commission should be directed to Michael Tharp, Airport Operations Specialist at 356-5045. Airport Commission #years as Country of Sexual Gender Name Term ending resident of IC Occupation Gender Ages Orgin* Orientation* Religion* Disability* Ethnicity* Identity` Race* Unique Identifiers' Minnetta Gardinier 6/30/2019-2nd Term 20 Assoc Dean F Robert Libby 6/30/2020-1st Term 1 month M Christopher Lawrence 6/30/2021-1st Term 10 Systems Admin M 29 Vacant 6/30/2022 Vacant 6/30/2022 Please note:The information provided is the information provided on the application at the time of submission. *Information is voluntary Airport Commission Agenda&Info Packet Meeting Date April 19,2018 Page 14 of 38 April 4, 2018 Page 2 Airport Commission ATTENDANCE RECORD 2017-2018 TERM o o 0 o o o o o o o o 9 A CD V CO O s N N N W W 41 N N - - - n - � to o o cco A cri °' NAME EXP. _ - V V V V V -4 CO CO CO 00 CO CO CO C° V Minnetta 07/01/19 0 Gardinier 1 0/ 0 E X X X E X /E X X X X X X X X Chris 07/01/18 0/ 0/ 0/ Ogren XXXXX XXX X XE X EE X A.Jacob 07/01/18 0/ 0 0/ 0/ 0/ 0/ 0/ 0/ Odgaard X X X X X E /E E E E X E E E X Robert 07/01/20 0 0/ 0/ Libby X /E X X E X X E X X X X X X X Christopher 07/01/21 N N 0/ Lawrence MMXXXEXX X X X X X X X Key: X = Present X/E = Present for Part of Meeting O = Absent O/E = Absent/Excused NM = Not a Member at this time Board/Commission Application Cover Board/Commission: Airport Commission Two Vacancies to fill a four-year term 7/1/2018-6/30/2022 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: 4/2/2018 Application Deadline: 5/8/2018 Council Appointment Date: 5/15/2018 Date of Non-Gender Appointment: 7/3/2018 After date above Council may appoint without regard to gender Gender Balance Requirement: 1-Female, 1-None Current Gender Balance: Female: 1 Male: 2 Gender Name and Address Male Lebrie, Derek 1015 W Benton St#38 Advisory Board/Commission Application Form 4Agt 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 6/12/2017 First Name* Derek Last Name* LaBrie Home Address` 1015 W Benton St#38 City IOWA CITY State IA Zip Code* 52246 1. Is your home address (listed above)within the corporate limits of Iowa City?* Yes Contact Phone Number* 860-501-7162 Email Address* derek.r.labrie@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Airport Commission 2. How long have you been a resident of Iowa City?* since August 1, 2016 3. Occupation:* flight instructor, student 4. Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* During my undergraduate education in North Dakota I served as a student senator and later a Governmental Affairs Commissioner which required I worked with state legislators and city council in enacting and supporting legislation that would positively impact students and the school itself. I was a registered lobbyist in North Dakota during that time,testifying in legislative committee hearings and working with other entities across the state. I was the sole student representative on the Academic Affairs Council and in a separate Association chaired the Merit-Based Scholarship Research Subcommittee aimed at rewriting the state's merit-based scholarship proposal. Basically,this experience allows me to know the complexities of state politics,local politics, and administrative bodies'need and operating mechanisms. I have experience at each of these levels of government,and look to put that experience to good use. I am also a law student at the University of Iowa, gaining more knowledge on governmental and administrative processes. Lastly, I am a commercial pilot for single-engine and multi-engine airplanes and hold flight instructor certificates for both types of aircraft in addition to instrument rating. I have a full understanding of the industry and can apply my background and flying experience to ensure the Airport Commission is doing all the good it can. 6.What is your present knowledge of each advisory board you are interested in?* I am familiar with the Airport Commission and their operations. I am familiar with the basic structure of the 5- member commission and its jurisdictional boundaries. 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 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 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 haft -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 22 ' 10.Country of Origin United States 11. Sexual Orientation heterosexual 12. Religion 13. Do you have a disability? No 14.Ethnicity white/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. Drop-down 05-15-18 1Ob OS-15-18 1Oc NOTICE 05-15-18 1Od THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMI� 05-15-18 HISTORIC PRESERVATION COMMISSION 1Oe Four Vacancies—Three Year Term July 1, 2018—June 30, 2021 (1)At Large Representative (1) College Green Representative (1) East College St. Representative (1)Woodlawn Representative • Duties of the Historic Preservation and Land Marks Commission include: conducting studies for the identification and designation of Historic Districts; reviewing and acting upon all applications for Certificate of Appropriateness; cooperating with property owners and city agencies regarding remedy of dangerous conditions. • Furthering the efforts of historic preservation in the City by making recommendations on preservation issues, when appropriate, by encouraging the historical, architectural or cultural value, and by encouraging persons and organizations to become involved in preservation activities. • Applicants for district representatives to the Historic Preservation Commission must reside in the district that is specified. • This Commission meets the second Thursday of each month at 5:30 p.m. • 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., Tuesday, May 8, 2018. Questions about the Iowa City Historic Preservation Commission should be directed to Bob Miklo, Sr Planner at 356-5240. Application forms are available from the Clerk's office upon request or on the City website at www.icgov.org. Historic Preservation Commission - Current members #years as Country of Sexual Gender Name Term ending resident of IC Occupation Gender Age* Orgin` Orientation* Religion* Disability* Ethnicity* Identity' Race" Unique Identifiers' Zachariah Bullata(at large) 6/30/2019-1st Term 6 M 1 _ Sharon DeGraw(Brown St) 6/30/2019-1st Term 15 F Cecile Kuenzli(Summit St) 6/30/2019-1st Term 46 F Vacant(Jefferson St) 6/30/2019 _ Natl Political Not Kevin Boyd(At large) 6/30/2021-2nd Term 25 Director M 37 USA LGBT practicing White Research Gosia Clore(Longfellow) 6/30/2021-2nd Term 5 Scientist F Thomas Agran(Northside) 6/30/2021-2nd Term 8 Artist M 30 USA Straight Caucasian GT Karr(At large) 6/30/2021-1st Term 38 Business Owner M 38 USA Hetrosexual Christian Caucasian Vacant At-Large 6/30/2021 Vacant College Green 6/30/2021 Vacant East College St. 6/30/2021 Vacant Woodlawn 6/30/2021 i Please note:The information provided is the information provided on the application at the time of submission. •Information is voluntary I I I HISTORIC PRESERVATION COMMISSION ATTENDANCE RECORD 2017-2018 TERM NAME EXP. 6/15 7/31 8/10 9/14 10/12 11/9 12/14 1/11 2/8 3/8 4/12 5/10 6/14 AGRAN, THOMAS 7/1/20 X X X X X X X X X X X BAKER, ESTHER 7/1/18 X X X X X X X X X X X BOYD, KEVIN 7/1/20 X O/E X O/E X X X X X X X BUILTA, ZACH 7/1/19 X 0/E X X X X X X O/E X X CLORE, GOSIA 7/1/20 X X O/E X X X O/E O/E X 0/E X DEGRAW, SHARON 7/1/19 X X X X X X O/E X X X X KARR, G. T. 7/1/20 — X X X X X X X X X X KUENZLI, CECILE 7/1/19 X O/E O/E X O/E X X X X X X MICHAUD, PAM 7/1/18 X X O/E X X X X X X X X SWAIM, GINALIE 7/1/18 X X X X X 0/E X X X X X WAGNER, FRANK 7/1/18 O/E O/E X O/E X X 0/E O/E X X X KEY: X = Present O = Absent O/E = Absent/Excused — = Nota Member Board/Commission Application Cover Board/Commission: Historic Preservation Commission -At-Large One vacancy to fill a three-year term 07/01/2018 - 6/30/2021 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: 4/2/2018 Application Deadline: 5/8/2018 Council Appointment Date: 5/15/2018 Date of Non-Gender Appointment: 7/3/2018 After date above Council may appoint without regard to gender Gender Balance Requirement: 2-Female, 1-Male, 1-None Current Gender Balance: Female: 3 Male: 4 Gender Name and Address Female Bowans, Lorraine 925 Barrington Rd Female Corcoran, Kate 20 Arbor Hill Circle #41 Male Foelsch, Lucas 711 Streb St. Male Pedelty, H 1111 E Burlington St. Male Pitzen, Quentin 2040 Tanglewood Male Prato, Adam 410 N. Scott Blvd Male Wagner, Frank 3rd Term ending 6/30/18 519 S. 1st Ave Male Wan, Shu Hawkeye Drive #448 .:.= AdvisoryBoard/Commission Application Form .a �I nl �*� 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 2/20/2018 First Name* Lorraine Last Name* Bowans Home Address* 925 Barrington Rd 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* 319-331-5032 Email Address* lbowans21@msn.com Boards & Commissions Select a Board or Commission you are interested in:* Historic Preservation Commission (HPC) Historic Preservation Commission Category* At-Large 2. How long have you been a resident of Iowa City?* 40 yrs 3. Occupation:* Realtor 4. Gender* 'this question is rrendatc y in order for the City to comply with the State's gender balance requirement,which treats gender as binary."Gender Identity"may be provided in the Cenugraphics sectioned the application bdcw. r Male I7 Female 5.Experience and/or activities which you feel qualify you for this position:* Lived at 510 S Governor St for 30 yrs.We did extensive work on the home to restore it.Worked on creating the Conservation District for Governor/Lucas.Worked on creating the original guide lines for a Conservation District. Have an associate degree in Civil Engineering Technology and worked in the City engineering division for 6 yrs.Currently serving on the City Neighborhood Council. Passion for historic homes. Member of Friends of I-storic Preservation.Serve on the Fair Housing and Education Committee for the Iowa Association of Realtors 6.What is your present knowledge of each advisory board you are interested in?* To preserve the historic homes and neighborhoods in Iowa City.To help identify properties that may fall into this category.To review plans for changes to historic homes.To review the guidelines for Conservation and 1-iistoric District requirements. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 riot 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?* Ivo 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 62 10.Country of Origin USA 11.Sexual Orientation hetro 12. Religion Christian 13.Do you have a disability? No 14. Ethnicity 15. Race white 16. Gender identity female '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* (6t•terei!/�'ffewfwed 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. Drop-down i -/ I --- =...i.-gr&... 47,1pIII .044r"_O°'caAdvisory Board/Commission/Committee CITY OF IOWA CITY Application Form UNESCO CITY OF LITERATURE 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 Boar 'ommissio ommittee Name m i .,p t . di/%.-_A. Al A Date of Application A Name ra Home Address A{yi n I, C.!__14410211, " .,52-70 — Contact ,j2Contact phone number —03 3 Email Addressf'�GcOIrG n ,�, Your home address m t be within the corporate limits of Iowa City? CCf� How long have you lived in Iowa City? �o, A Occupation: .t4 r spa t�� 1 4 45- Gender -Gender. Male Female Experiences and/or activities which you feel qualify you for this position: a 1444dreealtt.ie , a- -< 174 C, C°:sem -0 r *= N v D N What is your present knowledge of this advisory board? C �lAberra , J-- awn e---417--C13..1,14 CO 't i>i. raM 244* —2t b. 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 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. Section 362.5 City Council Resolution #15-300 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. #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 tb ,same time.You will be asked to resign from one if appointed to another. O' Do you currently have a conflict of interest?YES NO — C") 1111111.11D List potential conflicts of interest(See last page for information regarding conflfOrinte st) f Please indicate if there are none. 171 2 rn xQ BUSINESS NAME BUSINESS ADDIESS ��' Do you currently serve on another Iowa City board or commission? YES NO f� If so which one do you prefer? • 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: Age Country of Origin rfl Sexual Orientation G ,t1 / - Religion b/"e.. IP Do you have a disability?YES NO v Race,Color or Ethnic Group _ C �(,a V. *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* C....e.02-1-re31-0.--0. ((Ask 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 to contact individual Council Members to express your interest in serving.Contact information is attached. • O �a D=.t -•t =4 r) DD rem <m 323 = DN � IN) O KATE CORCORAN 20 Arbor Hill Circle#41 • Iowa City,IA 52245 • Cell:(206)941-8733 katecorc@gmail.com May 7, 2018 City Council City of Iowa City 410 E.Washington St. Iowa City,IA 52240 Re: Application for appointment as At Large Representative Iowa City Historic Preservation Commission Dear members of the City Council: As you may recall, I served as an At Large Representative on the City's Historic Preservation Commission from 2013 to 2016,but was not reappointed when my term ended. I'm writing today to tender my application for the at-large position that will be vacant July 1. Here's what I'd bring to the position: •substantive knowledge of historic preservation,including the related federal laws and Iowa City ordinances •understanding of the quasi-judicial process in which Commission members review and make decisions on Certificate of Appropriateness applications • a facility for gathering, digesting and analyzing information quickly •strong communication skills and the ability to resolve issues with courtesy, respect and compassion •high attention to detail,devotion to accuracy,and a talent for problem-solving • a native Iowa Citian's love for her community You are certain to have many qualified applicants,but I believe that my strong record of public service, together with my maturity,collaborative nature and good judgment,makes me a strong candidate for this appointment.Please allow me to bring my energy,high standards and passion for historic preservation to the Commision. Thank you for considering my application. c=, Sincerely yours, - c' 1605 -r r-- -v Kate Corcoran 570 a N 0 N KATE CORCORAN 20 Arbor Hill Circle#41 • Iowa City,IA 52245 • Cell:(206)941-8733 katecorc@gmail.com EXPERIENCE 12/17-present KELLY SERVICES,INC. IOWA CITY,IOWA Technical Editor,ACT, Inc. As temporary employee,edit,rewrite and manage production process for scores of ACT documents, forms, letters,booklets and test manuals. 8/16-11/16 2016 DEMOCRATIC CONSOLIDATED CAMPAIGN IOWA CITY, IOWA Political Field Organizer-RuraI Johnson County Identified,recruited,trained and supervised volunteers in towns and rural areas in 13 Johnson County townships to make contact with community members and support the election of national and state Democratic candidates.Planned,organized and executed extensive phonebanking and canvassing operations,and made 200 recruitment calls a day. 8/15-4/16 UNIVERSITY OF IOWA PATIENT FINANCIAL SERVICES IOWA CITY, IOWA Revenue Cycle Representative-Medicare Team Gained mastery of Epic medical-record and accounts-receivable systems to timely correct and file Medicare Part A and Part B hospital claims. Researched claims on Medicare online billing website,identified coding errors/omissions,sent claims to appropriate UIHC department for recoding and/or documentation of medical necessity,refiled claims,and submitted appeals.Collaborated with patients,insurance carriers,and federal agencies to resolve outstanding accounts receivable and credit balances. 10/13-1/2015 GENERAL DYNAMICS INFORMATION TECHNOLOGY CORALVILLE,IOWA Customer Service Representative-Dual-trained in Medicare and Marketplace/Affordable Care Act Used telephone,e-mail,Web browsers and multiple technology platforms simultaneously to provide knowledgeable responses and resolve callers' issues.Explained Marketplace and Medicare health insurance programs,rules,eligibility,enrollment,costs and coverage. Provided referrals to federal and state agencies and organizations.As Medicare claims specialist,traced and explained disposition of claims and appeals and interpreted HCPCS codes.Completed online applications and enrollment in health insurance andarug plans. O ee 2010-2011 PFAU COCHRAN VERTETIS AMALA SEATTIPWA115-1IN at N Contract Attorney c7-< i ��-�• Worked for plaintiffs' firm specializing in representing victims of chi17-11 d Equal abuse. Completed special projects that included organizing and reviewing agvaxi ly 71,F10 0 redacted discovery documents produced in civil cases filed in King C�, hine". D �ry� 2004-2010 UNIVERSITY OF WASHINGTON SEATTLE,Wi 1INGTON Assistant Director for Public Service/Public Interest Programs School of Law Center for Career Planning and Public Service,July 2007-April 2010 As career coach,helped law students identify interests,research opportunities,and prepare essays,resumes,and cover letters for internships,externships,clerkships,and full- and part-time positions.Directed Olympia Fellows and Pro Bono programs. Lecturer, School of Law,2004—2006 Taught beginning and advanced courses in legal research and writing and introductory law course for non-law students.Served on Curriculum and Admissions committees and was faculty supervisor for 29 law students performing for-credit externships. 1998-2004 UNIVERSITY OF IOWA IOWA CITY,IOWA Program Assistant, School of Journalism and Mass Communication Directed school's career services and internship-for-credit programs.Educated and advised students about careers and coached them as reporters,writers, designers, photographers,and researchers;solicited employers and organized on-campus interview programs;publicized internships and jobs;provided programming and opportunities for students to network with media professionals and alumni;provided written and oral references;nominated students for scholarships and awards;entered their work in national contests. Administered internships for credit for about 60 students a year. Summer'97 THE DAILY IOWAN IOWA CITY,IOWA Writing Coach Worked with 50-member editorial staff of 20,000-circulation University of Iowa student- run newspaper.Wrote daily critique of paper,conducted individual coaching sessions with editors,reporters,and designers,attended weekly editorial meetings,and was available during daytime and evening hours to answer questions and give advice. 1996-2000 LAW OFFICE OF KATE CORCORAN IOWA CITY,IOWA Attorney and Mediator Engaged in solo civil practice(part-time, 1998-2004)with emphasis on mediation. Conducted mediations for Iowa Public Employment Relations Board with teachers,school support personnel,police officers,sheriff's deputies,and county employees.Provided pro bono mediation of divorce and custody cases in Johnson and Linn County District Court and age,race, and sex discrimination cases filed with Iowa Civil Rights Commission. 1994-2001 UNIVERSITY OF IOWA IOWA CITY,IOWA Adjunct Assistant Professor, School of Journalism and Mass Communication Taught undergraduate and master's program courses in reporting and writing,editing, legal reporting and persuasive writing.For seven semesters,taught advanced Sgazine • production class in which students wrote,shot for,edited and designegnt al onlineT editions of the School's biannual alumni magazine. D. ■1 c)—C 1994-1996 IOWA SUPREME COURT DFIOES,ISO W A Executive Director,Iowa Supreme Court Commission on Planning for the 2Zstg' ntu rn Directed$250,000 strategic planning project on future of Iowa's judic4braniziliuOrgADd and staffed two conferences for 72-member commission,as well as miRtthly rp stings held by steering committee and five 12-member teams;wrote grant proposals and9:iod fund- raising;wrote press releases and handled media relations;researched and drafted questions for public opinion survey;conducted focus groups with 141 court stakeholders; traveled around Iowa to make presentations to judges,attorneys,court personnel and the public;organized public hearings throughout the state;and was in charge of compiling, editing,publicizing and disseminating commission's final report. 2 1992-1994 CHILDERS&FIEGEN,P.C. CEDAR RAPIDS,IOWA Attorney Associate in four-attorney firm that specialized in bankruptcy and commercial litigation. Worked on state and federal court cases and administrative proceedings.Counseled clients,drafted pleadings,motions,and briefs,conducted discovery,appeared at hearings and trials,negotiated settlements,handled appeals and supervised law-student interns. 1991-1992 IOWA SUPREME COURT DAVENPORT,IOWA Law Clerk to Justice Linda K. Neuman Researched and wrote bench memoranda on appeals of criminal,civil,administrative and attorney discipline cases.During monthly"court week" at capitol in Des Moines, did research, finalized opinions,and served as bailiff during oral arguments. Assisted with research,writing and editing for speeches and other special projects. Summer'89 UNIVERSITY OF IOWA IOWA CITY,IOWA Research Assistant to Professor Mary L. Dudziak, College of Law Did legal and historical research.Tracked down cases,read articles and books,and wrote memoranda.Edited drafts of scholarly articles and checked facts and citations.Read French newspapers from 1930-1945 to research life of Josephine Baker in Europe for book. 1986-1988 UNIVERSITY OF IOWA IOWA CITY,IOWA Associate Editor, University News Services Covered law and business colleges,Institute for Public Affairs and Division of Continuing Education.Wrote news and feature articles for internal and external publications.Wrote press releases and pitched university experts and stories to local,state,and national print and broadcast media. 1980s THE DAILY DISPATCH MOLINE,ILLINOIS Copy Editor, 1985 Edited stories and columns in news,features,editorial,business,farm and food sections; wrote headlines and captions and designed page layouts. Reporter/Editor, 1984-1985 0 Worked three days a week in Rock Island bureau covering federal andate coats, police, city government,and schools.Two days a week,produced/edited"Recereler, 12- zoned news supplement for Rock Island.Hired and supervised writer nelcove e; assigned stories and photos;did editing and page design. --1c� c r M rn Business Reporter, 1980-1981 O � Covered industrial,banking,real estate,labor,retail and transportatio tore?f Qua— City economy.On weekends, did police and general assignment reporting. ro 1982-1983 RENDEZ-VOUS MAGAZINE BRUSSELS,BELGIUM Managing Editor Responsible for editorial content of English-language monthly magazine.Recruited, trained and supervised staff;assigned stories and artwork.Shot photos and wrote stories; did copy editing,and designed pages. 3 1978-1980 CBS,INC. NEW YORK,NEW YORK Assistant Foreign Editor, CBS News, 1979-1980 One of four editors who assigned and supervised daily news coverage outside the U.S.by CBS staff members in 12 foreign bureaus and stringers around the world.Responsible for arranging coverage of international stories for use on regularly scheduled CBS news and radio programs, "60 Minutes,"network documentaries and"specials." Production Associate, CBS Reports(documentary division), 1978-1979 Did research and handled production arrangements for"Inside Yesterday,"an historical documentary pilot program that aired in 1979 with Mike Wallace as correspondent. Researcher, WCBS-TV,fall 1978 Hired during"sweeps" to do research and off-air reporting for assignment desk and to help produce special segments for evening newscasts. 1977-2006 FREELANCE WORK UNITED STATES and EUROPE Copy Editor,Reporter and Writing Consultant Edited and critiqued newspaper and magazine articles,book manuscripts,newsletters, scholarly articles,non-fiction pieces and reports.Served as writing coach to students working on special projects and dissertations. Judged writing and design contests.Wrote news and features for magazines and newsletters.During summers of 2000 and 2001,did stints on copy desks of Iowa City Press-Citizen and The Joplin(Mo.) Globe. 1975-1976 LEXINGTON SCHOOL DISTRICT LEXINGTON,MASSACHUSETTS Teacher, Grade 4,Adams School 1972-1973 INTERNATIONAL SCHOOL OF LUSAKA LUSAKA,ZAMBIA Teacher, Grade 4 1971-1972 LUSAKA BOYS'SCHOOL LUSAKA,ZAMBIA Teacher, Grade 5 ^, 1969-1971 INTERNATIONAL SCHOOL OF KUWAIT iWAtk,KUWjT Teacher,elementary science and high school drama r m VOLUNTEER WORK and PUBLIC SERVICEn •Member,board of directors,Iowa City Friends of Historic Preservat01 resect secretary,2017-present ,*= N •Member,Iowa City Historic Preservation Commission,2013-2016 2a w •Member,Iowa City Board of Adjustment,1996-1999;chairman,1999-2000 •Volunteer Mediator,Sixth Judicial District Family Mediation Project, 1997-2001 •Volunteer Mediator,Johnson County Small Claims Court,1997-1999 •State of Iowa Sixth District Judicial Nominating Commission,1996-2000 •Participating Attorney,Iowa Volunteers Lawyer Project, 1992-1999 EDUCATION J.D.,College of Law,University of Iowa, 1991 M.S.,Graduate School of Journalism,Columbia University,1978 B.A.,College of Education,University of Iowa,1970 4 _ Advisory Board/Commission Application Form ..�a This application is a public document and as such can be reproduced and distributed for .714. Nim'iil the public. This application will be considered for twelve months only and automatically Cil Y OF IOWA CITY considered for any vacancy during that time. UNESCO CITY OF UTE RATURE NOTE:Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 11/28/2017 First Name* Lucas Last Name* Foelsch Home Address* 711 Streb St City IOWA CITY State IA Zip Code* 52246 1.Is your home address(listed above)within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-321-3134 Email Address* lukefoelsch@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Historic Preservation Commission (HPC) Historic Preservation Commission Category* At-Large Select a Board or Commission you are interested in:* Parks and Recreation Commission 2.How long have you been a resident of Iowa City?* 17 years 3.Occupation:* Graduate Student/Leasing Agent 4.Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* Apart from having lived in Iowa City since childhood,my almost three years of experience working for a property management company here in town has added to my knowledge of Iowa City and its nuances. Probably most pertinent, I'm currently a first year graduate student at the University of Iowa's School of Urban and Regional Planning. I've completed reports requiring me to familiarize myself with the comprehensive plan and do in-depth research into neighborhoods in the area. My studies have given me a new perspective to view the area in which I've lived almost my entire life,and I'm excited at the prospect of getting involved in any way possible. 6.What is your present knowledge of each advisory board you are interested in?* I believe I'm familiar with the basic functions of commissions in that they are there to do the more in-depth research to make recommendations to City Council regarding their specific topic. The Historic Preservation Commission serves to maintain the character of historic neighborhoods in Iowa City to the fullest extent possible through designating new areas/landmarks and recommending actions on specific changes within current historic districts.Generally,the purpose is to pragmatically work to preserve historically significant aspects of the community and balance that with safety, property value,and common sense. The Parks and Recreation Commission serves a similar purpose but with respect to parks,playgrounds,and greenspace.The intent is to maximize the quality of life for Iowa City residents through accessibility and equity of parkland in the area. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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?* Yes List potential conflicts of interest[See next page for information regarding conflict of interest]* I am currently a part-time leasing agent for SouthGate Property Management. I don't believe that would constitute as a conflict of interest for the particular commissions I'm applying for,but I want to err on the side of caution. Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. 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). Business list of conflicts of interest Business Name* SouthGate Property Management Business Address* 755 Mormon Trek Blvd, Iowa City, IA 52246 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 25 10.Country of Origin United States 11. Sexual Orientation Straight 12.Religion Agnostic Atheist 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* Lift t foEL4cht- 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. Drop-down Advisory Board/Commission Application Form 4, �ztr� 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 5/8/2018 First Name* H Last Name* Pedelty Home Address* 1111 E Burlington ST 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* 319-325-3674 Email Address* hpedelty@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Historic Preservation Commission (HPC) Historic Preservation Commission Category* At-Large 2. How long have you been a resident of Iowa City?* 25.5 years 3.Occupation:* Librarian 4.Gender* 'This question is nerxiatory in cyder for the City to comply with the State's gender balance requirement,which treats gender as bnary."Gender Identity"nay be provided in the Cerrngraphics sectionof the application belay. r1 Male E Female 5. Experience and/or activities which you feel qualify you for this position:* I've owner occupied two properties in two historic districts(not at the same time)over the last 10 years. I'm an avid admirer or the work being done to preserve these properties among the general blandness of new construction. I'm a huge fan of the Univercity program,which I bought my current house from and look forward restoring the exterior. 6. What is your present knowledge of each advisory board you are interested in?* I read the agendas and minutes fairly regularly. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 44 10.Country of Origin USA 11.Sexual Orientation Heterosexual 12. Religion non-denominational 13. Do you have a disability? Nb 14.Ethnicity English/German Mix 15. Race Caucasian 16.Gender identity Male *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* ledeity 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. Drop-down FILED "'ow'.� Advisory BoardJCommissi�g/G(�law ip1et: 28 CITY OF IOWA CITY Application Form CUT CLERtt UNESCO CITY OF LITERATURE `OW ‘(' 0WA 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 6-1-o r i G re5C r�/a /0xi /6 id Date of Application PA y 7o/ Name O1/ r 7LZe — Home Address cP,C) Lo 177 ) /e W oo Contact phone number .8 mail Address Ljf zeQ1- ; I bi Your home address must be within the corporate limits of Iowa City? How long have you lived in Iowa City? y /' Occupation: ReF-t O a€l/ ICi ti( r Gender: Male v Female Experiences and/or activities which you feel qualify you for this position: 6 ?"2.szc r y 14.,3 Old { c 4 S S & /d�, ,u 5 What is your present knowledge of this advisory board? helps rGt - fib/ greel I Ne c/ o vre .�erval7'1io /Lig e 4eli 1—` PK -7/S 5 0 /t. U c't- e r 5 Ale e c-7(s � � �] �Ur CL� � reSet- U9 .7 e �1 Please contact the city attorney at 319-356-5030 to discuss quest ti4t,cEDs regarding a potential conflict of interest. Potential Conflict of Interest 'Me MAY —8 PM 1: 28 The Housing and Community Development Commission makes rcitiiti .«�: •• � the City Council regarding the distribution of federal CBDG/HOME fund rgit- alt - 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 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. Section 362.5 City Council Resolution #15-300 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. #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. Do you currently have a conflict of interest?YES NO List potential conflicts of interest(See last page for information regarding conflict of interest) Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS Do you currently serve on another Iowa City board or commission?YES NO If so which one do you prefer? ___ _ The City Council values all types of diversity on its boards and commissionsFo� resEi eD on this page provide valuable information to the Council in achieving that goal. QQ In order to ensure that the board and commission is representative �ifili ,»gunf M Ail Z c groups(s)which it serves,please provide your information for the folio ng: Age 6� C1TY CLERK! A Country of Origin 11/31A Sexual Orientation f of e r U IOWA CITY. 4C;J Religion Do you have a disability?YES NO Race,Color or Ethnic Group W I 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* Cle411,111° ' 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 to contact individual Council Members to express your interest in serving.Contact information is attached. 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 bwa City to apply Date of Application 8/7/2017 First Name* Adam Last Name* Prato Home Address* 410 N. Scott Blvd. 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* 3193381097 Email Address* prato.adam@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Historic Preservation Commission (HPC) Historic Preservation Commission Category* Jefferson St. 2.How long have you been a resident of Iowa City?* 11+years 3.Occupation:* Park Ranger 4.Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* As a national park interpreter for over 20 years I have been educating the public about the importance of historic preservation. I have a BA in History from Rutgers University, New Jersey. 6.What is your present knowledge of each advisory board you are interested in?* I admit I am mostly unfamiliar with the work of this advisory board. However, I am very interested in historic preservation and have no doubt I can quickly master knowledge of local issues. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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?* Yes List potential conflicts of interest[See next page for information regarding conflict of interest]* I work for the National Park Service,which may provide funds and other service to local governments. My position, however,does not work directly with those programs. Please identify any potential conflicts between membership on the advisory board and your personal interests, including financial interests and your duties to an employer. 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). Business list of conflicts of interest Business Name* National Park Service Business Address* 110 Parkside Drive, PO Box 607, West Branch, IA 52358 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 10. Country of Origin 11. Sexual Orientation 12. Religion 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 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* JIb,lC& _ 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. Drop-down AdvisoryBoard/Commission Application Form t ^h�� 4I, ���� 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 5/7/2018 First Name* Frank Last Name* Wagner Home Address* 519 S 1st Ave 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* 3193217910 Email Address* frankfwagnerphd@yahoo.com Boards & Commissions Select a Board or Commission you are interested in:* Historic Preservation Commission (HPC) Historic Preservation Commission Category* At-Large 2. How long have you been a resident of Iowa City?* Lifelong 3.Occupation:* General Contractor 4.Gender* "This question is rrendatory in order for the aty to comply with the States gender balance requirement,which treats gender as binary."Gender Identity"nay be provided in the Derrogrwhics sectionot the application below. Pr Male r Female 5.Experience and/or activities which you feel qualify you for this position:* I have been a lifelong historic preservation advocate.Specifically I am a general contractor who works almost exclusively on homes that fall under the"historic"category in Iowa City. I enjoy helping clients restore their historic home and/or build additions that are sympathetic to their home's historic character. 6.What is your present knowledge of each advisory board you are interested in?* I am very familiar with the duties and obligations of the historic preservation commission having served multiple terms as an at-large member. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 54 10. Country of Origin United States 11. Sexual Orientation 12. Religion 13. Do you have a disability? No 14. Ethnicity 15. Race 16. Gender identity *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. Drop-down AdvisoryBoard/Commission Application Form , r�� This application is a public document and as such can be reproduced and distributed for "�®'moi 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 uTE FATURE NOTE:Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 7/9/2017 First Name* Shu Last Name* Wan Home Address* No.448, Hawkeye Drive. City IOWA CITY State IA Zip Code* 52246 1. Is your home address (listed above)within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-383-5797 Email Address* shu-wan@uiowa.edu Boards & Commissions Select a Board or Commission you are interested in:* Historic Preservation Commission (HPC) Historic Preservation Commission Category* At-Large 2. How long have you been a resident of Iowa City?* Two years 3. Occupation:* Student 4. Gender:* Male 5.Experience and/or activities which you feel qualify you for this position:* As a graduate student with specificity in American Disability history in the University of Iowa, I own my B.A.and M.A.degrees in the U.S. history from my former university in China. In the meantime,worked as columnist and book reviewer for some public history-oriented journals and newspapers in China. Hence, I own enough professional knowledge of history and historic preservation. During the past two years in Iowa City, I have worked as volunteer for multiple institutions,such as the Animal Shelter,the Intervasity organization and the University Libraries.These experiences guarantee my familiarity with teamwork and collaboration. 6.What is your present knowledge of each advisory board you are interested in?* As far as I know,the main duty of this board is to assist the City Council and other commissions to consider and sanction varied historic preservation-related requests of appropriation,petition, reparation and other initiatives. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 26 10.Country of Origin China 11. Sexual Orientation 12.Religion 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 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* 514L)\ ,YAM 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. Drop-down Board/Commission Application Cover Board/Commission: Historic Preservation Commission - College Green One vacancy to fill a three-year term 7/1/18-6/30/2021 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: 4/2/2018 Application Deadline: 5/8/2018 Council Appointment Date: 5/15/2018 Date of Non-Gender Appointment: 7/3/2018 After date above Council may appoint without regard to gender Gender Balance Requirement: 2-Female, 1-Male, 1-None Current Gender Balance: Female: 3 Male:4 Gender r Name and Address -- { Female ' Burford, Helen 528E College St. J i r -041,resaucklr Advisory Board/Commission/Committee CITY OF IOWA CITY Application Form UNESCO CITY OF LITERATURE 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 14.1.f-fotto fizeselevaliew Comma c.ieN Date of Application n"Q^1 I Name Net-e' 5. BURFo?- Home Address 5 Ze e- It ecle St. (Co kreeN 4�'�s�oRir�g;st2 l Contact phone number 3I9-5 4 b`i 16. Email Address h sburford e *26' ' r Your home address must be within the corporate limits of Iowa City? ; :.<1;stnr —m _ rn How long have you lived in Iowa City? 11 earg N 0 Occupation: St le �efl►'Gd Gender: Male Female / Experiences and/or activities which you feel qualify you for this position: Witty t S4W44 keiviE 611 t. ColleSe. +t t luta r2a f i''d f v tk Q✓tiehub n I wwle Direcker Fi4ts_ Id I`siWa C lutfi B►U 7.0 -I2.8uxrn,9 trtiwre atevfted wih" iriic kvs er va hove 1-401 o.�a loli 1144( 4 f VtGe�c� Nov cr4 CS$1►buMes>`i two dis of ois. frle.Aad o lege ; ?goo Fbn4fl feSedui i44 oVwj Oak^4411 wife v l. a 4'S ,,N y ow„,-t NAT/el,. 5ufp eI mo)a l/h,': 'm?C 1t(t4l ihvar ad a,101-010Utal pa i ii trakil fJaktgonaxmlyi#74firie fl.feyva&t; ovrii,,ed grafi//fdwidi eef diA I Mekr42sp Q.ei✓"f ics cw Por/rNa. once/h'il Peat aahin 41`m/4- Tiicted �ettor�hoN s tos r% wasy,'rtgfiii orytni3ed4/ciki✓y Ifxac mvej re/occtftd 5dea fe teem bm 644117///7- /' sfs�dl kecy44yrcr.etuway/at/4,AAzdee✓ak6/ /ova 04,0 f /is tcc2�Mic dud 1 /'u"` a4 � What is your present knowledge of this advisory board. rreAlliffe ' Canttyl1el1joA/ eimduo/,rsfitd,� pNd bitp_ourafa ita Iraefi t2kogi y lut ntr: st*ichfiw did % tco&'U /it/ee dievoll�, /vu/ ,g17‘46,-s4"/ fry'aeon 9 u flit Cj0 1.56/ fitt4itaf 444dtis a 0 VewW144 4 o w+ pt aerl14/S4;4/ iri(4 0 42,1441,1>ia a/Le& fe Ste/r440 aistd ealitM1 verizte. 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 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. Section 362.5 City Council Resolution #15-300 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. #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. Do you currently have a conflict of interest?YES NO List potential conflicts of interest(See last page for information regarding conflict of interest) Please indicate if there are none. rs d BUSINESS NAME BUSINESS ADDRESS D. - -�r") rb i Do you currently serve on another Iowa City board or commission? YES Nl. ✓ C7 c..1 cn If so which one do you prefer? 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: Age (91 Country of Origin u Sexual Orientation 4 Religion Jeuji5k Do you have a disability?YES NO V Race,Color or Ethnic Group Wui"e Ca c,,-,,u *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* /f 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 to contact individual Council Members to express your interest in serving.Contact information is attached. • o0 --t c7 V ('r' M C4 Board/Commission Application Cover Board/Commission: Historic Preservation Commission — East College St. One vacancy to fill a three-year term 07/1/2018- 6/30/2021 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: 4/2/2018 Application Deadline: 5/8/2018 Council Appointment Date: 5/15/2018 Date of Non-Gender Appointment: 7/3/2018 After date above Council may appoint without regard to gender Gender Balance Requirement: 2 Female, 1-Male, 1-None Current Gender Balance: Female: 3 Male: 4 Gender Name and Address Female Baker, Esther Served 1-Partial &3 Full Terms 1022 E. College Street AdvisoryBoard/Commission Application Form ,, ;.ZC �+S 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 3/4/2018 First Name* Esther Last Name* Baker Home Address* 1022 E.College Street 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* 319-359-8067 Email Address* bakere34@hotmail.corn Boards & Commissions Select a Board or Commission you are interested in:* Historic Preservation Commission (HPC) Historic Preservation Commission Category* E. College St. 2. How long have you been a resident of Iowa City?* 14 years 3. Occupation:* Consultant 4.Gender* *This s question is rrarxiatory in order for the Oty to conply with the State's gender balance requirement,which treats gender as binary."Gender Identity"fray be provided in the Demographics sections(the application below. r Male F7 Female 5. Experience and/or activities which you feel qualify you for this position:* I have been on the l-storic Preservation Commission for several terms and am currently serving as vice-chair. have attended several historic preservation workshops over the years,and live in an 1896 house currently.All of my previous homes have also been historic structures. I would love to remain on the HPC if there is no new applicant for the East College listoric District to continue to use the experience I have gained as a member of this commission. I am committed to the preservation of our historic heritage as reflected in the architecture of Iowa City for future generations. 6.What is your present knowledge of each advisory board you are interested in?* Again, I have been an active and vocal member of the HCP and am currently serving as vice chair. I am well acquainted with the mission and charge of the commission. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 57 10. Country of Origin USA 11. Sexual Orientation Lesbian 12. Religion Jewish 13. Do you have a disability? No 14. Ethnicity Eastern European 15. Race Caucasian 16. Gender identity Female *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* Sell,fest ila4441- 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. Drop-down Board/Commission Application Cover Board/Commission: Historic Preservation Commission - Woodlawn One vacancy to fill a three-year term 7/1/2018—6/30/2021 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: 4/2/2018 Application Deadline: 5/8/2018 Council Appointment Date: 5/15/2018 Date of Non-Gender Appointment: 7/3/2018 After date above Council may appoint without regard to gender Gender Balance Requirement: 2-Female, 1-Male, 1-None Current Gender Balance: Female:3 Male:4 - Gender 1 Name and Address Male 1 Shope, Lee - _ I 1036 Woodlawn Ave _ _ I AdvisoryBoard/Commission Application Form A11__ 1 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 4/17/2018 First Name* Lee Last Name* Shope Home Address* 1036 Woodlawn Ave. 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=333=5867 Email Address* wieeshope@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Historic Preservation Commission (HPC) Historic Preservation Commission Category* Woodlawn 2.How long have you been a resident of Iowa City?* 59 years 3.Occupation:* Retired Univerity of Iowa Information Technology Administrator 4.Gender* "This question is mandatory in order for the City to comply with the States gender balance requirement,which treats gender as binary."Gender Identity"xray be provided in the tknDgraphcs sectionof the application below. p Male r Female 5.Experience and/or activities which you feel qualify you for this position:* am a proponent of preserving our historic buildnigs.l have livedin a historic district since 1987 and I am well acquainted with the issues in preserving and historic home. I have serve as an officer in the Woodlawn Association in various capacities--president,road committee chair and treasurer(current. I have served as a board member for the Iowa Valley Habitat you Humanity,the University of Iowa Retirees Association,and the University of Iowa Senior College. I am no longer active in those organizations. 6.What is your present knowledge of each advisory board you are Interested in?* I am aware that HPC has a role in establishing historic districts;that it oversees the application and approval process for making changes to historic structures;provides guidance to to applicants on the appropriateness of proposed modifications:and recommends changes to the city's historic preservation guidelines when appropriate. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 77 10. Country of Origin United States 11.Sexual Orientation male 12. Religion christian 13. Do you have a disability? No 14. Ethnicity american 15. Race white 16. Gender identity male *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* le. La/hit 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. Drop-down 05-15-18 10f NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: HOUSING & COMMUNITY DEVELOPMENT COMMISSION Three Vacancies —Three Year Terms July 1, 2018 —June 30, 2021 • Duties of the Housing and Community Development Commission include assessing and reviewing policies and planning documents related to the provision of housing, jobs, and services for low- and moderate-income residents; • reviewing policies and programs of the Public Housing Authority and Community Development Division and make recommendations regarding the same to the City Council; • reviewing and making recommendations to the City Council regarding the use of public funds to meet the needs of low- and moderate-income residents; housing policies and programs, and seeking public participation in assessing needs and identifying strategies to meet these needs; recommending to the City Council from time-to-time amendments, supplements, changes, and modifications to the Iowa City Housing Code. • The Housing and Community Development Commission will have monthly meetings. 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 of citizens to boards and commissions. When possible, Council will appoint persons with expertise in construction and/or finance, a person receiving rental assistance, and a member of the Local Homeless Coordinating Board. Applications must be received by 5:00 p.m., Tuesday May 8, 2018. 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 Housing and Community Development Commission should be directed to Tracy Hightshoe, Community Development Planner at 356-5244. Housing & Community Development - Current members #years as Country of Sexual Gender Name Term ending resident of IC Occupation Gender Age' Orgin' Orientation* Religion' Disability Ethnicity' Identity` Races Unique Identifiers' Paula Vaughan 6/30/2019-1st Term 5 F _ 6/30/2019-1st Term+ Christine Kay Harm_s Unexpired 35 F - _ 6/30/2019-1st Term+ Real Estate Loan Bob Lamkins Unexpired 19 Officer M _ - Charles Eastham 6/30/2020-1st Term 45 M Mainline Midwestern John W McKinstry 6/30/2020-2nd Term 24 Retired Pastor M 66 USA Heterosexual Protestant , Caucasian Filipino- Vanessa Fixmer-Oraiz 6/30/2020-1st Term 4.5 Planner F 38 USA Queer Spiritual American Vacant 6/30/2021 ..__ Vacant _ 6/30/2021 Vacant 6/30/2021 I Please note:The information provided Is the information provided on the application at the time of submission. i I •Information Is voluntary Housing and Community Development Commission Attendance Record 2017 -2018 Name Terms 3/7 4/20 6/15 8/17 9/21 10/30 11/16 1/18 2/15 3/15 Exp. Conger,Syndy 7/1/2018 X X X X X X 0/E X X X Eastham, Charlie 7/1/2020 --- --- --- X X X X X X X Fixmer-Oraiz, 7/1/2020 --- --- --- X X X X X O/E X Vanessa Harms, Christine 7/1/2019 X X X X X X X X X X Lamkins, Bob 7/1/2019 X O/E X X O/E X O/E X O/E X McKinstry, John 7/1/2020 X 0/E X X X X X X X X Olmstead,Harry 7/1/2018 X X X X X O/E X X X X Padron,Maria 7/1/2018 --- O/E X X X X O/E O/E Vaughan, Paula 7/1/2019 X X X X X X O/E X X X Key: X =Present O =Absent O/E =Absent/Excused =Vacant or prior commissioner Board/Commission Application Cover Board/Commission: Housing and Community Development Three Vacancies to fill a three - year term 7/1/2018—6/30/2021 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: 4/2/2018 Application Deadline: 5/8/2018 Council Appointment Date: 5/15/2018 Date of Non-Gender Appointment: 7/3/2018 After date above Council may appoint without regard to gender Gender Balance Requirement: 1-Female, 1-Male, 1-None Current Gender Balance: Female: 3 Male: 3 Gender Name and Address Female Alter, Megan 936 Aspen Court Male Brandt, Bill 973 Tamarack Trail Male Brouse, Mitchell 523 Dearborn St. Female Ferdig, Jessica 18 Dunuggan Court Female Johnson, Kristin 415 S Van Buren St Female Padron, Maria Unexpired term ending 6/30/2018 410 N Scott Blvd Female Rose, Care 928 E Bloomington St Male Smith, David 1315 Cedar St Female Stamus, Lynne 2318 Russell Dr. Female Taylor, Angel 2247 Plaen View Dr. AdvisoryBoard/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 5/8/2018 First Name* Megan Last Name* Alter Home Address* 936 Aspen Court 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* 3193253787 Email Address* mearlyalter@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Housing and Community Development Commission(HCDC) 2. How long have you been a resident of Iowa City?* 23 yrs 3.Occupation:* manager at ACT(Education and equity) 4.Gender* "This question is rreridatoy in order for the City to conply with the State's gender balance requirerrent,which treats gender as binary."Gender identity"nay be provided in the Danograph ics sectionof the application below. r Male P Female 5.Experience and/or activities which you feel qualify you for this position:* In my professional life, I am the vice chair of the corporate giving committee at ACT;thus, I have extensive experience reading and assessing high dollar grant applications. I also do this as a member of the community review committee for the Iowa Women's Foundation when it considers its annual awards to different organizations. I am also a Board member of the Iowa Women's Foundation,whose main focus is helping women(and families)overcome barriers to economic self-sufficiency.Accordingly, I study these barriers, particularly housing and child care. I attend different community report-outs like the ECl/UW of Johnson/Washington Co.on how local agencies and municipalities help low-income people navigate their challenges in practical ways. I also attended the Fair Housing training provided by the City of Iowa City recently. I have seen over the past 20 years the way Iowa City has grown and how its needs have changed as well. I am pleased that affordable housing is a priority,but know that changing demographics must make the City addresses change thoughtfully and truly inclusively.To keep the South side lower income does no good for the whole of IC. 6.What is your present knowledge of each advisory board you are interested in?* I have been following the Commission's meeting notes, not being able to attend until recently. I am particularly interested in the way the Commission uses the racial equity toolkit to help inform its decision-making and recommendations in order to align with the City's strategic plan. I appreciate the way there has been fairly open discussion about the South District Home Investment Partnership stabilization plans. I appreciate that the Commission understands its role not merely to'make a call',but to anticipate public reactions and questions and to make recommendations to the City Council that can answer some of those questions in order to help the entire community. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 48 10.Country of Origin USA 11.Sexual Orientation straight 12. Religion none 13. Do you have a disability? Nb 14. Ethnicity Northern European ancestry 15.Race white 16.Gender identity Female *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* pulpit.(irett Misrepresentations on this application will constitute just cause for removal of an i r Advisory Board/Commission/Committee CITY OF IOWA CITYApplication Form UNESCO CITY OF LITERATURE 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 A /4k i., slab Date of Application _ f1dZ 14 lea - Name //— d Home Address 973 ---r40-44.44/4e Contact phone numbel/', / 'r1-7,1 Email Address , I r(t 01 1/410, Your home address must be within the corporate limits of Iowa City? y 5 How long have you lived in Iowa City? -_; e4 Occupation: z9e47 47, g 4 + //4d,1.4�/eW4V6 Gender Male )(' Femaie Experiences and/or activities which you feel qualify you for this position: 417ZZ•ti o ari j.e a / e sevi`.uh)p4v ,t,,xs i-/r c 4,6144csmi cn rn Tv elitfe 44,./s/414,/ 7A44 r7-c - f" =t-) o• m What is your present knowledge of this advisory board? 7 y 5117 304$W e i44 4frty 00,6444040, PIease 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 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 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 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. Section 362.5 City Council Resolution #15-300 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. #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. ►� 00 Do you currently have a conflict of interest?YES NO ",c-, List potential conflicts of interest(See last page for information regarding conflit 1tmnte gt) r Please indicate if there are none. --G rn M BUSINESS NAME BUSINESS ADDR .p /Wile ociAtic Do you currently serve on another Iowa City board or commission? YES NO )X If so which one do you prefer? _ 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: Age 511 Country of Origin LISA -- Sexual Orientation MALE- Religion ALEReligion 4AiNDLle Do you have a disability?YES NO Race, Color or Ethnic Group_ £L //?4,9iii/irt 440. itis/ *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* 44L—ueR-�� ,ifs .GnJtyvp Misrepresentations on this application will constitute Just cause for removal of an,pointee. If you fail to answer all the questions, Council will not consider your application. coo LJ You are encouraged to contact individual Council Members to expresir eresfl'W serving.Contact information is attached. —'tr.. 0 on _� Advisory Board/Commission Application Form t_" _' '7' +, 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 UTERATURE NOTE:Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 5/8/2018 First Name* Mitchell Last Name* Brouse Home Address* 523 Dearborn Street 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* 801-884-6908 Email Address* mitch.brouse@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Housing and Community Development Commission(HCDC) 2. How long have you been a resident of Iowa City?* 6 years 3.Occupation:* Planner,Johnson County 4. Gender* '1hs question is rrendatory in order for the Oty to conply with the State's gender balance requirerrent,which treats gender as binary."Gender Identity"ray be provided in the arnograchics sectionof the application below. p Male r Female 5. Experience and/or activities which you feel qualify you for this position:* I am employed as a planner for Johnson County, where I develop planning documents, ordinances, and review development applications. I have attended various meetings of the Livable Community I-busing Action Team to discuss housing issues for Johnson County's aging population and served as a staff liaison for the Food Policy Council. While working on my masters in Urban and Regional Planning at the University of Iowa, I studied housing and community development, completing courses in housing policy, growth management, and community development finance,among others. 6.What is your present knowledge of each advisory board you are interested in?* The Housing and Community Development Commission makes recommendations to City Council regarding allocation of federal money,development of housing and community development policies,and planning for housing,jobs,and social services. I am interested in helping the commission make thoughtful recommendations to help lower and moderate income people. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 27 10. Country of Origin United States 11. Sexual Orientation Straight 12. Religion 13. Do you have a disability? No 14. Ethnicity 15. Race White 16. Gender identity Male *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* te// toti4e° 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. Drop-down AdvisoryBoard/Commission Application Form 11 • 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 5/8/2018 First Name* Jessica Last Name* Ferdig Home Address* 18 Dunuggan Ci 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* 3199300811 Email Address* jessferdig@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission Select a Board or Commission you are interested in:* Housing and Community Development Commission(HCDC) 2. How long have you been a resident of Iowa City?* 5 years 3. Occupation:* Clinical Research Associate/Project Manager 4. Gender* Ibis question is rraridatory in order for the Oty to coolly w i h the State's gender balance requirement,which treats gender as binary."Gender Identity..rray be provided in the Demographics sectionof the application below. r Male p Female 5. Experience and/or activities which you feel qualify you for this position:* MPH in Community and Behavioral Health (including courses of Social Determinants of Health, Health Disparities and Cultural Corr etence,Cornrnunity-Based Participatory Research,and others) Experience in grant writing for community projects and knowledge of local/national funding sources Experience with low-income populations through community outreach and employment Attendance of community events(UI Public Policy Center Conferences, Human Rights Conferences,UI Global Health Conferences,Johnson County DMC Conference,etc.) Experience with Latino populations in eastern Iowa(including being on the ICCSD Immigration Task-Force Committee) Bilingual English-Spanish(Spanish speaking household as husband and step-daughter are from Honduras) Johnson County native Interest and dedication to protecting human rights for all residents of Iowa City 6.What is your present knowledge of each advisory board you are interested in?* HRC holds meetings every 3rd Tuesday(no conflicts with schedule) HRC works on educating the public on issues of discrimination and human rights violations HRC makes recommendations to City Council through proper representation at City Council meetings HRC coordinates local events HRC members continue to be educated on human rights issues HRC is focused on social justice issues, including fair housing HRC has a balanced number of identified males and females serving HRC utilizes local data for discussion of issues and finding resolutions to community disparities I-RC has 8 members HRC utilizes democratic voting system to pass motions within the committee Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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?* Nb B.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 26 10.Country of Origin USA 11.Sexual Orientation Heterosexual 12. Religion None 13.Do you have a disability? No 14. Ethnicity Caucasian 15.Race Caucasian 16.Gender identity Female "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* c' -'& t. �� _ r � AdvisoryBoard/Commission Application Form A"lul1� 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 UTERATURE NOTE:Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 4/5/2017 First Name* Kristin Last Name* Johnson Home Address* 415 S.Van Buren St.,Apt.1 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* 319-594-1032 Email Address* sunshineariel99@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Library, Board of Trustees Select a Board or Commission you are interested in:* Community Police Review Board (CPRB) Select a Board or Commission you are interested in:* Human Rights Commission Select a Board or Commission you are interested in:* Housing and Community Development Commission(HCDC) 2. How long have you been a resident of Iowa City?* 22 years 3.Occupation:* volunteer 4.Gender:* Female 5.Experience and/or activities which you feel qualify you for this position:* I am active in some support groups which help me stay connected to the community and help me to take good care of myself,and interact with an interesting and diverse population in this city. 6.What is your present knowledge of each advisory board you are interested in?* I am aware that the library board term is a period of 6 years and helps determine policies and practices. I am aware that the Community Police Review Board is designed to help those concerned with criminal justice in this community.And I am aware that the Human Rights Commission is designed to help protect people with disabilities to be treated fairly in this community. 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 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 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-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 64 10. Country of Origin USA 11. Sexual Orientation heterosexual 12. Religion Episcopal 13. Do you have a disability? Yes Please explain: I have a mental health condition which I manage with medication and social activities and healthful activities. For example, I volunteer at a local peer support recovery center, volunteer for New Pioneer Co-op,& garden in the city garden. I also advocate with letters and phone calls to our elected representatives for a combination of issues I am concerned about, such as mental health parity,the environment and social justice.) also receive rental assistance. 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* 00;7012*6� gdie r 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 A"°� !'f� % 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 10ViA 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 4/10/2018 First Name* Maria Last Name* Padron Home Address* 410 N Scott Blvd 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* 319-930-9528 Email Address* marialorena.padron@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Housing and Community Development Commission(HCDC) 2.How long have you been a resident of Iowa City?* since 2008 3.Occupation:* designer 4.Gender* 'This question is mandatory in order for the Oty to comply with the States gender balance regiirerrent,which treats gender as binary."Gender Identity"nay be provided in the Darrographics sectionor the application below. r Male p Female 5. Experience and/or activities which you feel qualify you for this position:* I work in an engineering firm in Iowa City. I studied architecture and urban planning in Argentina. I have worked in the past in residential and commercial architecture. Even though in my current job I mostly work in civil engineering, I also design master plans for urban development. I am interested in affordable housing in Iowa City,and I want to study and find ways for the city and developers to create more housing for low income residents.Through my job, I got to know last year the project Forest View and I became very interested in it. I am also interested in the Poor Farm project and I am looking forward to seeing how that develops. 6.What is your present knowledge of each advisory board you are interested In?* I am a commissioner at the Housing and Community Development Commission. My term started in July 2017 and ends in June 2018. I have enjoyed serving on this commission,and I am thankful for this opportunity.What I have learned in this past year serving at the HCDC has helped me improve the work I do for non-profit organizations.And vice- versa:the work I do for other non-profit organizations(like the RIA,and UNA-USA),gives me a unique understanding of vulnerable and refugee communities,and helps me make decisions at the HCDC. There is still a lot of work to do,and I would like to be appointed one more term to be able to complete more projects and help more community members. We have talked with other commissioners about what we would like to work on this year,like childcare and the possibility of working with the Parks and Recreation Commission to add more green spaces in some neighborhoods in the south part of the city. I look forward to being appointed one more term at the Housing and Community Development Commission. Thank you for your consideration. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 42 10. Country of Origin argentina 11.Sexual Orientation heterosexual 12.Religion none 13.Do you have a disability? No 14. Ethnicity hispanic 15.Race mixed 16.Gender identity female *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 AdvisoryBoard/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 4/4/2017 First Name* Clare Last Name* Rose Home Address* 928 E Bloomington St 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* 3192130477 Email Address* cmartin204@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Housing and Community Development Commission(HCDC) Select a Board or Commission you are interested in:* Community Police Review Board (CPRB) Select a Board or Commission you are interested in:* Historic Preservation Commission (HPC) Historic Preservation Commission Category* North Side 2.How long have you been a resident of Iowa City?* 26 years 3.Occupation:* Technical Project Manager 4.Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I have been a project manager for five years at Pearson Education. My skills as a project manager, including gathering information from stakeholders, planning processes and documenting decisions I feel would be applicable to these commissions. Previously I was a research intern at a small think tank in Washington DC called SpiritHouse,where I was tasked with gathering large amounts of research and distilling it down into easily understandable pieces for press releases. In college I worked for a development firm who built low- income assisted living facilities in Iowa City, I was tasked with reviewing potential resident applications and approving income requirements. Finally, I have lived in Iowa City for 26 years,experiencing it as a child,a college student and finally an adult. I have the good fortune to be able to call on the perspectives of these multiple roles in considering issues that might come to the attention of these commissions. 6.What is your present knowledge of each advisory board you are interested in?* I have limited knowledge of the specifics of each of these advisory boards. I have lived in the Northside neighborhood most of my life and from a citizen observer perspective I am familiar with some of the duties of the Historic Preservation Commission. Regarding the Housing and Community Development Commission, I have reviewed the agendas and notes from the last few meetings. I recognize the role this commission plays in programs such as UniverCity and it work in providing assistance in allocating funds towards affordable house in Iowa City. 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 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 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-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. tf 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 34 10.Country of Origin United States 11.Sexual Orientation Heterosexual 12.Religion Atheist 13. Do you have a disability? No 14. Ethnicity White *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* 6)Izte,Otiel 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. AdvisoryBoard/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 10/24/2017 First Name* David Last Name* Smith Home Address* 1315 Cedar St. 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* 319 530 7594 Email Address* oso61ds@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission Select a Board or Commission you are interested in:* Housing and Community Development Commission(HCDC) 2. How long have you been a resident of Iowa City?* 10 yrs 3. Occupation:* Midamerican Energy 4. Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* White,gay adoptive parent of a black child in the ICCSD.Also foster parent of a trans daughter within the district. 6.What is your present knowledge of each advisory board you are interested in?* I keep informed of issues related to racial and gender based biases within the community. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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?* Nb 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 56 10. Country of Origin US 11. Sexual Orientation Gay 12. Religion Agnostic 13. Do you have a disability? No 14. Ethnicity White `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* .ft,U Q.-1\ 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. Drop-down r ""°"�� Advisory Board/Commission/Committee CITY OF IOWA CITY Application Form UNESCO CITY OF LITERAT URC 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 FADv5+n) a Coen Nnc,tub/ aNigoern&14 Ga`inVA1SSin Date of Application OrZ,• " ae_ i _ Name -- y 't'/Ue Q-,`t,a vii a 5 -- -- Home Address p.2., / g — G�'�. e?/7 ,a-c — N O Contactphone number9 "' .31�% �• 5/ �-U�'�il Address---c�n ro -11 >.-1 Your home address must be within the corporate limits of Iowa City? 0-C — .=tc) d How long have you lived in Iowa City? i�7 y A_.1' :.-Qt; Z,. fy Occupation: ,Of...,., -^%t v Gender:Male Female P-------" ' Experiences and/or activities which you feel qualify you fort s osiren: ` 1. y/_ ce_ .7(di, .Gr 1-44371-C xi.64- (-)be L� d Jkg299'Lc-r /_.eI4. -el ,020-e-t. lam" T Ja imtO -i -uf614^- 2 L�cja ? . taatel te Jc L6-1 .32- V„aw �,Ac# , 1-7_ C, Le-c-4--) r� , ''' 44 --,-ULL G- -4v-rr-t i htici ,,) .cicc a .6� 14,16:771-- .&tI 0 At AA-ttalt 4'Lt1-LEL d ou-' ' .il)i�xzt /G`tLI1t 1.aJ e c2 ,1 1 Ji ti ..e -- Alii-u/ZeL-Ze r7 'L ,Ll, ,Gine• ,o �G��d-e' �> W t'I al is ye tT .resent . owiedge of this advisory board? ug ' C b )3 G -fil r Via', '4- L'--6-7-r` L 1 " °�' a� ...La-Lc' cS -t- or\_6i.Lts..tt r��( c i ���G�J e4 t li�L a� cc, .Q-t i fs ,(�U r T n ,�r -L-,I-e- /L tifcars, 'u Lfippl""�(�c' nay alji1 ,, .-a-?Qi _ LLt° ZE$/L• ¢it -1 'L1_,.4c-f fit- t p.,14-0-a, '-GL244-e.")-eG lL�— ilk- d,-/-----4,--e-ter �n-w , ± 4/1i�tri-6,usJt"2.', (n-2r{ its- ,F.,,, ,/ A,\--P.A-1b . Q,4j �p 4) 4A 0il�GLt/ice /1�'1-et rrl-lvViz-e�-d:tieC3✓ Kt° --Mt Grs 70-4-A /1- t.�—� /Ligt2�i yie (6,7)1-8-4-11-27tasc�Z�ct i GAA_s t -d 1' "Al ntiti� .�t-e. '-t-t9---Lv i Due /Taunt - � • /14ua .4 JAM- J.41-(-1-1277-.14 .n..�J�-sem Ikt-fri Irl C-ez e a- SLe, aC-LCj 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 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.Section 362.5 City Council Resolution #15-300 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, cpjldren for whom the Council Member assumes parental responsibility,mother,father,son-in-law, deughter-ijirlaw, sister-in-law, grandparents, and grandchildren, aunt, uncle, niece, nephew, first cALsin,So9ter parent,poster child,persons who are parents of the same child,and persons whom the etiploifliegfin an intimate relationship. e ° t 4 L•J _ _ __ __ _ __ ` r.) .ted RAS. #3t5=300 states that each application for reappointment to a City Board or Commission will be c sidecrw t- ura ithout regard to incumbency. If reappointed, an individual would be limited to one rgpotied-i�tiiont to a full term in order to increase the opportunities for new applicants to serve. O Codncil 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_NO (/ List potential conflicts of interest(See last page for information regarding conflict of interest) Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS • Do you currently serve on another Iowa City board or commission?YES_NO p If so which one do you prefer? _ U 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: Age (fig - Country of Origin .4M Are i�, Sexual Orientation Religion _ d Do you have a disability?YES t�NO Race,Color or Ethnic Group *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 shrives 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 Applic:nt* . OO ,I Misrepresentations on this application will constitute just cause for removal of yah jypomft ee. If you fail to answer all the questions, Council will not consider your application..;L 3::11 r �� O ! You are encouraged to contact individual Council Members to express yoyt( terost, in rn serving.Contact information Is attached. 7.l. CI _u • tI J _ r 1 Advisory Board/Commission Application Form t "0 tit This application is a public document and as such can be reproduced and distributed for 1 "r®'� "nafi 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 5/4/2018 First Name* Angel Last Name* Taylor Home Address* 2247 Plaen view drive City IOWA CITY State IA Zip Code* 52247 1. Is your home address(listed above) within the corporate limits of Iowa City?* Yes Contact Phone Number* 3195941403 Email Address* angeltaylor99©hotmail.com Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission Select a Board or Commission you are interested in:* Housing and Community Development Commission(HCDC) Select a Board or Commission you are interested in:* Civil Service Commission 2. How long have you been a resident of Iowa City?* 40 years 3. Occupation:* Realtor 4. Gender* 'This question is mandatory in order for the City to comply with the Slate's gender balance requirement.which treats gender as binary."Gender Identity"nay be provided in the De mgrapirics sectionof the application below r Male A Female 5. Experience and/or activities which you feel qualify you for this position:* Advocacy, served on housing commission board 6.What is your present knowledge of each advisory board you are interested in?* I'm pretty familiar with both human rights&the housing commission board Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 10. Country of Origin 11. Sexual Orientation 12. Religion 13. Do you have a disability? Yes Please explain: ADHD&OCD 14. Ethnicity African American 15. Race Black 16. Gender identity Female *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* Vi) 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. Drop-down kkIQf- Kellie Fruehling From: Megan Alter <Megan.Alter@act.org> Sent: Monday, May 14, 2018 2:34 PM Late Handouts Distributed To: Council Subject: Housing and Community Development Commission application 1 . k . (Date) Hello, I am emailing to follow up on my application to join the Housing and Community Development Commission. I am a firm believer in the need of local government to engage the community and am one such community member who wants to be more involved.As Iowa City continues to grow and to grapple with issues of balance between growth and equity I see housing development as perhaps the most felt crux of this tension. In a college town that is welcoming more immigrants, non-native English speakers, and more diverse socioeconomic populations(up and down the scale),we must be vigilant against unfair practices; and in terms of long term city and neighborhood planning, we must be deliberate, thoughtful, and lawful about expansion, new housing, and rental properties.While not an expert in real estate, I am a long-time Iowa Citian who has lived on the Southeast side of town for over 10 years, with ties to the University community, and I am interested in contributing to Iowa City's continued growth and prosperity by considering and advising on equity and growth through housing and community development. Thank you for the opportunity, Megan Alter 1 05-15-18 10g NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: HUMAN RIGHTS COMMISSION One vacancy to fill an unexpired Term Upon appointment— December 31, 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 of citizens to boards and commissions. • The Human Rights Commission meets the third Tuesday of each month at 6:00 p.m. in the Lobby Conference Room at City Hall, 410 E. Washington Street. • Applications must be received by 5:00 p.m., Tuesday, May 8, 2018. Questions about the Iowa City Human Rights Commission should be directed to Stefanie Bowers, Human Rights Coordinator at 356-5022. Human Rights Commission - Current members #years as Country of Sexual Gender Name Term ending resident of IC Occupation Gender Age` Orgin' Orientation' Religion' Disability' Ethnicity" Identity' Race' Unique Identifiers' Business Sudanese Disable Adil Adams 12/31/2018-1st Term _ 18 Owner M 56 American M Muslim Phiscaly Black _ _ White/ Joe Coulter 12/31/2018-2nd Term 30 Professor M 71 USA Male Native Amer.Ind. Non Mobility- Eliza Jane Willis 12/31/2018-1st Term 23.5 F 61 USA Gay _ Practicing paralyzes White Retired Jeff Falk 12/31/2019-1st Term 1.75 Statistician M 72 USA Heterosexual Jewish 12/31/2019-Unexpired+ African Barbara Kutzko 1st Term 31 i F 67 USA Heterosexual American Dominican Tahuanty Pena 12/31/2019-1st Term 2 Physician M 38 Republic Heterosexual Hispanic Probation Cathy McGinnis 12/31/2020-1st Term 23 Officer F 42 USA Heterosexual Catholic _ Caucasian Jonathon Munoz 12/31/2020-1st Term 3 Attorney M 27 USA Heterosexual Catholic Hispanic/Latino Vacant 12/31/2020-Unexpired Please note:The information provided is the information provided on the application at the time of submission. •information is voluntary Member Attendance Sheet Member Term 1/9 1/23 2/22 3/20 3/29 4/17 5/15 6/19 7/17 8/21 9/18 10/16 11/20 12/11 Exp. _ Aron 1/2021 Present Excused Present Excused Resigned McGinnis 1/2021 Present Present Present Present Present Munoz 1/2021 Present Present Present Present Present Kutzko 1/2020 Excused Present Excused Present Present Falk 1/2020 Present Present Present Present Present Pena 1/2020 Present Present Present Excused Present Coulter 1/2019 Present Present Present Present Present Adams 1/2019 Present Present Present Present Present Willis 1/2019 Present Present Present Excused Present Board/Commission Application Cover Board/Commission: Human Rights Commission One Vacancy to fill an Unexpired Term Upon Appointment- 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: 4/2/2018 Application Deadline: 5/8/2018 Council Appointment Date: 5/15/2018 Date of Non-Gender Appointment: 7/3/2018 After date above Council may appoint without regard to gender Gender Balance Requirement: 1-Female Current Gender Balance: Female: 3 Male: 5 Gender Name and Address Male Bartlett, Rick 228 Raven Street Female Beiler, Deborah 2178 Willenbrock Cir Female - — Brown, Emmalyn 427 N Dubuque St. Apt 7 Female Bruss, Jessica Tl 2201 California Ave __ l Male Clemmensen, Rex 1108 Spruce St Male Coffey,Thomson 1247 Lakeshore Dr Female Crawford, Kathleen 401 Hawkridge Dr. Female _------ Crotty, Anne ---_T — _--- -_ -- —,----- --- 109 Cayman St. Female Donahue, Penny 1017 Rider St Male Drabek, Matt 815 N Johnson St Female Ferdig, Jessica 18 Dunuggan Ct Male Harper, Henri 3051 Wayne Avenue #42 Female Higley, Michelle 1328 Lower Muscatine Rd Male Hong, Sung Chul 1047 Westside Dr Female Johnson, Kristin 415 S. Van Buren St., Apt.1 Female Maliabo, Bijou 2602 Bartelt RD #2A Male NOURELDIN, WAIL 342 Finkbine Lane #3 Male Oladele-Ajose, Adedayo 301 Hawk Ridge Dr Apt #3311 Male Olmstead, Harry Current member Housing/Comm Dev. 1259 Shannon Dr Full Term 9/1/15 - 6/30/18 Female Park, Jiyun 20 Rocky Shore Dr Female Persson, Dorothy 14 Gallup Place Female Rands, Emily 615 N Linn St. Female Rasmussen, Mary Ann 1346 E. Bloomington Female Reger, Jackie 1215 Santa Fe Dr. Male Smith, David 1315 Cedar St. Male Taha, Mohamed Ahmed Elmandi 2532 Bartlet Rd #2C Female Taylor, Angel 2247 Plaen View Dr. Female Watson Epting, Susanne 86 Broadmoor Lane Female White, Lauren 1901 Broadway St. APT 6 Male Worlds, Solomon 1015 Oakcrest St. Apt i4 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 11/15/2017 First Name* Rick Last Name* Bartlett Home Address* 228 Raven Street 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* 3195125807 Email Address* ricky@kmryradio.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?* 7yrs 3.Occupation:* Broadcast Journalism 4.Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* As someone of multicultural decent,as well as disabled, I have engaged in many advocate groups professionally and privately concerning topics of basic human rights. *I have worked in India helping differing Cast systems advance in the job market when their station if birth prevents then from basic human rights. *I have worked with the Vermont Refugee Resettlement program to aid Somali refugees escaping was-torn Somalia. *I have worked with SportAbility of Iowa to advance the disabled community. 6.What is your present knowledge of each advisory board you are interested in?* I am very knowledgeable of the Human Rights Commission. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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?* Nb 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 10.Country of Origin 11.Sexual Orientation 12. Religion 13. Do you have a disability? Yes Please explain: Amputee 14.Ethnicity *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. Drop-down AdvisoryBoard/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 10/25/2017 First Name* Deborah Last Name* Beiler Home Address* 2178 Willenbrock Cir 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* 608-575-8370 Email Address* beilerdeb@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?* 3 months 3.Occupation:* retired 4.Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I served in community service as a chief inspector at the elections in Madison Wisconsin for about 10 years. 6.What is your present knowledge of each advisory board you are interested in?* I have a lifelong interest in social justice,and donate monthly to the Human Rights Campaign. I listen and read alternative media. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 61 10. Country of Origin United States 11.Sexual Orientation heterosexual 12. Religion Jewish 13. Do you have a disability? No 14.Ethnicity American *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* ate/ ota/iY t 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. Drop-down 1 r 1 4-4 Advisory Board/Commission/Committee CITY OF lowA CITY Application Form UNESCO CITY OF LITERATURE 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 N U nn Ci-Aft 1 q; S CAMt'\'11 S CC]] as Date of Application 5/ /201 b C`? am M Name E..mmulyh LAYcp-.Gt� ir'�' Home Address 4 oZ 7 vyuctus., (CUx ft.\-1 1/4-k ,a14) Contact phone number 40%1`b } Email Address ernmA.tr— tuOLAJO- .t ,r- CD Your home address must be within the corporate limits of Iowa City? How long have you lived in Iowa City? ',O\ Occupation: Sttac eza Gender:Male Female XI Experiences and/or activities which you feel qualify you for this position: Ar/101"°\ my maJcry I carr Put)(suAinCI a 1iu►vtatr, Ric hs Cv�-{,-�,cu,�e souct9 U.bA.tc, mt►mor, 1 Inlaire, am,\ Ya \te I - U- s cid $erns\ 'ro co��Fe �'eltca�) si-tn�eY.t� p. 1-hrz.�r r tq vtts . 1 evorh ar c rAo4N c�0 A ai-�o n ad va wore �� Sta�ua l o-ss owl (-J advocate Yard o�'s es -dor �d 't rev ev�'hvn pn2 lYtnq lin L1a�S 1Q-SSo-n5 Id 1oc.CAl SuAoo\S �t c O ?DS itCPAs VeCtiv U+�t �` !-es C oc 1161.�s 1 owck. -P p1\� i �slgav2 0,+.0 loblo�e8 the Pra 4..tch a•S -Vo r cR)A vS t a\S o �ry-Q, c,,\ fi�vcs do r T t 1 k Ov�kv�.rut- steT�hS ".)0(Ylei^ 0-0(•6 1 hUUIQ C-Q.YNbe A ocs at Ler\ S 5 l0 Y1 G t t�„¢ uoG�kszi3,, p{� t\ lncm51r� , (It/t--1 oN e, pt, E,1-rc ` MA-ern th.n.r�e UniId w4,t x6Q. Cont )hA ) ltd OVI�Li�? K �cecJ -� „ cif\edts 0,-Nd What is your present knowledge of this advisory board. 10,-1 tom_ �"� hd� I h air Q 1 c it ea abow -vv,t } . CO(Nam 5 S u:A t� c�h al s t 4_5 n w (fir] sh,,cjtes and Vtc '€ \ -rhe PlicA3u,re p� h-.crz (� SQ A S I cr\ l✓l Co v\a u r\ C l 1 O,\ W tch cx. cO u r se.. I Kr)o w 4-Kat 5.6u. the, pub huo'v-Nu" R\c�tnt s /c i v t\ R\9,h\--c- } p\ah a ev nA-s ct. c\ re-c)uutvlb b. / s tan') 1n4orn-.s Yht, c.e.w,v..\ Y\ t'(i ane, C4 -Z_bl at1UrS 1'o\ck r on- 1 � � mee,�,r\�6 oft off, +c? 11,c :)t.k131 ore 1 w\ Correll ah or t h m cacx is ate- clt.S m rnu1 v.�Y\ as S\ ,SLA r k et. <, \sr\3 r �/ 1 b C�e,t` v\d s-42-1 RiS VOA CJ ua-Ct-6 tit- r- I I vw, 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 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. Section 362.5 City Council Resolution #15-300 established a policy that the following persons shatgnot be eligible for appointments to Boards and Commissions. -: c-) 3L A council member's spouse, domestic partner or partner in cohabitation, childr ,Aep Mildren*.... children for whom the Council Member assumes parental responsibility,mother, *het',sonlin-la daughter-in-law, sister-in-law, grandparents, and grandchildren, aunt, uncle, nieLeictephge, firs cousin,foster parent,poster child,persons who are parents of the same child,and pgysm th employee is in an intimate relationship. W P t.3 Res.#15-300 states that each application for reappointment to a City Board or CommissionTill 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 NO vl List potential conflicts of interest(See last page for information regarding conflict of interest) Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS Do you currently serve on another Iowa City board or commission?YES NO K If so which one do you prefer? 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: Age Lb Country of Origin t)c-.)A— Sexual Orientation H e}PXp sey.uctO Religion t�(j 1105s lc/awl 5-\tOx\ (— —- Do you have a disability?YES )( NO (SSD/l 1 v8! - ar45Wilk) Race,Color or Ethnic Group *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) ea r — m Signature of Applicant* eassio 2 < -4 r Misrepresentations on this application will constitute just cause for removal ap}Eintee If you fail to answer all the questions,Council will not consider your applicatia C cp You are encouraged to contact individual Council Members to express your interest in serving.Contact information is attached. r AdvisoryBoard/Commission Application Form r c ► � 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 5/3/2018 First Name* Jessica Last Name* Bruss Home Address* 2201 California Ave 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* 3196211950 Email Address* jrbruss@yahoo.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?* 19 years 3.Occupation:* Client Services Professional 4.Gender* 'This question s m3ndatcry in cyder for the Oty to c rrply with the States gender balance reguirenent,which treats gender as binary."Gender identity"tray be provided in the Oarrographics secticnof the application below. r Male p Female 5.Experience and/or activities which you feel qualify you for this position:* I have a son with disabilities due to a genetic condition. My husband,who also had disabilities,recently passed away from the same condition. I have spent a great deal of time advocating for my son to schools and vocational rehabilitation. I took relevant courses at the University of Iowa including Citizenship in a Multicultural Society,Global Aging,and Introduction to Assistive Technology. I have also taken leadership courses and understand barriers to equality faced by women. I will graduate from the University of Iowa in May 2018 with a bachelor of liberal studies degree with an emphasis on organizational studies and a leadership certificate. 6.What is your present knowledge of each advisory board you are interested in?* I understand that the commission meets the third Tuesday of each month. Duties of commissioners include educating the public about human rights, making recommendations on legislation and grants. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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?* Nb 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 United States 11. Sexual Orientation Heterosexual 12. Religion Loosely Christian 13. Do you have a disability? No 14. Ethnicity European 15. Race Caucasion 16. Gender identity Female *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* jeSS�c gross 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. Drop-down AdvisoryBoard/Commission Application Form :40ii �� 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 10/24/2017 First Name* Rex Last Name* Clemmensen Home Address* 1108 Spruce St 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* 515-257-3096 Email Address* clemmensen@yahoo.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?* 45 years 3.Occupation:* Retired from ACT 4. Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* While working at ACT I moderated fairness calls with representatives of various group, ran numerous meetings,and established procedures to ensure all ACT testing material and other material was fair and inclusive.Also worked with a diverse group and tried to ensure that ACT hired a diverse group of people. Additionally, I was raised by parents who were models of integrity.They instilled in me a sense of fairness and decency. 6.What is your present knowledge of each advisory board you are interested in?* I follow the news regarding human rights internationally,nationally,and at the local level including the actions of the Human Rights Commission. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 64 10. Country of Origin United States 11. Sexual Orientation Heterosexual 12. Religion Agnostic 13. Do you have a disability? No 14. Ethnicity White *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. Drop-down Advisory Board/Commission Application Form rY 1 ^� P� ,;.C'*E r 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 10/8/2017 First Name* Thomson Last Name* Coffey Home Address* 1247 Lakeshore Dr City IOWA CITY State IA Zip Code* 52246 1.Is your home address(listed above)within the corporate limits of Iowa City?* Yes Contact Phone Number* 2054519241 Email Address* Thomson-Coffey@ulowa.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?* 8 years 3.Occupation:* Student 4.Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* As a student, I have been studying Human Rights and have an in-depth understanding of what is entailed by protecting such rights.Also,through my class we have met with attorneys who work in the Human Rights department for the city and they encouraged members of our class to apply for this commission.Also,I have been a resident of Iowa City for nearly half my life and for all of my formative years; I would love to give back to my City and make sure it remains as inclusive as it has always been. 6.What is your present knowledge of each advisory board you are interested in?* I understand that the Committees responsibilities are included by not limited to disseminating and looking into acts of discrimination or violations of civil rights,recommend legislation to the City Council on protecting rights of the citizens of the city,as well as put on educationals for the public to know about their rights and how to prevent discrimination. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of Interest.The following describe 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 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 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-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 19 10.Country of Origin United States 11.Sexual Orientation Straight 12.Religion Christian 13.Do you have a disability? Nb 14. Ethnicity White *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* 004/04"6`) , 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. Drop-down 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 2/18/2018 First Name* Kathleen Last Name* Crawford Home Address* 401 Hawkridge Dr. City IOWA CITY State IA Zip Code* 52246 1.Is your home address(listed above)within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-594-1123 Email Address* karhyuiowa25@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Library, Board of Trustees Select a Board or Commission you are interested in:* Senior Center Commission Select a Board or Commission you are interested in:* Human Rights Commission 2. How long have you been a resident of Iowa City?* 10 3.Occupation:* Health Professional 4.Gender* Ibis question is nwndatory in order for the City to comply with the State's gender balance requirement,which treats gender as binary."Gender Identity"rmy be provided in the D3rrographics sectionof the application below r Male l4 Female 5. Experience and/or activities which you feel qualify you for this position:* I have worked with many diverse groups through graduate school and the community. I have organized student academic fairs:graded assignments via ICON;and lead biology discussions. In addition, I have organized a health professional organization,where I solicited speakers, gained funding for a office, and mentored students. I have worked with various technologies and advised about policies and procedures. 6.What is your present knowledge of each advisory board you are interested in?* I believe that the University libraries and public libraries are outstanding offering a plethora of services for citizens. I hope that it can accomplish as much as possible for the next generation. The senior center I am aware of some of its activities in technology and social events. In addition,the human rights board,I have seen events that deal with atrocities in the country. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 10.Country of Origin 11.Sexual Orientation 12. Religion 13.Do you have a disability? 14.Ethnicity 15.Race 16.Gender identity *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* &Q lt2'4 C:441,0,47- 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. AdvisoryBoard/Commission Application Form This application is a public document and as such can be reproduced and distributed for • ®saTA 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 5/8/2018 First Name* Anne Last Name* Crotty Home Address* 109 Cayman St 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* 3193257258 Email Address* anne-crotty@uiowa.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?* 12 years 3.Occupation:* Program Coordinator at Child Health Specialty Clinics 4.Gender* `This question is rrerdatory in order for the City to con*w rib the State's gender balance re it rerrert,which treats gender as binary."Gender Identity'trey be provided in the Denngraphics sectionot the application below. r Male p Female 5. Experience and/or activities which you feel qualify you for this position:* I work in health equity at Child Health Specialty Clinics,which is Iowa's Title V program for children and youth with special health care needs. My passion for health equity really grew after I attended a two-day Racial Equity Institute workshop a few years ago and watched the Race:The Power of an Illusion documentary series. This passion that began as an element of my work has become a personal passion as well,and that is why I am applying for this commission.As part of the Strategic Planning Committee, I was instrumental in weaving health equity into all areas of our strategic plan. I have lead activities for staff to illustrate components of health equity a series of articles for staff on health equity.Topics include white privilege, inequities in ADI-ID among children of color,school to confinement pipeline, implicit bias,and historical trauma. I am building a grassroots group of employees to request that our Division place a greater focus on equity in the future. I have attended the Urgency for Equity Conference,Juneteenth,and community conversations sponsored by the Black Voices Project. I am a member of Showing Up for Racial Justice, including the book club. I recognize the great amount of work that needs to be done at all levels to create equitable opportunities and outcomes. I would enjoy working with others on the Human Rights Commission to advance these efforts. 6.What is your present knowledge of each advisory board you are interested in?* I participated in several of the Human Rights Commission's accomplishments,including MLK Day activities and Juneteenth. I read with interest the article in the Reveal Magazine about lending disparities among Hispanic individuals within Iowa City. I would very interested in collaborating with other members of the commission to reach out to Fills Bank or other banks to discuss disparities and solutions,and examine the intersection of accessible,universal and affordable housing. I am also very interested in using a variety of techniques to educate the community on the rich history of people of color and tools that can facilitate courageous conversations on difficult topics, such as white privilege or institutional racism. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 35 10. Country of Origin United States 11.Sexual Orientation Straight 12.Religion Catholic 13. Do you have a disability? No 14. Ethnicity White 15.Race White 16.Gender identity Female '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* Aloe Cebf 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. l- --®te umor FILED ."--e‘rit Advisory Board/Commission/Committee CITY OF IOWA CITY Application Form 23I711oy 13 PP UNESCO CITY OF LITERATURE �: 22 Cin ^IT•y ':it This application is a public document and as such can be reproduced and distributed ter the public. This application will be considered for twelve months only and automatically considered for any vacancy during that time. Advisory Board/Commission/CommitteeName (MSA mt\e,,\\ \\S Date of Application k-1\1:\\P\ O\\o\\V,k_ NNAr \ 113 aon Name ((�� Home Address 1 \\(�� ' Contact phone number Jb c)SSU Email Address cc-l\h\J\ON Q 0,`KZ.(p� Your home address must be within the corporate limits of Iowa City? \ How long have you lived in Iowa City?h_s_ Q \fh `L Occupation: c<9)J)11 3/ \ Gender: Male Female J Experiences`\ k and/or activities which you feel qualify you for this position: `\ p �Ql �� bbcts it OC lsN. - What is your present knowledge of this advisory board? E i \9.1)\stiV ' ate\ Ci u� N�9 ‘. \p�1sJA a1 4 • wad % , \\yrY. } toc,\m,tnv` t v ksrc s-w. a K4, Vg)dd0 C� k Please contact the city attorney at 319-356-5030 to discuss questions or concerns regarding a potential conflict of interest. Potential Conflict of Interest t i C The Housing and Community Development Commission makalylegr endatie3 t9 the City Council regarding the distribution of federal CBDG/HOME funds. ?The genekl'rnteCs that no persons who exercise or have exercised any functions or responsibilifg withirespect to federally funded activities, or who are in a position to participate in the de i4Iti 4m4kin`g: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 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. Section 362.5 City Council Resolution #15-300 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.#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. Do you currently have a conflict of interest?YES NO / List potential conflicts of interest(Sec last page for information regarding conflict of interest) Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS Do you currently serve on another Iowa City board or commission? YES NO l If so which one do you prefer? 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 thee coirL utistyjand the groups(s)which it serves, please provide your information for the following: Age-13 Pn 2: 7• CI- Ty sic Country of Origin \ ; i'ol r.IT. t' Sexual Orientation (_q �` (� Religion �\ R�ci' \Q� i� ti� \\gtiYet J w €14 ctnurs p(-� (� Do you have a disability? YES_NO f �° 1 lhitiltf(pS' Race, Color or Ethnic Group *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* ton) ii41/24k 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 to contact individual Council Members to express your interest in serving. Contact information is attached. AdvisoryBoard/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 5/8/2018 First Name* Matt Last Name* Drabek Home Address* 815 N Johnson St City IOWA CITY State LA Zip Code* 52245 1. Is your home address(listed above)within the corporate limits of Iowa City?* Yes Contact Phone Number* 502-693-2926 Email Address* matt.drabek@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?* 10 years 3.Occupation:* Content Specialist 4.Gender* "This question is mandatory in cyder far the ay to conpty with the State's gender balance requirerrert,which treats gender as binary."Gender Identity"rimy be provided in the Oertograplics sectionof the appicatim below. F7 Male r Female 5. Experience and/or activities which you feel qualify you for this position:* During my ten years of residence in Iowa City, I have approached life in Iowa City from a number of different angles:as someone who moved here from somewhere else, as a student and faculty member at The University of Iowa,and(now)as an employee of one of the largest non-university employers in Iowa City. In these roles, and through community activism, I've come to appreciate the need to balance the needs of a wide variety of groups of people in Iowa City and to make special efforts to welcome and encourage those who come to Iowa City because they have been marginalized elsewhere. My record of service,research,and activism has focused mainly on issues concerning class,gender and sexuality,though also to some degree race and socioeconomic status.This record includes service on a University of Iowa committee aimed at creating a sustainability certificate(which was successful,and the sustainability certificate is now a part of the university's curriculum), local activism with groups focused on feminism and gender issues,and several articles(on topics ranging from the social effects of scientific classification to the social impact of pornography)and one book(Classify and Label:The Unintended Marginalization of Social Groups, Lexington Books,2014). I hope to bring my analytical training to bear on discussing and investigating human rights concerns. 6.What is your present knowledge of each advisory board you are interested in?* My understanding of the Human Rights Commission is that its central function is to work with and educate both the city council and general public concerning human rights issues,and to receive and evaluate complaints of human rights violations as defined by Iowa City's human rights ordinance/human rights code. It also serves as a key point of contact for the Social Justice and Racial Equity Grant and annual Human Rights Awards. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 34 10.Country of Origin USA 11.Sexual Orientation Queer 12. Religion None 13. Do you have a disability? No 14. Ethnicity white 15.Race white 16.Gender identity Man(cisgender) *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. r AdvisoryBoard/Commission Application Form 417.4447,-sat 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 5/8/2018 First Name* Jessica Last Name* Ferdig Home Address* 18 Dunuggan Ct 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* 3199300811 Email Address* jessferdig@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission Select a Board or Commission you are interested in:* Housing and Community Development Commission(HCDC) 2. How long have you been a resident of Iowa City?* 5 years 3.Occupation:* Clinical Research Associate/Project Manager 4.Gender* 'This question is nsndatory in order for the City to comply with the States gender balance requirement,w ttich treats gender as binary."Gender klentity"nay be provided in the C-rmgraphics sectiaiof the application below. r Male p Female 5. Experience and/or activities which you feel qualify you for this position:* MPH in Community and Behavioral Health(including courses of Social Determinants of Health, Health Disparities and Cultural Competence,Community-Based Participatory Research,and others) Experience in grant writing for community projects and knowledge of local/national funding sources Experience with low-income populations through community outreach and employment Attendance of community events(UI Public Policy Center Conferences, Human Rights Conferences, UI Global Health Conferences, Johnson County DMC Conference,etc.) Experience with Latino populations in eastern Iowa(including being on the ICCSD Immigration Task-Force Committee) Bilingual English-Spanish(Spanish speaking household as husband and step-daughter are from Honduras) Johnson County native Interest and dedication to protecting human rights for all residents of Iowa City 6.What is your present knowledge of each advisory board you are interested in?* HRC holds meetings every 3rd Tuesday(no conflicts with schedule) HRC works on educating the public on issues of discrimination and human rights violations HRC makes recommendations to City Council through proper representation at City Council meetings HRC coordinates local events HRC members continue to be educated on human rights issues HRC is focused on social justice issues, including fair housing HRC has a balanced number of identified males and females serving HRC utilizes local data for discussion of issues and finding resolutions to community disparities HRC has 8 members HRC utilizes democratic voting system to pass motions within the committee Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 6. 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 26 10.Country of Origin USA 11.Sexual Orientation Heterosexual 12. Religion None 13. Do you have a disability? No 14. Ethnicity Caucasian 15. Race Caucasian 16. Gender identity Female *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. Drop-down Advisory Board/Commission Application Form ��i�-p frav,„. 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 UTERATURE NOTE:Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 11/2/2017 First Name* Henri Last Name* Harper Home Address* 3051 Wayne Avenue#42 City IOWA CITY State IA Zip Code* 522240 1.Is your home address(listed above)within the corporate limits of Iowa City?* Yes Contact Phone Number* 3199366611 Email Address* henri.harper05@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?* 22 3. Occupation:* Iowa City Police 9 Outreach) 4. Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* I have worked and lived in Iowa City for over 20 years with extensive community advocacy work.Also working with families and agencies to further diversity within the Iowa City community 6.What is your present knowledge of each advisory board you are interested in?* The Human Rights commission is a board I am extremely interested in to further the advancement of all of it citizens. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 60 10.Country of Origin USA 11.Sexual Orientation Married 12. Religion Baptist 13.Do you have a disability? No 14. Ethnicity Black *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* Weette'9-40.1t- 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. Drop-down AdvisoryBoard/Commission Application Form "InC1�� 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 11/3/2017 First Name* Michelle Last Name* 1igley Home Address* 1328 lower Muscatine rd 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* 3196219314 Email Address* disgobean@yahoo.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?* 16 years 3.Occupation:* Rockwell Collins 4.Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I have a bachelor's degree in human behavior and grew up gay in the south. I've lived in Iowa city for quite some time and have been engaged In this community for a good long while. 6.What is your present knowledge of each advisory board you are interested in?* I feel i have quite a bit to offer from muy perspectives and observations. I have knowledge of laws governing discrimination and a desire to make life better for all around me. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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 hatf -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 48 10. Country of Origin United States 11.Sexual Orientation Lesbian 12.Religion Buddhist 13. Do you have a disability? Yes Please explain: Cancer 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. Drop-down r AdvisoryBoard/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 5/1/2018 First Name* Sung Chul Last Name* Fong Home Address* 1047 Westside Dr City IOWA CITY State IA Zip Code* 52246 1.Is your home address(listed above)within the corporate limits of Iowa City?* Yes Contact Phone Number* 3194000413 Email Address* hongsungchul@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?* 1.5 years 3.Occupation:* Student 4.Gender* This question is nendatory in order for the Oty to corrply with the She's gender balance reglxenerd,which treats gerxfer as tinny."Gender Identity"nEy be provided in the Derrogaphics sectional the appication below F7 Male r Female 5. Experience and/or activities which you feel qualify you for this position:* Immigrant Spouse of international student Son of Korean War refugees Bachelor degree in Law Work for Samsung Electronics about 12 years Experiences in the UK, Germany,and France. 6.What is your present knowledge of each advisory board you are interested in?* I majored in Law Now studying introduction American law at Kirkwood I have a perspective of immigrants and international student. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of Interest.The following describe 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 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 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-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 42 10.Country of Origin Korea 11.Sexual Orientation as straight 12. Religion Christian 13. Do you have a disability? No 14.Ethnicity Korean 15.Race Asian 16.Gender identity Male *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. Drop-down AdvisoryBoard/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 4/5/2017 First Name* Kristin Last Name* Johnson Home Address* 415 S.Van Buren St.,Apt.1 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* 319-594-1032 Email Address* sunshineariel99@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Library, Board of Trustees Select a Board or Commission you are interested in:* Community Police Review Board (CPRB) Select a Board or Commission you are interested in:* Human Rights Commission Select a Board or Commission you are interested in:* Housing and Community Development Commission(HCDC) 2. How long have you been a resident of Iowa City?* 22 years 3.Occupation:* volunteer 4.Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I am active in some support groups which help me stay connected to the community and help me to take good care of myself,and interact with an interesting and diverse population in this city. 6.What is your present knowledge of each advisory board you are interested in?* I am aware that the library board term is a period of 6 years and helps determine policies and practices. I am aware that the Community Police Review Board is designed to help those concerned with criminal justice in this community.And I am aware that the Human Rights Commission is designed to help protect people with disabilities to be treated fairly in this community. 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 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 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-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 64 10.Country of Origin USA 11.Sexual Orientation heterosexual 12.Religion Episcopal 13. Do you have a disability? Yes Please explain: I have a mental health condition which I manage with medication and social activities and healthful activities. For example, I volunteer at a local peer support recovery center,volunteer for New Pioneer Co-op,& garden in the city garden. I also advocate with letters and phone calls to our elected representatives for a combination of issues I am concerned about,such as mental health parity,the environment and social justice.I also receive rental assistance. 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* cLGCliv CgAr&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. Advisory Board/Commission Application Form Nw®I'r-'a,„ 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 4/16/2018 First Name* Bijou Last Name* Maliabo Home Address* 2602 Bartelt RD#2A City IOWA CITY State IA Zip Code* 52246 1. Is your home address(listed above)within the corporate limits of Iowa City?* Yes Contact Phone Number* 6073732382 Email Address* wisefille@icloud.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?* 20 years 3.Occupation:* Employed by ACT 4.Gender* "Thus question is mandatory in order for the City to comply with the State's gender balance requirement,which treats gender as binary."Gender Identity"may be provided in the Denvgraphics sectional the application bek . r Male (17 Female 5. Experience and/or activities which you feel qualify you for this position:* I help translate for the school district,the University of Iowa and churches for immigrants and students. I have been doing this for about ten years now. I also mentor and counsel a variety of people(young kids,couples, students etc...)I encourage them to be active in the community by participating in events,to help others and follow the city law. I help new family find housing,apply for food stamps and medical insurance and help with immigration application. 6.What is your present knowledge of each advisory board you are interested in?* My present knowledge of the Human Right Committee is based on the information that Stefanie Bowers provided me with at our meeting and from reading about it on the website. My understanding is that the Human Right Committee helps the commission by planning events and activities both public and private for the community,schools,housing,education, public safety and others.They provide awards to youth, educate the public on human rights and make recommendation to the City Council about it and in regard to discrimination. They also meet eleven times in a year. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 36 10.Country of Origin D. R of Congo 11.Sexual Orientation Heterosexual 12. Religion Christian 13. Do you have a disability? No 14. Ethnicity Non-Hispanic 15. Race Black 16. Gender identity Female '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* Awl V!y/!aAlGrO 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. Drop-down AdvisoryBoard/Commission Application Form :. . �"ili 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 11/9/2017 First Name* WAIL Last Name* NOURELDIN Home Address* 342 FINKBINE LANE#3 City IOWA CITY State IA Zip Code* 52246 1.Is your home address(listed above)within the corporate limits of Iowa City?* Not Sure Contact Phone Number* 3192297888 Email Address* WAIL.M.NOURELDIN@OUTLOOK.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?* 4 YEARS 3.Occupation:* VOLUNTEER 4.Gender:* Male 5.Experience and/or activities which you feel qualify you for this position:* I KNOW WHAT THE OTHERS NEED . 6.What is your present knowledge of each advisory board you are interested in?* LAW. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 10. Country of Origin 11.Sexual Orientation 12. Religion 13. Do you have a disability? 14. Ethnicity *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* p90‘,0Hc:, 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. Drop-down 1 r j A.:IIIMkE'� Advisory Board/Commission/Committee CITY OF IOWA CITY Application Form UNESCO CITY OF LITERATURE 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 IJJirkif1 1h4 Corp, j5i vj Date of Application SiZ/ i? Name .Acieda o OIa fe Home Address 201 R II✓....JJJJ____ Di Ap- _.2131 mo Contact phone number 3(7—6 i I-1orj7 Email Address aOIac ie (' o f,c(` t� Your home address must be within the corporate limits of Iowa City? =1 to -.Cr" ,o r How long have you lived in Iowa City? S pep atZgt) Occupation: 4 1er(c 12 member, Qi',►2ei41 c care Spec.,<A1 I Gender: Male X Female Experiences and/or activities which you feel qualify you for this position: 44 feud prbj 6G-4,5 4o Ocfe e � Q01 P11 G �y s�-h�b � . h (-4 E7Wo hi)13 wQ (,e3ct Ad 4.0 he(P-gl w(- S41 . Pf e5e(I4' a4 "Hie PuM4 ti 140 P1gh f5 Come (4Q�u-¢ w � s "74E5 ��mrc r9h-LS and how 1.4 Pe l i5 bQ5e-4 of diScPiMilq-/,'q What is your present knowledge of this advisory board? 1011111 4he /1010/i/ Pdh-1-5 COM 01 4Ge re 0�5; �► ji�i t5 i��t��' ecktar t►� P 9 'the eul(1.G d1 h(161° 1 t%8-f 1(1 mi-f� I 9 -�J�, G-�Y C �r�U ( 76 miwa 5 apPraac urKl ai (--f`l\mi '0 )1j @la fv4/13 54'&f0)13 -cor 41v-6 Soc-fql 3-us-tic_e and eCAi q lul� Ion cecA, 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 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. Section 362.5 City Council Resolution #15-300 established a policy that the following persons shall not be eligible for appointments to Boards and Commissions. cv A council member's spouse, domestic partner or partner in cohabitation, children, :r chilgn, children for whom the Council Member assumes parental responsibility,mother, fath• ..,.: iniv, daughter-in-law, sister-in-law, grandparents, and grandchildren, aunt, uncle, niece, r , fust r— cousin,foster parent,poster child,persons who are parents of the same child,and perso�}trigoni ecce rn employee is in an intimate relationship. rn -9 Res. #15-300 states that each application for reappointment to a City Board or Commisi{i fn wills 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 NO X List potential conflicts of interest(See last page for information regarding conflict of interest) Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS Do you currently serve on another Iowa City board or commission?YES NO/ If so which one do you prefer? 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: Age 73 C Country of Origin ....).. Sexual Orientation Religion CJI �h ii Do you have a disability?YES NO • Race,Color or Ethnic Group Aril' 4rpri Ca 1) *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 to contact individual Council Members to express youratiAresaeu serving.Contact information is attached. D� '71 c-).< C.. 1 Dxcp CA v to AdvisoryBoard/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 4/4/2018 First Name* Harry Last Name* Olmstead Home Address* 1259 Shannon Drive Apartment 326 City IOWA CITY State IA Zip Code* 52246 1. Is your home address(listed above)within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-855-2666 Email Address* Harry03@aol.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?* 8 years 3.Occupation:* retiredw 4.Gender* 'This question is mandatory in order for the Oty to corrpy with the State's gender balance requirement,which treats gender as binary."Gender identity"nay be provided in the Oenographics secbcnof the application below. p Male (— Female 5.Experience and/or activities which you feel qualify you for this position:* I served on the Human Rights Commission for 5.5 years(2years as Chair).Currently chair on Housing and Community Development my term ends this July and if appointe to the HRC I'm willing to leave the HCDC early. 6.What is your present knowledge of each advisory board you are interested in?* Have been on HRCand enjoyed the work we did. fm also an advocate for marginal person's,especially persons with disabilities. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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?* Yes Board current serving on* Housing and Community Development Commission(HCDC) If Yes,preference on first choice* Human Rights Commission 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 You 10.Country of Origin ,USA 11. Sexual Orientation 12. Religion Quaker 13.Do you have a disability? Yes Please explain: I'm a person with a right above the knee amputation from getting MERSA. I depend on a pourer wheelchair for mobility 14.Ethnicity Born in USA 15.Race White 16.Gender identity male "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* 971:710t_ey Cliottaread 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. Drop-down I ? 1 � m � ,i _'""'°°'®_ Advisory Board/Commission/Committee CITY OF town CITY Application Form UNESCO CITY OF LITERATURE 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. nI Advisory Board/Commission/Committee Name 144wo...— wW.nv`Ss Dry o Date of Application _ IZ. • 9 . if Qnto en r"—t f7 ..... NameLjt&h rAFk c7-{ VI I 1; Home Address _2.0 17-06,1 chore Dr. 7.<1;<tn -p m T s 0 Contact phone number 1.14-142),CoCt I.r b t Email Address i c0 " d "`. r`9 CA Your home address must be within the corporate limits of Iowa City? "' How long have you lived in Iowa City?_ _7n Occupation: .uFPG- urt4 PnhtJn,.: 51-144 i.o intro( tf or Cemrninn Oj4•nt�r : fowc,c 20 I�, Gender. Male Female 1../ CA-64-ii;J -(o I""__�ll l0.iur 4/*Avn 4C-) e4.-P 1tM1A t e,,k 4 Ph�tsl•S Cw rteta.(wr► Ivi.wett-tor : prbjeck olf II Experiences and/or activities which you feel qualify you for this position: 13oolrc1 &Icier-Ser Fa c - C tet g's. m . oulol Gotn.nmAk;.i 4Lotivcce, .rn-ettnCaufer C rstn,l{-r..i Eivipow•ern4L4- CA-des . Neco- P(' hr Floor a-rri c 42hrT -Conn ec4c Gni Ielretn -Eo (� icitk 2s J ScrcvtisLa e,eovSc' `( e1 p.pri t - a tz lwa- is 13 Co(1,041oYa.tpr W/ lowaUi CAl e.t� � J J� Co(la loa-.* e dvcsotit.l San--c1 CflTHR C btskc, (a.e...ktnrCSkiA-2,-tA-)Ce(i'4434111.0 What is your present knowledge of this advisory board? 5 • 0,6 GM her ih .� U I eSt9( 1~itln 4r,2Tv -012- SQk$2 (''' ;oltwht�.on ohecet of- C5$ o Ak\CL C2rtCS-rn-S D€ i-o .rh A -5 . I'th koti J 1 Sc-v en l re 5 v.F v[StA wt}k c\A t& Lt54etu CowtwL F ervi WeAVC Cobnv\.9M til Ilki here km. JItitnia. Some to -to jhvi-k evet2 efo. ve 4 our -f we. ts) otkLcC slr. v,Q, beads 044 ove4-coM2.- -fear,tsetoy-Amee 4 Cat-c '—tJrNo-treLs at kl#241 Cove_, �i co.J 041^-4W-Q- Fes},e - -'r//Jfie"We-Ro i %-. D Jr, t 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 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.Section 362.5 City Council Resolution #15-300 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. 11) r=s (:) - —.+— q Res.#I5-300 states that each application for reappointment to a City Board or Comm#i'sip wine .11 considered without regard to incumbency. If reappointed, an individual would be limited to..une reappointment to a full term in order to increase the opportunities for new applicants to.sq . -- rq i + f Council policy is not to permit an individual to serve on two Boards or Commissions, tttne e time.You will be asked to resign from one if appointed to another. • Do you currently have a conflict of interest?YES NO List potential conflicts of interest(See last page for information regarding conflict of interest) Please indicate if there are none. BUSINESS NAME BUSINESS ADDRESS Do you currently serve on another Iowa City board or commission? YES NO I. If so which one do you prefer? _ 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: Age qD Country of Origin S. n,l_Qjti Sexual Orientation &M I R Religion .NL / Nt's-ii Do you have a disability?YES_NO I/ Race,Color or Ethnic Group l avk *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 to contact individual Council Members to express your interest in serving.Contact information is attached. ro o0 m y=� c-) ...,. 0-C = r �n =gy r m =p c. N 1> {lt <.5.1 _ r_ AdvisoryBoard/Commission Application Form 4, 404-AZT� 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 10/29/2017 First Name* Dorothy Last Name* Persson Home Address* 14 Gallup Place 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* 319-337-3347 Email Address* dorothy-persson@uiowa.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?* since August, 1972 3. Occupation:* retired academic librarian 4. Gender:* Female 5.Experience and/or activities which you feel qualify you for this position:* I have volunteered for Shelter House since 2001,and I am currently serving on the Shelter House Board. I finished a term on the Housing and Community Development Commission in the spring of 2017. When employed, I was active in the Iowa Library Association and am a past president of that organization.As a retiree, I still serve on an awards committee for the American Library Association.When employed, I served on committees within the American Library Association related to my duties within my organization. 6.What is your present knowledge of each advisory board you are interested in?* I know people who have served. I have followed their decisions and decision-making process as reported in the press. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 68 10.Country of Origin USA 11.Sexual Orientation heterosexual 12. Religion Lutheran--Christian 13.Do you have a disability? Yes Please explain: I am hearing impaired. 14.Ethnicity White *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. Drop-down AdvisoryBoard/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 -•a.ar� CITY OF IOWA CITY considered for any vacancy during that time. UNESCO OTY OF LITERATURE NOTE:Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 11/14/2017 First Name* Emily Last Name* Rands Home Address* 615 N Linn st. 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* 319-594-8624 Email Address* emilyrrands@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 months 3.Occupation:* Job Placement Specialist at Goodwill 4.Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* I recently relocated back to Iowa from the east coast to begin my family and have always been inspired by my grandfather's(Henry Vargas)commitment to activism. In September, I was able to see him inducted into the 2017 Iowa Latino Hall of Fame and now feel the desire to follow his example and take a more active role in advocating for social justice. I have many fond memories of the Davenport LULAC from my childhood and successfully ran for queen in 2000.As an adult, I possess over 7 years of experience working with people with disabilities in various roles and have thoroughly enjoyed assisting them in becoming more actively involved in their community. I have also volunteered for the Dubuque county Democrats in the past,as well as candidates in Davenport and Rhode Island. I believe it is important to work for the inclusion of all our community members because with greater exposure to different views and cultures,we are better able to see our similarities. I would greatly appreciate the opportunity to assist in any capacity with the Human Rights Commission. 6.What is your present knowledge of each advisory board you are interested in?* The Human Rights Commission mission is to educate the community on civil and human rights.They plan events to bring people together and work with the City council on legislation regarding discrimination. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 34 10.Country of Origin United States 11.Sexual Orientation Heterosexual 12.Religion None 13. Do you have a disability'? No 14. Ethnicity Hispanic *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. Drop-down I L AdvisoryBoard/Commission Application Form 3► ,�� 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 lova City to apply Date of Application 4/9/2018 First Name* Mary Ann Last Name* Rasmussen Home Address* 1346 E. Bloomington 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* 319-338-8337 Email Address* maryann-rasmussen@uiowa.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?* since 1980 3.Occupation:* Assoc. Professor,Department of Gender,Women's and Sexuality,UI 4.Gender* 'This question is rmndatory in order for the Qty to conply with the State's gender balance requirement,which treats gender as binary."Gender Identity"xray be provided in the[ rographics sectionof the application below. r Male F7 Female 5.Experience and/or activities which you feel qualify you for this position:* I have devoted much of my career at UI to improving the lives of diverse students and teaching courses that help students understand differences of gender,race,ethnicity and sexuality in the US. I am currently Director of Undergraduate Studies for the Department of Gender Women's and Sexuality Studies. I have taught courses in both GWSS and in English that focus diverse American girls,working for social justice, and women's art and writing. I have also taught courses in Asian American literature and culture,Asian American women writers,World War II in Japan and America,the Japanese American Internment,and reading race and racism in American fiction.My service to the University has also focused on social justice issues. I served on the UI Council on the Status of Women from 2007-2010 where as Chair my last year I ran monthly meetings; participated in the search for a new Chief Diversity Officer;and spearheaded efforts to craft and win administrative approval for a new sexual harassment survey of undergraduate students. I was also worked with the President's Office on crafting new sexual harassment and sexual assault policies. 6.What is your present knowledge of each advisory board you are interested in?* I am aware of the important work of the Human Rights Commission particularly regarding issues of race and racism in our community and their support of social justice and rarity equity funding opportunities.This seems to me really important work and rd like to be involved with it. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 67 10.Country of Origin USA 11.Sexual Orientation heterosexual 12.Religion none 13. Do you have a disability? No 14.Ethnicity Northern European via Chicago and South Carolina 15. Race Caucasian 16.Gender identity cisgender woman *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* / tq(i�ira ilJMru/.hw 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 -10 �� 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 4/15/2018 First Name* Jackie Last Name* Reger Home Address* 1215 Santa Fe dr City IOWA CITY State IA Zip Code* 52246 1. Is your home address(listed above)within the corporate limits of Iowa City?* Yes Contact Phone Number* 319-400-3639 Email Address* jackiereger@msn.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?* 17 yrs 2months 3.Occupation:* nurse practitioner 4.Gender* *This question is nndatory in order for the Oty to comply with the State's gender balance regluerrent,which treats gender as binary."Gender Identity"rmy be provided in the ainographics secticnof the application belay. r Male p Female 5. Experience and/or activities which you feel qualify you for this position:* I am an adult nurse practitioner at the Veteran's Affairs health center. I work in primary care and have developed a transgender health clinic for veterans. I am a married lesbian. I have no special training or education in human rights other than my own reading. 6.What is your present knowledge of each advisory board you are interested in?* only the basic description provided. i do not anyone who is or has been on the committee Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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?* Nb 8. Do you currently serve on another Iowa City board or commission?* Nb 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 56 10.Country of Origin usa 11.Sexual Orientation lesbian 12.Religion unitarian universali 13.Do you have a disability? No 14.Ethnicity polish/german/french 15.Race caucasian 16.Gender identity female *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. Drop-down AdvisoryBoard/Commission Application Form mm gr.t 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 10/24/2017 First Name* David Last Name* Smith Home Address* 1315 Cedar St. 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* 319 530 7594 Email Address* oso61 ds a@gmaii.com Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission Select a Board or Commission you are interested in:* Housing and Community Development Commission(HCDC) 2.How long have you been a resident of Iowa City?* 10 yrs 3.Occupation:* Midamerican Energy 4.Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* White,gay adoptive parent of a black child in the ICCSD.Also foster parent of a trans daughter within the district. 6.What is your present knowledge of each advisory board you are interested in?* I keep informed of issues related to racial and gender based biases within the community. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 56 10.Country of Origin US 11.Sexual Orientation Gay 12.Religion Agnostic 13.Do you have a disability? No 14. Ethnicity White *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* z,,,,4 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. Drop-down 7011C • { , vi r y _ LU/ / / . U ' 1 P r _____ '__ Advisory Board/Commission/Committee CITY OF IOWA CITY Application Form UNESCO CITY OF LITERATURE 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. Q ` Advisory Board/Commission/Committee Name pQ Lies iye Date of Application Name /thilitled ,2/ id 561/44/A. %a Home Address ,2532 Ba d it i#a.a. !Dam Q �9- 5,2.1.11 Contact phone number 314 542_9 7-33 Email Address 9AeditiabkStai CDS Your home address must be within the corporate limits of Iowa City? How long have you lived in Iowa City? 1- f OP 5 o Q Occupation: s 146- fe /4 C A=, n Gender: Male ✓ Female n cn r- 3=''' — rim r7 cc" Experiences and/or activities which you feel qualify you for this position: Rolla ppie44 pPar in sage G A!edit. N What is your present knowledge of this advisory board? / girt laeil/' iii t ns/tet,") For non enn4s4 $,veS2- -- emnd /yCtLeA idem 12v id O►al w//% /eye,/ Au/ho+^1T r Cen p /)o 1/31;;24 /1e 7ob-ce G jou/ any Law-44S S 11-I,tOID0Si /`'1ciree./1- teva hdp CA etrain /✓1eS/�l ant afiviZei Td tCe/L4jC tela ane /401 wave 0 &at ale 1/4d1 5Sue3 . 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 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. Section 362.5 City Council Resolution #15-300 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. #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 Commissitis at the'same time. You will be asked to resign from one if appointed to another. ={y Do you currently have a conflict of interest?YES NO cry List potential potential conflicts of interest(See last page for information regarding conflicfocintiest) Please indicate if there are none. '- BUSINESS NAME BUSINESS ADDRESS Do you currently serve on another Iowa City board or commission?YES NO If so which one do you prefer? 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: Age_ 52 Country of Origin SU Dani Sexual Orientation e Religion /�,(�,S G j/►? Do you have a disability?YES_NO t— Race, Color or Ethnic Group f}f iorzn 471444[an *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* 4141— 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 to contact individual Council Members to express your interest in " serving. Contact information is attached. d G �-C? O n—C W �o r— n r '..J ry 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 5/4/2018 First Name* Angel Last Name* Taylor Home Address* 2247 Plaen view drive City IOWA CITY State IA Zip Code* 52247 1.Is your home address(listed above)within the corporate limits of Iowa City?* Yes Contact Phone Number* 3195941403 Email Address* angeltaylor99@hotmail.com Boards & Commissions Select a Board or Commission you are interested in:* Human Rights Commission Select a Board or Commission you are interested in:* Housing and Community Development Commission(HCDC) Select a Board or Commission you are interested in:* CMI Service Commission 2. How long have you been a resident of Iowa City?* 40 years 3.Occupation:* Realtor 4.Gender* "This question is mandatory in order for the City to conply with the State's gender balance requirement,which treats gender as binary."Gender Identity"rrey be provided in the Demographics sectionof the application below. r Male F7 Female 5.Experience and/or activities which you feel qualify you for this position:* Advocacy, served on housing commission board 6.What is your present knowledge of each advisory board you are interested in?* I'm pretty familiar with both human rights&the housing commission board Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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?* Nb 8. Do you currently serve on another Iowa City board or commission?* Nb 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 10.Country of Origin 11.Sexual Orientation 12. Religion 13. Do you have a disability? Yes Please explain: ADHD&OCD 14. Ethnicity African American 15. Race Black 16.Gender identity Female *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. Drop-down r 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 10/25/2017 First Name* Susanne Last Name* Watson Epting Home Address* 86 Broadmoor Lane 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* 563-554-0209 Email Address* skwatsonepting@aol.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?* 25 yrs.total,but gone 15, back now 1 3.Occupation:* retired clergy 4.Gender:* Female 5. Experience and/or activities which you feel qualify you for this position:* As someone wtio served in human services here for many years, I have experience with people with disabilities of all kinds. I worked at the Free Medical Clinic for years as the HIV coordinator and know about the hurdles in early years. I lobbied for a sane AIDS policy and one of the first hate crimes laws in the nation. I was awarded the Isabel Turner Award from the Commission in 1996. I am currently involved in an effort to establish a racial justice center at Old Brick. I worked with the UN Commission on the Status of Women while living in New York. I am aware of my privilege as a white woman and of some of the stereotyping that comes with being an'old" woman. I have always been passionate about human rights and have spent my life working in that area in a variety of ways. 6.What is your present knowledge of each advisory board you are interested in?* I am aware of the work of the Human Rights Commission and was around in the early years of its establishment. I am proud that Iowa City maintains this tradition and has expanded this important work over the years. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 68 10.Country of Origin USA 11.Sexual Orientation straight 12.Religion Episcopalian 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 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* d Skiva.mr f%t✓eer i r� 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. Drop-down Advisory Board/Commission Application Form �S 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 11/9/2017 First Name* Lauren Last Name* White Home Address* 1901 BROADWAY STREET,APT 6 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* 312-768-0805 Email Address* Inwhite9@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 years 3.Occupation:* Program Manager 4. Gender:* Female 5.Experience and/or activities which you feel qualify you for this position:* Anti-Defamation League(ADL)- Peer Trainer 6.What is your present knowledge of each advisory board you are interested in?* Program planning among other responsibilities of members providing the public information on the how to eliminate racial,religious,cultural issues in relation to sex,color,creed,disability,gender/identity, sexual orientation, marital status,age and national origin. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 35 10.Country of Origin US 11.Sexual Orientation 12. Religion 13. Do you have a disability? No 14. Ethnicity Non Hispanic *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* ceezeet se Jt."fere ° 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. Drop-down Advisory Board/Commission Application Form iipm4' ort,, 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 Or LITERATURE NOTE:Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 10/29/2017 First Name* Solomon Last Name* Worlds Home Address* 1015 Oakcrest St.Apt i4 City IOWA CITY State IA Zip Code* 52246 1. Is your home address (listed above)within the corporate limits of Iowa City?* Yes Contact Phone Number* 7608807407 Email Address* solomonfuriousworlds@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?* 4+years 3.Occupation:* Hospital Administration 4.Gender:* Male 5. Experience and/or activities which you feel qualify you for this position:* Mental Health First Ald certification UI President's Black Student Advisory Committee LGBTQ Safe Zone Facilitator Volunteer with the Public Defender's office on immigration matters Taskforce to Support Immigrant Students and their Families through ICCSD Equity and Engagement Intern through ICCSD City Council Intern in Iowa City Managed a local campaign for a candidate focused on housing,economic, and mental health policy 6.What is your present knowledge of each advisory board you are interested in?* The Human Rights Commission regularly sends recommendations to the City Council on matters pertaining to human rights. Past proposals have focused at proclamations and policies supporting various communities within Iowa City.The Rapid Response Team, however, is the topic that continually peaks my interest. During my time as an intern with the Iowa City Community School District's Equity and Engagement department, I was heavily involved in a taskforce created to support immigrant students and their families. I see a rapid response team as a necessary component to prepare and an excellent backup plan in the event of a raid/seizure,mass or otherwise. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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?* Nb 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 22 10.Country of Origin United States 11.Sexual Orientation Heterosexual 12. Religion Christian 13. Do you have a disability? No 14. Ethnicity Black `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. Drop-down 05-15-18 1Oh NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION: PLANNING AND ZONING COMMISSION Two Vacancies— Five-Year Terms July 1, 2018—June 30, 2023 • The duties of the Planning and Zoning Commission members include making (or causing to be made) surveys, studies, maps, plans, or charts of the whole or any portion of the municipality and any land outside which--in the opinion of the Commission--bears relation to a comprehensive plan; also include recommending to the City Council from time-to-time amendments, supplements, changes, and modifications to the Zoning Ordinance. • This Commission conducts formal meetings the first and third Thursdays of each month at 7:00 p.m. (Informal workshops are held the preceding Mondays at 5:30 p.m. on a as needed basis.) 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., Tuesday, May 8, 2018. An application can be completed and submitted on the City of Iowa City website at www.icgov.orq. or by contacting the Clerk's office. Questions about the Iowa City Planning and Zoning Commission should be directed to Robert Miklo, Sr Urban Planner at 356-5240. Planning & Zoning Commission - Current members n years as Country of Sexual Gender Name Term ending resident of IC Occupation Gender Age* Orgin* Orientation* Religion* Disability* Ethnicity* Identity* Race* Unique Identifiers* Medical Examiner Michael Hensch 6/30/2020-1st Term 25 Administrator M _ _ _ Max Parsons 6/30/2020-1st Term 3 —Treasurer M Mark Signs 6/30/2021-1st Term 19 Realtor M Retired Carolyn Stewart Dryer 6/30/2021-2nd Term 38 Professor F Phoebe Martin 6/30//2022-2nd Term 13 Realtor F 44 USA Vacant 6/30/2023 Vacant 6/30/2023 Please note:The information provided Is the information provided on the application at the time of submission. *Information is voluntary I I I I I PLANNING &ZONING COMMISSION ATTENDANCE RECORD 2017 - 2018 8/3 8/17 9/7 9/21 10/5 10/19 11/2 12/7 12/21 1/4 1/18 2/15 3/1 DYER, CAROLYN X X X X X X O/E X X X X X X FREERKS, ANN X O/E X X X X X O/E X X O/E X X HENSCH, MIKE X X X X X X X X X X X X X MARTIN, PHOEBE X X X X X X X X O/E O/E X X X PARSONS, MAX X X O/E X X X X X X X X O/E X SIGNS, MARK X X X X X X X X X X X X X THEOBALD, JODIE 0/EX X X X X X X X O/E X O/E X KEY: X = Present O = Absent O/E = Absent/Excused --- = Not a Member Board/Commission Application Cover Board/Commission: Planning and Zoning Commission Two Vacancies to fill a five-year term 7/1/2018-6/30/2023 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: 4/2/2018 Application Deadline: 5/8/2018 Council Appointment Date: 5/15/2018 Date of Non-Gender Appointment: 7/3/2018 After date above Council may appoint without regard to gender Gender Balance Requirement: 1-Female, 1-None Current Gender Balance: Female:2 Male: 3 Gender i Name and Address Male Baker, Larry 1217 Rochester Ave Male — — — — Boothroy, Doug — 1507 Buresh Ave Female Townsend, Billie 713 Whiting Ave 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 2/22/2018 First Name* Larry Last Name* Baker Home Address* 1217 Rochester Avenue 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* 3193382838 Email Address* icwriter@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Planning and Zoning Commission (P&Z) 2. How long have you been a resident of Iowa City?* 35 years 3.Occupation:* writer 4.Gender* `TFTs question is mandatory ii order for the Oty to comply with the State's gender balance regiirerrenf,which treats gender as bialy."Gender entity"rray be provided in the Derrographics sectionof the application below. 17 Male r Female 5. Experience and/or activities which you feel qualify you for this position:* Long-time resident with continuous interest in City development issues. Served partial term on P&Z 81-83, partial term on Board of Adjustment 92-93,full term on Board of Adjustment 2011-2016.City Council-member, 83-87,93-97. 6.What is your present knowledge of each advisory board you are interested in?* Prior experience on other boards and commissions as well as Council. I follow development issues as reported in local media. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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?* Nb 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 10.Country of Origin US 11.Sexual Orientation 12. Religion 13.Do you have a disability? Yes Please explain: Sometimes wear a hearing aid. 14.Ethnicity 15. Race 16.Gender identity *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* t9ealet 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. Drop-down _ AdvisoryBoard/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 4/11/2018 First Name* Douglas Last Name* Boothroy Home Address* 1507 Buresh Ave 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* 319-430-8637 Email Address* dwboothroy@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Planning and Zoning Commission (P&Z) 2. How long have you been a resident of Iowa City?* 50 years 3. Occupation:* Retired 4.Gender* 'Itis question is mandatory in order for the City to con*with the States gender balance requirement,which treats gender as binary."ender Identity'may be provided in the Demographics sectionof the application bdow. F7 Male r Female 5.Experience and/or activities which you feel qualify you for this position:* Education: MA in Urban&Regional Planning.City of Iowa City work experience: Director of Neighborhood Development Services(2014-17); Director of Housing Inspection Services(1984-2014); Senior Planner(1980- 84);Assistant Planner(1975-80). Professional organizations: President, Iowa Chapter of American Planning Assn. (1990-92); Board member Iowa APA(1990-94). Forty-two years of leadership and commitment to Iowa City community in housing and development services(including affordable housing,neighborhood stabilization, code enforcement,economic development,and environmental sustainability). 6.What is your present knowledge of each advisory board you are interested in?* Forty-two years experience working with Iowa City P&Z Commission, Iowa City Board of Adjustment and the Iowa City Housing Commission.Authored the first bylaws of the Iowa City P&Z Commission and the Iowa City Board of Adjustment. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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 71 10. Country of Origin United States 11.Sexual Orientation Heterosexual 12.Religion Protestant 13.Do you have a disability? No 14.Ethnicity Caucasian 15.Race Caucasian 16.Gender identity Male *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. Drop-down AdvisoryBoard/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 4/17/2018 First Name* Billie Last Name* Townsend Home Address* 713 Whiting Avenue 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* 3 Email Address* cheespeedy@msn.com Boards & Commissions Select a Board or Commission you are interested in:* Planning and Zoning Commission (P&Z) 2.How long have you been a resident of Iowa City?* 29 years 3.Occupation:* retired from University of Iowa 4.Gender* "This question is rrendatory in order for the Oty to comply with the State's gender balance requirement,which treats gender as binary."Gender kientity"may be provided in the[krrographics sectional the application below. r Male A Female 5. Experience and/or activities which you feel qualify you for this position:* I have read the duties of the commission and am in the process of reading the Iowa Codes. I have also attended one of the meetings to make sure this commission is what I envisioned. I know that I have a lot to learn but I am sure I can get up to speed quickly. i have been a resident of the Iowa City Community for 29 years and have been amazed at the growth in and around the Corridor. I would like to become a part of the Commission that is involved with making recommendations on new businesses and developments i the Iowa City Area. I am aware that Iowa City appears to be in transition and a good part of that is planning and fore-site.As the community changes it is important that we think ahead and initiate planning that will accommodate the needs of the community. 6.What is your present knowledge of each advisory board you are interested in?* i have heard many good things about the Planning and Zoning Commission....that this is one of the Commissions that does the work and to get the job done. I would be honored to serve on this Commmission. Please contact the City Attorney at 356-5030 to discuss questions or concerns regarding a potential conflict of interest.The following describe 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 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 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-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?* Nb 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 United States 11. Sexual Orientation heterosexual 12. Religion Methodist 13. Do you have a disability? Nb 14. Ethnicity American 15. Race Black 16. Gender identity Female *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* eiY/F C-?�,q(/wd 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. Drop-down