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HomeMy WebLinkAbout2018-08-21 AppointmentItem Number: 19.a. I r , CITY OF IOWA CITY UNESCO CITY OF LITERATURE August 21, 2018 Community Police Review Board - One vacancy to fill an unexpired term, Upon appointment - June 30, 2021. (Royceann Porter resigned) ATTACHMENTS: Description Jacancy Notice/Coversheet Board Demographics/Attendance Eastham, Charles -Application Goldsmith, Zachary -Application Olmstead, Harry -Application Taha, Mohamed Ahmed EI Mandi -Application NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: COMMUNITY POLICE REVIEW BOARD One Vacancy: Unexpired Term Upon Appointment — June 30, 2021 Duties of the Community Police Review Board include: • Reviewing Police Department investigations into allegations of misconduct lodged against police officers; conducting further investigation of the complaint when the Board deems it necessary, and issuing a public report which explains why and the extent to which the complaint is sustained or not sustained; Maintaining a central registry of complaints against sworn police officers and issuing annual reports regarding the disposition of the complaints to the City Council; • Reviewing police policies and practices from time -to -time and recommending changes to the City Council when the Board deems it appropriate. Iowa City -appointed members of boards and commissions must be at least 18 years of age and live in Iowa City. The City Iowa City encourages diversity in the appointment of citizens to boards and commissions. Applications must be received by 5:00 p.m., Tuesday, August 14, 2018. An application can be completed and submitted on the City of Iowa City website at www.ic.gov.org or by contacting the City Clerk's office. Questions about the Iowa City Community Review Board should be directed to Chris Olney City Clerk's Office at 356-5043. Board/Commission Application Cover Board/Commission: Community Police Review Board (CPRE) One Vacancy to fill unexpired term Upon appointment - 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: 7/3/2018 Application Deadline: 8/14/2018 Council Appointment Date: 8/21/2018 Date of Non -Gender Appointment: 10/4/2018 After date above Council may appoint without regard to gender Gender Balance Requirement: 1 -Female Current Gender Balance: Female: 1 Male: 3 Gender Name and Address Male Eastham, Charles 953 Canton St Male Goldsmith, Zachary 721 Kimball Rd Male Olmstead, Harry 1259 Shannon Dr. Apt #102 Male Taha, Mohamed Ahmed EI Mandi 2532 Bartelt Rd #2C Community Police Review Board - Current members # years as Name Term ending resident of IC Occupation Gender Age* Countryof Sexual Orgin* Orientation* Gender Religion* Disability* Ethnicity* Identity* Race* Unique Identifiers* Donald.. King 6/30/2019 -1st term _ 15 Security officer M Monique Green 6/30/2020-lstterm 10 F 0 M, If 11 e Townsend _ 6/30/2020 -lstterm 53 M David Semler 6/30/2021-Sstterm 4 lawyer Vacant 6/30/2021 -Unexpired M 38 ---- USA Male ------ Unitarian No Caucasian No - — ---- No No Please note: The information provided is the information provided on the application at the time of submission. * Information is voluntary i 1" ------ - --- COMMUNITY POLICE REVIEW BOARD ATTENDANCE RECORD YEAR 2017-2018 (MeetingDate KEY: X = Present O = Absent O/E = Absent/Excused NM = No meeting --- = Not a Member TERM 8/29 9/12 10/10 11/14 12/7 1/9/18 2/13/18 3/19/18 4/17/18 4/23/18 5/8/18 6/12/18 7/23/18 NAME EXP. Mazahir 7/1/21 X X X X O/E --- --- ---- ---- ------ ----- ------- ------- Salih Donald 7/1/19 X X X X X O X X X X X X X King Monique 7/1/20 X X X X X X X X X X X X X Green Orville 7/1/20 X X X X X X X X X X X X X Townsend Royceann 7/1/21 ---- ---- ---- ---- ---- ---- X O/E X O/E X O/E— Porter David 7/1/21 X O X O/E X X X X X X X X X Selmer KEY: X = Present O = Absent O/E = Absent/Excused NM = No meeting --- = Not a Member r Advisory Board/Commission Application Form 7,,r� This application is a public document and as such can be reproduced and distributed for ,%NN- � 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 1!3!2018 First Name Charles Last Name Eastham Home Address* 953 Canton 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 319 541-3972 Email Address eastham@outlook.com Boards & Commissions Select a Board or Commission You are int erested in:* Community Police Review Board (CPRB) 2. How long have you been a resident of Iowa City? 45 years 3. Occupation: Retired 4. Gender:* Male 5. Experience and/or activities which you feel qualifyyou for this position:* I am currently actively participating in the following organizations and groups. My involvement with these groups requires analyzing racial and ethnic disparities in numerous outcomes and developing strategies for reducing those disparities. Iowa City Community School District Equity Advisory Committee Center for Worker Justice Board of Directors Black Voices Project Coalition for Racial Justice 6. What is your present knowledge of each advisory board you are interested in?* Currently, the Iowa City Community Police Review Board (CPRB) may review police policies, procedures, and practices, and recommend modifications to them as appropriate. The CPRB also provides a complaint process for claims of misconduct by individual police officers. At its April 18, 2017 Work Session the Council supported proposals by Police Chief Jody Matherly to aggressively address the Iowa City Police Department's disproportionate minority contact issues over the next five years by, among other measures, increasing the role of the CPRB in reviewing police policies. At the April 18, Work Session the Council also discussed a number of strategies proposed by Council Member Kingsley Botchway to address racial disparities in ICPD policing outcomes. Those strategies include restructuring the CPRB so that the Board: • Focuses on policies and procedures and whether these policies and procedures align with community expectations; • Focuses on use of force data and whether patterns align with community expectations; • Reviews key areas of disproportionality and reports improvement; • Requires independent investigation of any police misconduct as determined by the CPRB. If appointed, I am looking forward to working with other members of the CPRB, the police department and the Council to substantially reduce disproportionate minority contact by the ICPD and to conducting fair, thorough, and accurate investigations of misconduct complaints brought against individual officers. 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 nterest 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 Community Police Review Board 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 76 10. Country of Origin United States 11. Sexual Orientation Heterosexual 12. Religion None 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's 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 lr^„� 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 UTERATURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 8/10/2018 First Name Zachary Last Name Goldsmith Home Address* 721 Kimball Road 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* 319-383-6832 Email Address* zachgoldsmith95@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Community Police Review Board (CPRB) Select a Board or Commission you are interested in:* Senior Center Commission 2. How long have you been a resident of Iowa City?* 39 years 3. Occupation:* Teacher 4. Gender* *This question is rrandatory in order for the City to con* with the State's gender balance requirenent, which treats gender as binary. "Gender Identity" nay be provided in the DDrrographics sectionof the application below. 17 Male r Female 5. Experience and/or activities which you feel qualify you for this position: I feel that I bring a wealth of knowledge about Iowa City to the table. I've have spent my whole life here, and have many connections throughout the community. For the Police Commission I would bring a unique perspective, and would hope to make sure that there is justice being served for populations that feel underrepresented. In terms of wanting to be a part of the Senior Center Commission, I have always felt a great connection to the Senior and Elder population in my life. Time spent with them is time well spent, and if I can help to make their lives a little bit better then I would like to work to do that. 6. What is your present knowledge of each advisory board you are interested in? I know that the Police Commission was set up after the untimely death of Eric Shaw. I would believe that the Senior Center Commission helps with the running of the Senior Center after reading some of the past meeting notes. 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 sere. Council policy is not to permit an individual to sere 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 United Stated of America 11. Sexual Orientation Straight 12. Religion Jewish 13. Do you have a disability? No 14. Ethnicity Jewish 15. Race White 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. 'r a — Advisory Board/Commission Application Form lr�W� 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 8/14/2018 First Name Harry Last Name Olmstead Home Address * 1259 Shannon Drive, Apartment 102 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:* Community Police Review Board (CPRB) 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 2. How long have you been a resident of Iowa City?* 10 years 3. Occupation: * Retired Teacher 4. Gender* *This question is mandatory in order for the City to comply with the State's gender balance requirement, which treats gender as binary. °Gender klentity" Trey provided in the DErrographiccs sectmof the application below. R Male r Female 5. Experience and/or activities which you feel qualify you for this position:* I believe knowledge, experience, and experience develop leadership skills. Educationally I went to Layton School of Art Photograph major 1973 2 year certificate. University of Wisconsin -Milwaukee BS Education and Recreational Therapy 1975. University of Alabama at Birmingham Rehabilitation Counseling (3 credits shy of Masters. Teach for America 1991 - 1974 Special Education LD & BD. I also have served on the Iowa Human Rights Commission 6 years (2 years as chair), Iowa City Housing and Community Development Commission 3 years (1 year as chair), Johnson County Para -transit Board 5 years (2 years as vice -chair, Johnson County Liviable Community 4 years (3 years as chair of Transportation sun - committee, University of Center for Human for 6 years to present (4 years as vice -chair), State of Iowa Olmstead Consumer Task Force 5 years (11 year as vice -chair & 2 years co-chair of Medicaid Privatization sub- committee. 6. What is your present knowledge of each advisory board you are interested in?* Having serving on several Iowa City Commissions I have a working knowledge of how boards serve the citizens and City Council. I have given a presentation to the Iowa City Senior Center Col mission also I've attended 3 years of the annual report and public forum of the Iowa City Police Review 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 68 10. Country of Origin United States of America 11. Sexual Orientation Straight 12. Religion Quaker 13. Do you have a disability? Yes Please explain: I'm a person with a right above the knee and and use a power wheelchair for mobility. 14. Ethnicity United States of America 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) I Signature of Applicant* Qlat-y1 ter? 04&4ulre 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 CITY OF IOWA CITY UNESCO CITY OF LITERATURE Advisory Board/Commission/Committee Application Form C?P)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 considered for any vacancy during that time. Advisory Board/Commission/Committee Name Liee kd-v Date of Application Name Home Address 25 32, Ba kl& � w.* 4.?,� t,0" Contact phone number ,3d 542— 4733 Email Address A4d& - fes, Your home address must be within the corporate limits of Iowa City? How long have you lived in Iowa -;+ 9 Y 1!t%S Occupation: ,S'1/(�fJj rC11)Gender: Male Female _� M Experiences and/or activities which you feel qualify you for this position .. pD �Geyi�ad�l What is your present knowledge of this advisory board? /1 `7 d -/L' Mjkph AUAC%^ 51�I.t�rDHsl OA m edlIj aft a,/j V/ Z,-, s -T6 i U�%e C 4�1J` ��' a N &,u Vjje lee ej 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, 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 Commissi*©js 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 NO -�N... List potential conflicts of interest (See last page for information regarding conflict.gfnteftst) Please indicate if there are none. ca r"a Do you currently serve on another Iowa City board or commission? YES__ NO—Z 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 infonnation 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 1511 DI y, Sexual Orientation r1A e Religion Do you have a disability? YES NO t -- 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* 4d— 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. ! L Item Number: 19.b. I r , CITY OF IOWA CITY UNESCO CITY OF LITERATURE August 21, 2018 Library Board of Trustees - One vacancy to fill an unexpired term, Upon appointment - June 30, 2021. (Adam Ingersoll resigned) ATTACHMENTS: Description Jacancy Notice/Coversheet Board Demographics/Attendance Beaty, Wesley -Application Crawford, Kathleen -Application Ford, Justin -Application Hansen, Peter -Application Olmstead, Harry -Application NOTICE THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD: BOARD OF LIBRARY TRUSTEES One Vacancy: Unexpired Term Upon Appointment - June 30, 2021 • The Board of Library Trustees is a semi -autonomous body of nine persons empowered by State Law to plan, direct, and control all affairs of the Public Library. This includes having control of funds allocated or given to the library, determining long-range goals of Library service, adopting written policies to govern operation of the Library, and employing a competent staff to help plan and implement the Board's service goals. Iowa City appointed members of boards and commissions must be 18 years of age and live in Iowa City. The City of Iowa City encourages diversity in the appointment of citizens to boards and commissions. • The Library Board meets the fourth Thursday of each month at 5:00 p.m. Iowa City -appointed members of boards and commissions must be at least 18 years of age and live in Iowa City. The City Iowa City encourages diversity in the appointment of citizens to boards and commissions. Applications must be received by 5:00 p.m., Tuesday, August 14, 2018. An application can be completed and submitted on the City of Iowa City website at www.icgov.org or by contacting the City Clerk's office. Questions about the Iowa City Board of Library Trustees should be directed to Susan Craig, Library Director at 356-5200. Board/Commission Application Cover Board/Commission: Library, Board of Trustees One Vacancy to fill an Unexpired Term Upon appointment - 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: 7/3/2018 Application Deadline: 8/14/2018 Council Appointment Date: 8/21/2018 Date of Non -Gender Appointment: 10/4/2018 After date above Council may appoint without regard to gender Gender Balance Requirement: 1 -Male Current Gender Balance: Female: 6 Male: 2 Gender Name and Address Male Beary, Wesley 2041 Rochester Court Female Crawford, Kathleen 401 Hawkridge Dr. Male Ford, Justin 407 Magowan Ave Male Hansen, Peter 1 Oaknoll Court Apt 439 Male Olmstead, Harry 1259 Shannon Dr. Apt #102 Library Board of Trustees - Current members Name Term ending # years as resident of IC Occupation Gender Country of Age* Orgin* Sexual Orientation* Religion* Gender Disability* Ethnicity* Ra Diane Baker 6/30/2019 -1st Term 2 Retired F Jay Semel 6/30/2019 -1st Term 35 Retired UI Admin M Janet Freeman 6/30/2019 -1st Term Sl Retired Professor F Vacant 6/30/2021 Unexpired - John Beasley 6/30/2021 -1st Term 54 Attorney M Monique Washington 6/30/2021 -1st Term 24 Clerk III F Kellee Forkenbrock 6/30/2023 -1st Term 17 Education IF 38 USA Heterosexual Catholic Black Carol Kirsch 6/30/2023 -1st. Term 22.5 Retired Librarian F 65 USA Heterosexual Christian Caucasian Robin Paetzold (JC REP) 16/30/2023- F Tease note: The information provided Is the information provided on the application at the time of submission. * Information is voluntary �- Board or Commission: ICPL Board of Trustees ATTENDANCE RECORD 12 Month MeetingDate Name KEY: X = Present O = Absent O/E = Absent/Excused NM = No meeting ExpTermmiration 10/26/17 11/06/17 11/16/17 12/4/17 12/21/17 1/25/18 2/22/18 3/22/18 4/26/18 5/24/18 6/28/18 7/26/18 Diane Baker 6/30/19 X x X x x x o O/E X x x X John Beasley 6/30/21 x X O/E x O x x x x x x x Kellee Forkenbrock 6/30/23 X X O O/E x x x x X O/E x x Janet Freeman 6/30/19 X X X X X O/E X X X x O/E O/E Adam Ingersoll 6/30/21 O X X O/E O/E X O/E X x X x x Carol Kirsch 6/30/23 X X X X X O/E X X x X x O/E Robin Paetzold 6/30/23 X X X X X X X O/E x x x I x Jay Semel 6/30/19 X X X X X X X X X x X x Monique Washington 6/30/21 X O X X O X X X X Q O x KEY: X = Present O = Absent O/E = Absent/Excused NM = No meeting '._--r._4 Advisory Board/Commission Application Form %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 7/28/2018 First Name Wesley Last Name Beary Home Address 2041 Rochester Ct City IOWA CITY State IA Zip Code 52245 1. Is your home address (listed above) within the corporate limits of Iowa City? * Yes Contact Phone Number* 5157791304 Email Address geemus@gmail.com Boards & Commissions ou are interested in:* Library, Board of Trustees 2. How long have you been a resident of Iowa City?* 7 years 3. Occupation:* Software Architect 4. Gender* 'This queston is rrendatory in order for the City to co~r}afy with the State's gender balance requirerrent, w hich treats gender as bnary. "Cx�der k�entity" rey be provided in the [a4Tographics sectionof the applicator below FT Male I� Female 5. Experience and/or activities which you feel qualify you for this position:* I am in my 4th year of service on the Iowa City Friends Foundation board and just finished a term as president. As a lifelong learner and community organizer, libraries have long been close to my heart. My experiences working with the Friends to support the mission of the library, community organizing, and professional leadership experience all prepare me to fulfill this position effectively and enthusiastically. 6. What is your present knowledge of each advisory board you are interested in? * As a current member and former president of the Iowa City Public Library Friends Foundation, I already receive regular updates on many of the decisions and discussions from the trustees. Through my time I have also met and worked with a number of the existing trustees at one time or another. 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 lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a 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 Heterosexual 12. Religion Agnostic 13. Do you have a disability? Ido 14. Ethnicity European American 15. Race European American 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* .vl.Ex�• �3�J 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 NrI 4 Advisory Board/Commission Application Form x`01 �� 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 CIN 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 r Commission you are interested in: ibrary, 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* "'This question is mandatory in order for the oty to corrply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray be provided in the DD=graphics sectionof the application below. F Male F7 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* 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. 1�^: 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 UTERATURE NOTE: Must be 18 years of age and live within city limits of Iowa City to apply Date of Application 8/13/2018 First Name Justin Last Name* Ford Home Address* 407 magowan ave 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* 7739831486 Email Address justincford@gmail.com Boards & Commissions Select a Board or Commission you are interested in:* Library, Board of Trustees 2. How long have you been a resident of Iowa City? 3 years 3. Occupation: * Environmental Specialist 4. Gender* This question is rrandatory in order for the City to conply with the State's gender balance requiren ent, which treats gender as binary. 'C,encler klentity" rray be provided in the Darographics sectionof the application below. 17 Male I— Female 5. Experience and/or activities which you feel qualify you for this position:* I have overseen large projects and budgets for both government and private groups, but more importantly my family have been avid library users for years. Many years ago it was the Iowa City Library that was a principle reason we decided to choose Iowa city for my wife's internship. My children have used the library from birth, many of those years have included the ICPL. I have experienced many other library systems around the country and I have deep love for what libraries bring to our cities. 6. What is your present knowledge of each advisory board you are interested in?* I am aware that the current boards responsibilities are to support the library staff, by providing leadership in regards to goals, policies, and staffing as well as performing oversight of the use of monies, to ensure that the community is well served by the library. The board also has a role as a liaison to represent the library within the larger city government and 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 39 10. Country of Origin Unites Sates 11. Sexual Orientation Straight 12. Religion A/theist 13. Do you have a disability? No 14. Ethnicity NA 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* ffiAW 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^I k _4 Advisory Board/Commission Application Form � � This application is a public document and as such can be reproduced and distributed for the public. This application Wil 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 8!6!2018 First Name Peter Last Name Hansen Home Address* 1 Oaknoll Ct Apt 439 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* 319-466-3119 Email Address* pjhansen717@gmaii.com Boards & Commissions Select a Board or Commission you are interested in:* Library, Board of Trustees 2. How long have you been a resident of Iowa City? Since 1999 3. Occupation: * retired chemistry professor 4. Gender* "This question is nsndatory in order for the City to cm* with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" may be provided in the Derrographics sectionof the ap I cation belay. W Male r- Female S. Experience and/or activities which you feel qualify you for this position:' I currently serve on the boards of the Iowa City Foreign Relations Council and Friends of Nigeria (a Peace Corps alumni group) and from 1991 to 1996 1 served on Northwest Regional Library Board (Iowa). In addition, I have served as the treasurer of both Friends of Nigeria (for 20 years) and the Johnson County Democrats (for five years). 6. What is your present knowledge of each advisory board you are interested in? * As published on the State Library of Iowa website, a library board's five primary roles are: to advocate for the library; to plan for the future of the library; to monitor and evaluate the library's effectiveness; to establish library policies; and to hire and evaluate the library director. 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 lowagenerally prohibits, with certain important exceptions, a member of a City Board or Commission from having an interest in a City contract. City Council Resolution # 15-300 established a 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 79 10. Country of Origin USA 11. Sexual Orientation heterosexual 12. Religion Christian 13. Do you have a disability? No 14. Ethnicity Euro -American 15. Race Mite 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's 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 l�I -4 Advisory Board/Commission Application Form r�aIt� 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 8/14/2018 First Name Harry Last Name Olmstead Home Address* 1259 Shannon Drive, Apartment 102 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:* Community Police Review Board (CPRB) 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 2. How long have you been a resident of Iowa City?* 10 years 3. Occupation: * Retired Teacher 4. Gender* 'This question is rrandatory in order for the City to corrply w ith the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rrey be provided in the Derrographics sectioiof the application below. F7 Male r Female 5. Experience and/or activities which you feel qualify you for this position:* I believe knowledge, experience, and experience develop leadership skills. Educationally I went to Layton School of Art Photograph major 1973 2 year certificate. University of Wisconsin -Milwaukee BS Education and Recreational Therapy 1975. University of Alabama at Birmingham Rehabilitation Counseling (3 credits shy of Masters. Teach for America 1991 - 1974 Special Education LD & BD. I also have served on the Iowa Human Rights Commission 6 years (2 years as chair), Iowa City Housing and Community Development Commission 3 years (1 year as chair), Johnson County Para -transit Board 5 years (2 years as vice -chair, Johnson County Liviable Community 4 years (3 years as chair of Transportation sun - committee, University of Center for Human for 6 years to present (4 years as vice -chair), State of Iowa Olmstead Consumer Task Force 5 years (1 year as vice -chair & 2 years co-chair of Medicaid Privatization sub- committee. 6. What is your present knowledge of each advisory board you are interested in?* Having serving on several Iowa City Commissions I have a working knowledge of how boards serve the citizens and City Council. I have given a presentation to the Iowa City Senior Center Co! mission also I've attended 3 years of the annual report and public forum of the Iowa City Police Review 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 68 10. Country of Origin United States of America 11. Sexual Orientation Straight 12. Religion Quaker 13. Do you have a disability? Yes Please explain: I'm a person with a right above the knee and and use a pourer wheelchair for mobility. 14. Ethnicity United States of America 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* 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