HomeMy WebLinkAbout2018-11-20 AppointmentItem Number: 20.a.
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CITY Ok 10WA CITY
www.icgov.org
November 20, 2018
Board of Adjustment - One vacancy to fill a five-year term, January 1, 2019 -
December 31, 2023. (Term expired for T. Gene Chrischilles)
ATTACHMENTS:
Description
vacancy Notice & Coversheet
Board Demographic & Attendance
Hahn, Mike -Application
Pretorius, Amy - Application
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING BOARD:
BOARD OF ADJUSTMENT
One Vacancy — Five — year term
January 1, 2019 — December 31, 2023
The Board of Adjustment is a citizen panel that:
• reviews requests for special exceptions and variances.
• The Board also considers appeals when there is a disagreement about an administrative
decision made by the City.
• Members of the board act like judges, making decisions about individual properties and
uses that may have difficulty meeting a specific zoning regulation or to resolve disputes
about administrative zoning decisions.
• The Board is assisted in its work by planning staff and the City Attorney's office. Decisions
made by the Board of Adjustment are binding upon all parties unless overturned upon
appeal to District Court.
• The Board meets the second Wednesday of each month at 5:15 p.m.
Iowa City -appointed members of boards and commissions must be 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, November 13, 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 Adjustment Commission should be directed to Sarah Walz,
Associate Planner at 356-5239.
Board/Commission Application Cover
Board/Commission: Adjustment, Board of
One vacancy to fill a five-year term
1/1/2019 —12/31/2023
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: 10/02/2018
Application Deadline: 11/13/2018
Council Appointment Date: 11/20/2018
Date of Non -Gender Appointment: 01/02/2019
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 Hahn, Mike
52 Brentwood Lane
Female Pretorius, Amy
670 Walker Circle
Adjustment, Board of
Name Term ending
#years as
resident of IC Occupation
Country of Sexual
Gender Age* Orgin* Orientation*
Gender
Religion* Disability* Ethnicity* Identity* Race* Uni ue Identifiers*
ConstanceGoeb 12/31/2019 -2nd Term
5.5 Retired HR
F
Tim Weitzel 12/31/2020 -1st Term
30
M
Bryce Parker 12131/2021 -1st Term
11
M
Ryan Hall 12/31/2022 -1st Term
1 Student
M 24 Pansexual
Caucasian
Vacant 12/31/2023
Please note: The information provided is the information provided on the application
at the time of submission. '.. '..
* Information is voluntary
BOARD OF ADJUSTMENT
ATTENDANCE RECORD
2017-2018
NAME
TERM EXP.
4/12
5/10
6/14
7/12
10/11
12/11
2/14
5/09
6/13
CHRISCHILLES, T. GENE
1/1/2019
X
X
X
X
X
X
X
X
X
GOEB, CONNIE
1/1/2020
X
X
X
O/E
X
X
O/E
X
X
HALL, RYAN
1/1/2023
--
--
--
--
--
--
X
X
X
PARKER, BRYCE
1/1/2022
O/E
X
X
O/E
X
X
X
X
X
SOGLIN, BECKY
1/1/2018
X
X
X
X
X
X
--
-
-
WEITZEL, TIM
1/1/2021
X
X
X
X
X
X
X
X
X
KEY: X = Present
O = Absent
O/E = Absent/Excused
--- = Not a Member
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
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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
11/5/2018
First Name
mike
Last Name
hahn
Home Address*
52, brentwood 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*
3196310847
Email Address*
mhahn@mccomaslacina.com
Boards & Commissions
Select a Board or Commission you are interested in:
Adjustment, Board of
2. How long have you been a resident of Iowa City?*
50years +
3. Occupation: *
construction firm owner
4. Gender*
'This question is mandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r1 Male
r Female
5. Experience and/or activities which you feel qualify you for this position:*
have been involved in the construction of both commercial and residential properties for over 40 years with my
main focus on pricing and valuation of projects for clients helping in securing financing i have a first hand
working knowledge of cost of construction and value of land cost in the Iowa city area
6. What is your present knowledge of each advisory board you are interested in?*
helping to mediated a fair property value if there is a disagreement between the property owner and the city
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 familyties, during their tenure or for one year thereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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
male
12. Religion
catholic
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
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
11/12/2018
First Name
Amy
Last Name
Pretorius
Home Address*
670 Walker Circle
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*
3196218554
Email Address*
amy@amypretorius.com
Boards & Commissions
Select a Board or Commission you are interested in:
Adjustment, Board of
2. How long have you been a resident of Iowa City?*
11 years
3. Occupation:
Home Builder
4. Gender*
'This question is mandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r Male
17 Female
5. Experience and/or activities which you feel qualify you for this position:*
I consider myself an Iowa City native, though I was technically born in Davenport and graduated from West
Branch High School. I attended the University of Iowa and graduated from the Nursing program. I worked at
Mercy Hospital in Iowa City for nearly 6 years before I shifted gears and began working for the Peninsula
Development Company in Iowa City in 2010. 1 was the Assistant Project Manager for the company that
developed and built out the majority of the Peninsula Neighborhood in Iowa City. This unique subdivision was
practically a city within a city and boasted walkability, Live/Work units, affordable housing (just over 10% when
sold) and classic new urbanism design. This subdivision, though beautiful and unique, was fraught with issues
and complications. I spent countless hours working with Engineers, Contractors and City Staff attempting to
complete this community as it was envisioned, while keeping it affordable and sellable, not an easy task. While
at the Peninsula I, at times, had to go before the Board of Adjustments, Planning and Zoning and the City
Council. I think knowing what it feels like and what it is to be on the other side of the table will make me a more
understanding and informed member. I have also learned that these Boards and Committees exist to manage
all of the unknowns and changes in our City. Often things are put into place and at the time they were it made
sense. Over time as technology changes and perspectives change our City has to be prepared to change with
it. At the same time members need to understand when something does not make sense and be able to say
"no". As I have learned from past experience, you do not join these boards and committees to win a popularity
contest. You are there to do what is in the best interest of the City as a whole. I know this is something I can
do.
As the Peninsula reached its completion I knew I wanted to continue to build homes as it was truly my passion.
started a company with Nathan Knause in April of 2017, Elevation Home Builders. We operate on a much
smaller scale and provide new construction, remodel and repair services. I love what I do and I think it is
reflected in my work. I enjoy being active in the community and would like to become more active at the City
level. Below are certifications I have and groups/committees I have been active in:
• Current Registered Nurse in the State of Iowa
• Certified Graduate Builder designation by the National Association of Home Builders
• 10 Hour OSHA Certification
• President and Director of the Peninsula HOA Board (2012-2015)
• Peninsula Neighborhood Architectural Review Board (PNARB) member — this was a three person committee
made up of City Senior Planner Bob Miklo, Architect Robert Lipka and myself (2010-2018)
• Parks Improvement Committee for the Peninsula (2015-2017)
• HBA Legislative Committee Member (2014 -current)
• HBA Women's Council and Membership Committee (2014 -Current)
• 2nd Way Out Committee — provide secondary access if Foster Rd. is to ever flood
I thank you in advance for your consideration.
6. What is your present knowledge of each advisory board you are interested in?*
The Board of Adjustments is a panel of Iowa City residents appointed by the City Counsel that are put in place
to sometimes allow certain items to pass through the City that may not normally be allowed based on code or
historical acts. At the same time this panel is meant to allow items when it makes sense and is in the best
interest of Iowa City, as a whole, and to also not allow items that are not in keeping with the City's vision. This
panel is instrumental in shaping the future of Iowa City and necessary to help forward motion that is often
limited by out of date and irrelevant rules formally put in place. The City is an evergrow ing and changing entity
and the Board of Adjustments may, at times, be on the forefront of this change.
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 familyties, during their tenure orfor one yearthereafter.
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
37
10. Country of Origin
United States
11. Sexual Orientation
Heterosexual
12. Religion
n/a
13. Do you have a disability?
No
14. Ethnicity
Caucasian
15. Race
Non -hispanic 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*
7fk, }, A6Ai"
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
Item Number: 20.b.
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CITY Ok IOWA CITY
www.icgov.org
November 20, 2018
Human Rights Commission - Three vacancies to fill a three-year term,
January 1, 2019 - December 31, 2021. (Terms expired for Adil Adams, Joe
Coulter, Eliza Willis)
ATTACHMENTS:
Description
,vacancy Notice & Coversheet
Board Demographic & Attendance
Adams, Adil -Application
Bartlett, Rick -Application
Beiler, Deborah -Application
Boscaljon, Daniel -Application
Brockett, Travis -Application
Brown, Emmalyn -Application
Bruss, Jessica -Application
Carroll, Victoria -Application
Clemmensen, Rex -Application
Coffey, Thomson -Application
Crawford, Kathleen -Application
Crotty, Anne -Application
Drabek, Matt -Application
Donahue, Penny -Application
Dresser, Kasey -Application
Ferdig, Jessica -Application
Ford, Noemi -Application
Garske, Caroline -Application
Glass, Jason -Application
Harper, Henri -Application
Higley, Michelle -Application
Hong, Sung Chul -Application
Janakiraman, Venkatesh -Application
Lichte, Kayelyn -Application
Noureldin, Wail -Application
Oladele-Ajose, Adedayo -Application
Olmstead, Harry -Application
Park, Jiyun -Application
Persson, Dorothy -Application
Quigley, Meg -Application
Rands, Emily -Application
Rasmussen, Mary Ann -Application
Reger, Jackie -Application
Rochester, Zachary -Application
Smith, David -Application
Taha, Mohamed Ahmed Elmandi -Application
Taylor, Angel -Application
Watson Epting, Susanne -Application
White, Lauren -Application
Worlds, Solomon -Application
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
HUMAN RIGHTS COMMISSION
Three Vacancies: Three -Year Terms
January 1, 2019 — December 31, 2021
• 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.
• 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.
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, November 13, 2018. An application can be
completed and submitted on the City of Iowa City website at www.icgov.orq or by contacting the City
Clerk's office.
Questions about the Iowa City Human Rights Commission should be directed to Stefanie Bowers, Human
Rights Coordinator at 356-5022 or Stefanie-Bowersa-iowa-city.orq
Board/Commission Application Cover
Board/Commission: Human Rights Commission
Three Vacancies to fill a Three- Year Term
1/1/2019 -12/31/2021
It is hereby established, as a formal policy of the City Council of Iowa City, that each application for reappointment to
a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be
limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve.
Council Announcement Date: 10/02/2018
Application Deadline: 11/13/2018
Council Appointment Date: 11/20/2018
Date of Non -Gender Appointment: 01/02/2019
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
Male
Adams, Adil
252 Bartelt Rd #1C
Male
Bartlett, Rick
228 Raven Street
Female
Beiler, Deborah
2178 Willenbrock Cir
Male
Boscaljon, Daniel
1210 Yewell St
Male
Brockett, Travis
2203 Plaen View Dr
Female
Brown, Emmalyn
427 N Dubuque St. Apt 7
Female
Bruss, Jessica
2201 California Ave
Female
Carroll, Victoria
116 Pentire Circle
Male
Clemmensen, Rex
1108 Spruce St
Male
Coffey, Thomson
1247 Lakeshore Dr
Female
Crawford, Kathleen
401 Hawkridge Dr.
Female
Crotty, Anne
109 Cayman St.
Female
Donahue, Penny
1017 Rider St
Male
Drabek, Matt
815 N Johnson St
Female
Dresser, Kasey
711 E Jefferson
Female
Ferdig, Jessica
18 Dunuggan Ct
Female
Ford, Noemi
407 Macgowan Ave
Female
Garske, Caroline
225 S Gilbert St Apt 2731
Male
Glass, Jason
1730 Windsor Court
Male
Harper, Henri
3051 Wayne Avenue #42
Female
Higley, Michelle
1328 Lower Muscatine Rd
Male
Hong, Sung Chul
1047 Westside Dr
Male
Janakiraman, Venkatesh
3101 Friendship St
Female
Lichte, Kayelyn
1727 Glendale Rd
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
Quigley, Meg
3202 Friendship St
Female
Rands, Emily
615 N Linn St.
Female
Rasmussen, Mary Ann
1346 E. Bloomington
Female
Reger, Jackie
1215 Santa Fe Dr.
Male
Rochester, Zachary
2446 Bittersweet Ct
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
Human Rights Commission - Current members
Name
Term ending
# years as
resident of IC
I Occupation
Gender
Age*
Country of
Orgin*
Sexual
Orientation*
Religion*
Disability*
I Ethnicity*
Gender
identity'
Race*
Unique Identifiers*
Jeff Falk
12/31/2019 -1st Ter
1.75
Retired
Statistician
M
72
USA
Heterosexual
Jewish
Barbara Kutzko
12/31/2019-
Unexpired + 1st
Term
------
31
----
F
----
67
USA
Heterosexual
African
American
Tahuanty Pena
12/31/2019-1st Ter-
_--_ ---_ ------
2
Physician
M....
38
Dominican
Republic
----
Heterosexual
Hispanic
Cathy McGinnis
12/31/2020-1st Ter,
23
Probation
Officer
F
42
USA
Heterosexual
Catholic
Caucasian
----.
Jonathon Munoz
-----------------
12/31/2020 -1st Teri
-_-
3
Attorney
M
27
USA
Heterosexual
Catholic
Hispanic/
Latino
Bijou Maliabo
12/31/2020-Unexpii
20
ACT
F
36
DR of Congo_
Heterosexual
----.
Christian
--------._.
Non-
Hispanic
Female
Black
----.
Vacant
12/31/2021
----
Vacant
12/3112021
Vacant
12/31/2021
.Please note: The information provided is the information provided on the application at the time of submission.
----�:--------
---- ----
* Information is voluntaryI
---- ----
Member Attendance Sheet
Member
Term
Ex .
119
1/23
2128
3/20
3/29
4/17
5/15
6/19
7/17
8121
9/18 10!18
Maliabo
1/2021
—
—
Present
I Present
Present
Present
McGinnis
1/2021
Present
Present
Present
Present
Present
Present
Present
Present
Present
Present
Presets
Mt1flOZ
Kutzko
112021
112020
Present
Excused
Present
Present
Present
Present
Present
Present
Excused
Present
Present
Excused
Excused
Falk
1/2020
Present
Present
Excused
Presets
Present
Present
Present
Present
Excused
Present
Present
Present
—Present
Present
Pe
1/2020
Preserrt
Present
Present
Excused
Present
Present
Present Present
Present • Excused
Present
Present
Present
Present
Present
Coulter
1/2019
Present
Present
Present
Presets
Present
Present
Present
Present
Excused
Present
Present
Present
Present
Adams
1/2019
Present
Present
Present
Present
Present
Present
Present
Present
Present
Excused
Preserrt
Willis
112019
Present
Present
Present
Excused
Prwcs.ro
Pry i
o, -.e..,
I —, i raoacui I rresenr
r
4710 -
Advisory Board/Commission/Committee Application
I �1` This application is a public document and as such can be reproduced and distributed for
CITY OF IOWA CITY the public. This application will be considered for twelve months only and automatically
UNESCO CITY OF LITERATURE considered for any vacancy during that time.
NOTE: Must be 18 years of Age and live within city limits of Iowa City to apply
Date of Application 3
Which Board or Commission are you interested in t`► '"� a >1 ►i°e 7 '�
APPHeant Information:
First Name A- ID L— Last Name VVA
Home Address 2 5
City '� 'O �� CAh 2 State Zip Code '5 'L2-L4
Contact phone number �j\ 5 q '0 Z Email Address el eJ qa LA J 2I
I A,
1. Is your home address (listed above) within the corporate limits of Iowa City? YES ZNO
2. How long have you been a resident of Iowa City? !i \ y P� V-%
3. Occupation: V V/1 �&,,Q\ o y ," .} —
4. Gender* Y\/\l
*This question is mandatory in order for the City to comply with the State's gender balance requiremegwhich
treats gender as binary "Gender Identity' may be provided in the demographics section of the applicatio0elow,
Male - ry
❑ Female t
5. Experiences and/or activities which you feel qualify you for this position:
��g,�-� �S S� S�"��' �}SG' ®cn.d 1 ✓��.��a—vF-a— �,S c-�
6. What is your present knowledge of each advisory board you are interested i ?
j � k � PDQ c.�,. e nGL G,� j� ..✓ � i' ��
Please contact the city attorney at 319-356-5030 to discuss questions or concerns regarding a potential
conflict of interest. The following describe some but not all potential conflicts.
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 lizted to one
....reappointment to a full term in order to increase the opportunities for new applicants tQserve'-' '
................................................................................... •,.......•x;.........,
7. Do you currently have a conflict of interest? YES NO
Please identify any potential conflicts between membership on the advisory board and your.pemnal
interests, including financial interests and your duties to an employer/ List all businesses in which you or
your spouseldomestic partner, have an ownership interest (for example, sole proprietor, partner, 5% or more
of corporation's stockholdings).
List potential conflicts of interest (See above for information regarding conflict of interest)
Please indicate if there are none.
BUSINESS NAME BUSINESS ADDRESS
AK��
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.
8. Do you currently serve on another Iowa City board or commission? YES V/ NO
If yes, which one do you prefer?y Y) rv'\ a n
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:
Demographic Information:
9. Age
10. Country of Origin
11. Sexual Orientation Vit`
12. Religion M Q 5 \, 'f -A
13. Do you have a disability? YES NO
14. Ethnicity]
15. Race
16. Gender Identity 'll--
,.71
Note: + {
The Human Rights Commission strives to ensure the Commission is representative of the –1 unity.
Therefore, appointment shall take into consideration persons of various racial, religious, cu t� 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 fmance
and one person who receives rental assistance. (lkesolution)
Signature of Applicant*–
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. Contact information is attached.
(rev. 5/8/18)
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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.
'1 have worked in India helping differing Cast systems advance in the job market when their station if birth
prevents then from basic human rights.
'1 have worked with the Vermont Refugee Resettlement program to aid Somali refugees escaping was -torn
Somalia.
'1 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 familyties, during their tenure orfor one yearthereafter.
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:
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
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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 familyties, during their tenure orfor one year thereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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*
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
11/4/2018
First Name
Daniel
Last Name
Boscaljon
Home Address*
1210 Yewell 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*
3196215117
Email Address*
daniel.boscaljon@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?*
20 years
3. Occupation:
Teacher
4. Gender*
'This question is mandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r1 Male
r Female
5. Experience and/or activities which you feel qualify you for this position:*
My graduate work in Religion and Literature helped to develop an ethical position focused around humanism,
with an awareness of some of the logics, structures, behaviors, beliefs and practices that lead to human rights
violations. In my role as the moderator of "Coffee with Dan," and a consultant with the Green Room, I have
been working as part of the community with educational initiatives and conversational forums designed to give
people a non-partisan look at the political dimension of civic life. In general, my training has allowed me to think
both critically and compassionately through a range of differing perspectives. I can translate among
perspectives, describing the relative merits and issues with each, and am able and willing to ask critical
questions concerning uses of power.
6. What is your present knowledge of each advisory board you are interested in?*
My knowledge at present is limited to the information on the web page of the council. But I'm deeply familiar
with and passionate about humanism, and the need for communities to balance the justifiable claims of the
most vulnerable within society as important and I would like to serve my community in this way.
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 familyties, during their tenure orfor one yearthereafter.
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
41
10. Country of Origin
united states
11. Sexual Orientation
heterosexual
12. Religion
agnostic
13. Do you have a disability?
No
14. Ethnicity
euro-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*
�llatt l u r STT 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.
Drop-down
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
5/10/2018
First Name
Travis
Last Name
Brockett
Home Address*
2203 Plaen View 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*
3198501994
Email Address*
tbrockett319@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?*
7 years
3. Occupation: *
Assistant Vice President, Loan Officer
4. Gender*
'This question is rrandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r1 Male
r Female
5. Experience and/or activities which you feel qualifyyou for this position:*
I have served as a mentor for black youth via Big Brothers Big Sisters and a neighborhood center. The center
was Homework Hangout in Decatur, IL, which is where I attended college. It was an after-school program for
inner-city black youths to receive tutoring and mentoring. I participated in both as well as taught chess. It
started out as a service project for school but turned into a regular thing. I was the member of a fraternity that
had men from all walks of life and also served as a Chapter Advisor for the same fraternity at Western Illinois
University. As someone who is bi-racial, I have dealt with discrimination throughout my life in career,
educational, and social settings.
6. What is your present knowledge of each advisory board you are interested in?*
My understanding is that the goal of the Human Rights Commission is to strive to end discrimination in our
community. This is done though education and other avenues.
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 policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will
be asked to resign from one if appointed to another.
7. Do you currently have a conflict of Interest?*
No
8. Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
9. Age
36
10. Country of Origin
USA
11. Sexual Orientation
Male
12. Religion
Agnostic Atheist
13. Do you have a disability?
Yes
Please explain:
I have bipolar disorder, which is classified and covered under the Americans with Disabilities Act
14. Ethnicity
Non -Hispanic
15. Race
Bi -Racial (Black/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
Advisory Board/Commission/Cornmi tee
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 H u (v1 O.,n � l #lt
Date of Application _ 5� 101 b
Name m mu 1 �y� ~gam saM
Home Address 4 �J uQ u -Q- C.uxrpun t 1 v lAe}�)
Contact phone number 4:40%1Cb Email Address
Your home address must be within the corporate limits of Iowa City?
How long have you lived in Iowa City?
Occupation: Shjjp-
Gender: Male Female
Experiences and/or activities which you feel qualify you for this position:
pt
m
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What is your present knowledge of this advisory board. i`t wtM Cx\ R I yon ov,�)
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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__w _
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 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 LO -
Country of Origin
Sexual Orientation
Religion
Do you have a disability? YES .X NO OFTS-D /I A-YUnY 5f )
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*
Misrepresentations on this application will constitute just cause for removal of an appointee.
If you fall 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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live Within city limits of Iowa City to apply
Date of Application
11/8/2018
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*
319-621-1950
Email Address*
jrbruss@yahoo.com
Boards & Commissions
Select a Board or Commission you are interested in:*
Human Rights Commission
Select a Board or Commission you are interested in:
Parks and Recreation Commission
2. How long have you been a resident of Iowa City?*
19 years
3. Occupation:*
Client Services Professional
4. Gender*
`This question is rrandatory in order for the City to comply w ith the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" ray
be provided in the Derrographics sectionof the application below.
r Male
V Female
5. Experience and/or activities which you feel qualify you for this position:*
I was born and raised in the Iowa City Area. I participated in Iowa City Kickers and Iowa City Girls Softball as a
youth. My children both participated in Iowa City Kickers. I recently graduated with a BLS from the University of
Iowa with an Organizational studies emphasis. My husband had disabilities and my son has disabilities.
6. What is your present knowledge of each advisory board you are interested in?*
I understand that each advisory board meets one time per month. The parks and recreation board is
responsible for policies and budgets related to the parks and recreation department. The human rights
commission develops policies and information to help 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 familyties, during theirtenure orfor one year thereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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
38
10. Country of Origin
USA
11. Sexual Orientation
Heterosexual
12. Religion
Agnostic
13. Do you have a disability?
No
14. Ethnicity
European -American
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
I I IAdvisory Board/Commission Application Form
f
.6�1114 Im
*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
CITY OF IO CITY ITY and automatically 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
Date captured on form submission
First Name*
Last Name*
E� — �V-r-
Home Address
city
IOWA CITY
State
IA
Zip Code's
I. Is your horse address (listed above) within the corporate limits of Iowa City?*
Contact Phone Number`
�I. 1
Email Address *
SL(5ai.6.C.&rrvt) Zs M .CAN)
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Select a Board or Commission you are interested in:*
AAUV-AO-V\'
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2. How long have you been a resident of Iowa City?*
A_
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3. Occu patio n: *
Nt trSG- - G&�4
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
Identity" may be provided in the Demographics sectionof the application below.
Female
ry
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6. What is your present knowledge of each advisory board you are interested in?*
m► 5" &-A-5
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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 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, 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 (https:!lcoolice.legis.iowa.gov/Cool-ICE/default.asp?
category=billinfo&service=lowaCode&input=362.5) 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?*
8. Do you currently serve on another Iowa City board or commission?* cc
rr
az
M
Demographic Information,
The City Council values all types of diversity on its Boards and Commission ;11Yo responses on
this page provide valuable information to the Council in achieving that goal. _j
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
I CA--AL&A ( t C_
13. Do you have a disability?
AD
14. Ethnicity
rz8 ki Cir r�na n
16. Race
ana et V1
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 cad4ejo rerr%al of
an appointee. If you fail to answer all the questions, except c ograpFws,
Council will not consider your application. ten. M
rn
You are encouraged to contact individual Council Members 30r'
(https://www.icgov.org/staff-directory?term—node_tid_depth=247) tA express
your interest in serving.
Drop-down
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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 followthe 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 familyties, during their tenure orfor one year thereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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@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?*
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 familyties, during their tenure or for one year thereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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?
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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*
`This question is rrandatory in order for the Oty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Demographics sectionof the application below.
F Male
W Female
5. Experience and/or activities which you feel qualifyyou 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 familyties, during their tenure orfor one yearthereafter.
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?*
N
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*
Calf/.�-Ff �: jtrT�rlrr.�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.
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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 rrandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r Male
17 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 ADHD 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 MILK 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 Hills 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 familyties, during their tenure orfor one yearthereafter.
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
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*
,4Grl�E Coal;
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
10/10/2018
First Name
Matt
Last Name
Drabek
Home Address*
815 N Johnson 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*
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?*
11 years
3. Occupation: *
Content Specialist/Non-Profit Educational Management
4. Gender*
'This question is rrandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r1 Male
r Female
5. Experience and/or activities which you feel qualify you for this position:*
I've lived in Iowa City for 11 years, first as a student and faculty member of the University of Iowa, and later as
an employee of one of Iowa City's largest non -university employers. As someone who has experienced Iowa
City both as a new resident and as a member of the community, I hope to be able to speak with people of very
different backgrounds and situations.
My record of service, research, and activism is mainly on issues concerning class, gender, and sexuality,
though also 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). 1 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 main function is communicative. It educates both
the public and the city council on issues concerning human rights, inclusive of formal violations of civil rights,
discrimination, and broader cultural and environmental issues that concern a city like Iowa City. This includes
things from public events to recommendations for legislation.
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 familyties, during their tenure orfor one yearthereafter.
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?*
N
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
Queer
12. Religion
None
13. Do you have a disability?
No
14. Ethnicity
white
15. Race
white
16. Gender identity
Man
*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
illlr ilk%.
Advisory Board/Commission/Committee
CITY OF IOWA CITY Application Form 731? Nov 13 pry �e
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 ` L'A A
Date of Application t v s�
pp � � t� � a�c����
Name
Home Address
Contact phone number; Email Address��
{
Your home address must be within the corporate limits of Iowa City?
How long have you lived in Iowa City?
Occupation:
Gender: Male Female
Experiences and/or activities which you feel qualify you for this position;
Jam'
What is your present knowledge of this advisory hoard?
Ak
R
Ile USy\1
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 mak??jVqyd titin,. t the City
Council regarding the distribution of federal CBDGIHOME funds. The gene dF1 r6re�is that no
persons who exercise or have exercised any functions or responsibilitj6T With} re�p�ct to federally
funded activities, or who are in a position to participate in the de�isroY��r�,lcin�,-gto�ess 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 federallyassistedactivity, 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 Convnission 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, fust
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 I BUSINESS ADDRESS
Do you currently serve on another Iowa City board or commission? YES
If so which one do you prefer?
NO ,/
The City Council values all types of diversity on its boards and cointnissions. Your responses on
this page provide valuable information to the Council in achieving that goal.
In order to ensure that the board and connnission is representative of th'F'V....Qybfid the
groups(s) which it serves, please provide your inforniation for the following:
Agel2 0 i 7 H0 13 P1. 20 2t'
�W
Country of Origin
Sexual Orientation
Religion �C�i�\�ti } f VY\,
Do you have a disability? YDS NO , �fWI/r
Race, Color or Ethnic Group _�6 ti � n n t t,,y)
*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 A licant* h
g p17 1�
V
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
11/2/2018
First Name
Kasey
Last Name
Dresser
Home Address*
711 E Jefferson 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*
760-710-1592
Email Address*
kdresser98@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
3. Occupation: *
Student/ Public Relations Assistant UI CGRER
4. Gender*
'This question is rrandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r Male
17 Female
5. Experience and/or activities which you feel qualifyyou for this position:*
A large number of Iowa City's population is comprised of students from all walks of life. In order to fully
understand their needs it takes a student to be able to represent that part of the population. As a socially
active and involved member of the University of Iowa, I believe I am the student for the job. I am a Political
Science student with a passion for fairness, equality, and safety. I am originally from San Diego and
understands the behavior of city heavily centered around civil understanding. I am fluent in sign language and
have experience working with the disabled population in Iowa City.
6. What is your present knowledge of each advisory board you are interested in?*
I understand the importance of a human rights commission and the needs to effectively carry out change in 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 familyties, during their tenure or for one year thereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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
20
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
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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 rrandatory in order for the City to comply w ith the State's gender balance requirement, which treats gender as binary. "GenderIdentity" ray
be provided in the Derrographics sectionof the application below.
r Male
rJ 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 familyties, during their tenure orfor one yearthereafter.
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
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*
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live Within city limits of Iowa City to apply
Date of Application
10/24/2018
First Name
Noemi
Last Name
Ford
Home Address*
407 Magowan Avenue
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*
773 983 1487
Email Address*
noemiford@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 yrs
3. Occupation: *
Licensed psychologist, in private practice
4. Gender*
'This question is rrandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r Male
17 Female
5. Experience and/or activities which you feel qualify you for this position:*
I have been prOviding assessment and psychotherapy services to members of various under represented
groups within the IC community, including immigrants, asylum seekers, people who identify as transgender or
bi, gay, or pan sexual. Also to people with disabilities and to women and non native English speakers. I have
presented at professional conferences on the psychological impact of immigration in children, families and the
individual, have been trained and I am a member of the physicians for human rights group at Harvard medical
school, Boston. Have been successfully working with district attorney and the immigration law clinic at Ui to
provide mental health assessments to immigrant and those without legal paperwork. Also, as an immigrant
myself, I have been the leader of international student groups as well as I am currently the co chair of the
diversity and social justice committee of the iowa psychological association.
I am a member of the American psychological association, division for psychoanalysis and the division for the
study of ethnicity, race and diversity.
6. What is your present knowledge of each advisory board you are interested in?*
Some
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 familyties, during their tenure orfor one yearthereafter.
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
42
10. Country of Origin
Hungary
11. Sexual Orientation
None
12. Religion
None
13. Do you have a disability?
No
14. Ethnicity
None
15. Race
None
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*
'lam b44'
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
11/6/2018
First Name
Caroline
Last Name
Garske
Home Address*
225 S Gilbert St Apt 2732
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*
6363464806
Email Address*
caroline-garske@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?*
5 years
3. Occupation: *
Undergraduate Program and Outreach Coordinator - UI
Dept of Geography
4. Gender*
*This question is rrandatory in order for the oty to comply w ith the State's gender balance requirement, which treats gender as binary. "GenderIdentity" ray
be provided in the Derrographics sectionof the application below.
r Male
rJ Female
5. Experience and/or activities which you feel qualify you for this position:*
I graduated from the University of Iowa with degrees in History (Honors) and Political Science and a minor in
International Relations. In addition to my fields of study, I also have been learning Russian for the last 2 years.
As a globally -minded individual with a passion for social justice, I believe I could contribute forward -thinking
ideas to promote inclusion and decrease discriminatory practices in the Iowa City community. My honors
history thesis focused on the discriminatory intentions and effects drug policy (specifically crack cocaine) of the
1986 Anti -Drug Abuse Act. With an expansive background in historical legacies of discriminatory and punitive
legislation, I feel I am experienced in the politics and history of equity in the United States and can apply this
knowledge in educating the public on illegal discriminatory practices. In addition to my educational background,
I have a growing toolkit of digital and social media skills that could be implemented to aid communication and
visibility of the Human Rights Commissions activities, events, and overall mission. As the Undergraduate
Program and Outreach Coordinator for the University of Iowa's Dept. of Geographical and Sustainability
Sciences, I have managed communication with a network of over 200 current undergraduates, graduate
students, faculty, and staff members informing them of the latest news, updates, and opportunities within the
department. I also have created effective advertisements (digital and physical) for upcoming courses,
internship opportunities, grants, and colloquiums to alert the Iowa City community of our department's
activities. I have extensive event planning experience with my current position and my previous position as
office assistant to the UI Departments of Communication Studies and Cinematic Arts. I regularly reserve
spaces, lodging, and coordinate catering and reservations for visiting speakers, guests, and students. I am a
confident public speaker prepared to speak to all members of the community on issues that affect their daily
lives. I am well-equipped to communicate with individuals from all backgrounds, as I do daily. I am responsible,
dedicated, and passionate about human rights, local politics, and creating an inclusive community free of
discrimination and intolerance. I will happily provide a CV, writing sample, cover letter, and/or letters of
recommendation if necessary.
6. What is your present knowledge of each advisory board you are interested in?*
My present knowledge of the Human Rights Commission is that the board strives for social justice and equity
for all. I also understand that the commission coordinators with other local agencies to plan events and
programs that promote inclusiveness, acceptance, and a sense of community among all groups. I also am
aware of the Social Justice and Racial Equity Grant that is awarded to groups working to promote equality and
reduce discrimination. Also, the commission engages in educational efforts to broaden the community's
knowledge of discrimination and provides individuals with the information they need to combat illegal
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 familyties, during their tenure orfor one yearthereafter.
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
23
10. Country of Origin
United States
11. Sexual Orientation
Heterosexual
12. Religion
None
13. Do you have a disability?
No
14. Ethnicity
White, not Hispanic or Latinx
15. Race
White, not Hispanic or Latinx
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
11/9/2018
First Name
Jason
Last Name
Glass
Home Address*
1730 Windsor 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*
3193217405
Email Address*
glass0l@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?*
4 Years
3. Occupation: *
Human Resources
4. Gender*
'This question is rrandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r1 Male
r Female
5. Experience and/or activities which you feel qualify you for this position:*
I have over 18 years of experience in human resources roles (16 in the Iowa City/Cedar Rapids area) in a
variety of industries including public and private, for profit and not for profit, service and manufacturing. I have
been the top human resources leader for my respective organization for the past six years. A significant
portion of these roles have been focused on equal opportunity and diversity in the workplace. I have
investigated and resolved dozens of workplace harassment and discrimination claims. I have strived to make
the workplaces I support more welcoming and supportive. I have delivered training to employees and leaders
on these topics, both within and outside of my organization.
I am a past Board Member and President of Professional & Technical Diversity Network (PTDN), a non-profit
focused on welcoming and supporting a diverse workforce in The Corridor. Before ceasing operations in 2010,
we held dozens of events. During my two years as Board President, I developed and led the creation of the
Corridor Welcome Receptions, which have continued to this day under the leadership of the chambers in Iowa
City and Cedar Rapids. I was the lead speaker at a few of the events as well.
I was appointed by Governor Branstad as a public member of the Iowa Human Rights Board. I served a four
year term ending in 2016 supporting the Iowa Department of Human Rights and their mission. I led the
development of strategic priorities for the board, attended meetings and events in Des Moines, and
collaborated with state legislators on the department's mission.
I am also actively serving in the Iowa Army National Guard as a member of the 34th Army Band based in
Fairfield (my hometown). In my nearly 25 years of service, I have served the state in several ways. I am the
Equal Opportunity leader for my unit. As part of this role I conduct training for the soldiers in my unit and help
facilitate resolution to any issues that arise. I have attended several training classes as part of this role,
including a two-week resident course on Equal Opportunity where I finished 2nd in a class of 30 soldiers. I
have consulted at the state level and participated in activities outside of my unit, utilizing the civilian career
experience.
I have a BBA and MBA from the University of Iowa, both with an emphasis in management/human resources. I
also have past certifications in human resources and change management.
I believe my experience and passion for human and civil rights would make me an acceptable candidate for the
commission. I look forward to the opportunity to discuss my interest and potentially serve Iowa City.
Thank you for your consideration.
6. What is your present knowledge of each advisory board you are interested in?*
I am aware of the Iowa City Human Rights Commission, but have not been actively involved. My application is
an effort to be more actively involved in the Iowa City Community since moving into town few years ago from
North Liberty. I have read past meeting minutes and agendas to get a better sense of the work they have done
and are doing. I have also occasionally seen the Commission referenced in news articles as the work they
have done has been promoted. I look forward to opportunity to learn more about their work.
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 familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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
United States
11. Sexual Orientation
Heterosexual
12. Religion
Roman Catholic
13. Do you have a disability?
No
14. Ethnicity
Caucasian
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*
,,T63014 �1,3_TS
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
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 familyties, during theirtenure orfor 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
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*
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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
Higley
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 familyties, during theirtenure orfor 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
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*
�V
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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
Hong
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 rrandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r1 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 lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
11/6/2018
First Name
Venkatesh
Last Name
Janakiraman
Home Address*
3101 Friendship 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*
6088867639
Email Address*
venkJ@hotmail.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 year
3. Occupation: *
Software Engineer
4. Gender*
'This question is mandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r1 Male
r Female
5. Experience and/or activities which you feel qualifyyou for this position:*
Travel to several countries with documented human rights violations; growing up in a developing nation;
passion for making sure that all humans are treated with respect and dignity.
6. What is your present knowledge of each advisory board you are interested in?*
As an immigrant who has lived in multiple countries and traveled to multiple countries with documented
histories of human right violations, I have some understanding of the challenging work that lies ahead of us.
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 familyties, during their tenure or for one year thereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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
India
11. Sexual Orientation
Straight
12. Religion
Hindu
13. Do you have a disability?
No
14. Ethnicity
Asian/Indian
15. Race
Asian/Indian
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
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
11/2/2018
First Name
Katelyn
Last Name
Lichte
Home Address*
1727 Glendale 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*
3202412844
Email Address*
katelyn.lichte@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: *
Manufacturing Engineer
4. Gender*
'This question is rrandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r Male
17 Female
5. Experience and/or activities which you feel qualify you for this position:*
I am heavily involved with the Society of Women Engineers and have always been a strong advocate of
equality. I have advocated for anti -discrimination laws at the federal level, and I have previously helped to run
programs at the college I graduated from focused on eliminating racial, gender, sexual orientation, etc based
discrimination.
I also perform a lot of STEM outreach in the Iowa City/Cedar Rapids communities, and I would like to get more
involved in the community and strengthen the community as a whole.
6. What is your present knowledge of each advisory board you are interested in?*
The Human Rights Commission works to educate the public on matters of discrimination/civil rights and ensure
that community members know the laws. They also work with City Council to provide recommendations for
legislation where gaps are found. The Human Rights Commission also plans events to eliminate 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 familyties, during their tenure orfor one yearthereafter.
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
23
10. Country of Origin
United States
11. Sexual Orientation
Straight
12. Religion
Athiest
13. Do you have a disability?
No
14. Ethnicity
15. Race
White
16. Gender identity
cis 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
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
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 familyties, during their tenure or for one year thereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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*
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
11/4/2018
First Name
Adedayo
Last Name
Oladele-Ajose
Home Address*
301 Hawk Ridge 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*
3196711057
Email Address*
ddayoajose@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?*
5 years
3. Occupation:
Nurse Assistant
4. Gender*
'This question is rrandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r1 Male
r Female
5. Experience and/or activities which you feel qualifyyou for this position:*
I was a presenter at the Human Rights Conference, presenting about the violation of Human rights frisking
infringes among the colored community. Being a black individual in America, I have been a victim of
discrimination and would love the opportunity to educate the public about illegal discrimination. Being able to
intern alongside former councilman Kingsley Botchway gave me insight on how to increase equity and
proficiency among the Iowa City community. I would like to use these experiences and work together with other
organizations to improve individuals Human rights.
6. What is your present knowledge of each advisory board you are interested in?*
The information I was given was: the position would give the applicant the opportunity to educate the public on
illegal discrimination, meet with other organizations to terminate tensions between inter -groups, and this job
must be neutrally gendered.
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 policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will
be asked to resign from one if appointed to another.
7. Do you currently have a conflict of Interest?*
No
8. Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
9. Age
23
10. Country of Origin
United States
11. Sexual Orientation
Male
12. Religion
Christian
13. Do you have a disability?
No
14. Ethnicity
African American
15. Race
Black
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
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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 aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r1 Male
r 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. I'm 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 familyties, during their tenure or for one year thereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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 power 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*
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 P i
—®12
Advisory Board/Commission/Committee
CITY OF 101NA 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 Nance h�rwS5t0n
Date of Applicationan
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Your home address must be within the corporate limits of Iowa City?
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Experiences and/or activities which you feel qualify you for this position:
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What is your present knowledge of this advisory board?
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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. r.a
q
Res. #15-300 states that each application for reappointment to a City Board or CommWip wile
considered without regard to incumbency. If reappointed, an individual would be lips k to -ane
+ ....
reappointment to a full term in order to increase the opportunities for new applicants tos4o��»s. M--
i
�J� +�
Council policy is not to permit an individual to serve on two Boards or Commissiosne salFie
time. You will be asked to resign from one if appointed to another. F33
Do you currently have a conflict of interest? YES NOVZ u
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 -AZ
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 -�P_
Country of Origin
Sexual Orientation�(�
Religion lf4VL_/
Do you have a disability? YES NO
Race, Color or Ethnic Groupe
*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 affaehort
r�J
._a
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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 CITY
State
IA
Zip Code
52246
1. Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
319-337-3347
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 familyties, during their tenure orfor one year thereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
11/7/2018
First Name
Meg
Last Name
Quigley
Home Address*
3202 Friendship 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*
859-630-8966
Email Address*
mquigley721 @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 year, 3 months
3. Occupation:
Social Worker
4. Gender*
'This question is mandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r Male
17 Female
5. Experience and/or activities which you feel qualify you for this position:*
grew up in a small town in Kentucky, where most people, my family included, do not venture out. I, however,
was anxious to see and experience other places. After completing my undergraduate degree at the University
of Kentucky, I moved to Arizona where I served two years with AmeriCorps VISTA. Throughout my AmeriCorps
service, I was given the experience I had been seeking; to work, collaborate with, and learn with people from
various cultures, backgrounds, social classes, and with varying life experiences. In my second year of service
at a poverty -relief center, I worked predominantly with families to assist them in meeting their basic human
needs including food, shelter, and clothing. I earned a Master's Degree in Social Justice & Human Rights in
2013; during graduate school I studied the intersections of identity, power, and privilege, the prison industrial
complex, immigrant rights, globalization, housing rights, and the history of violence against women. After
completing graduate school, I lived and worked in Washington D.C. at a national violence prevention
organization, followed by Denver, Colorado where I worked with college students with disabilities.
I currently work with teenagers (and their families) at United Action for Youth and am both humbled and
empowered by the resiliency and strength they so often show throughout our programming. Additionally, I am
an Adjunct Instructor at the University of Iowa; I teach an empowerment -based sexual assault resistance
course for students who identify as women.
I am passionate about working toward a more equal society; a society where people from different cultures,
backgrounds, and/or identities can voice their opinions and make contributions to their community, while
enjoying equal space and representation as those who regularly enjoy those unearned privileges. Though I am
new(er) to Iowa City, this community feels like home to me. I would love to join the efforts of the Human Rights
Commission.
6. What is your present knowledge of each advisory board you are interested in?*
To my understanding, the Human Rights Commission is a committee that works closely with the Office of Equity
and Human Rights to educate our community members of what human rights are, and to work toward
diminishing divisiveness and discrimination in our community. Additionally, the Human Rights Commission
makes recommendations to the City Council for Social Justice and Racial Equity Grant funding, as well as for
additional local legislation as it relates to discrimination.
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 familyties, during their tenure orfor one yearthereafter.
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
31
10. Country of Origin
United states
11. Sexual Orientation
Gay
12. Religion
N/A
13. Do you have a disability?
No
14. Ethnicity
Caucasian
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*
�1 j WI&I
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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 familyties, during their tenure orfor one yearthereafter.
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*
[*,q# �'qh
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa 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 rrandatory in order for the oty to comply w ith the State's gender balance requirement, which treats gender as binary. "GenderIdentity" ray
be provided in the Derrographics sectionof the application below.
r Male
rJ 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 11 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 I'd 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 familyties, during their tenure orfor one yearthereafter.
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*
rb
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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 rrandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r Male
17 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 familyties, during their tenure or for one year thereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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
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
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
10/3/2018
First Name
Zachary
Last Name
Rochester
Home Address*
2446 Bittersweet Ct
City
IOWA CITY
State
IA
Zip Code
52246-4100
1. Is your home address (listed above) within the corporate limits of Iowa City?*
Yes
Contact Phone Number*
7124903037
Email Address*
zacharyjrochester@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?*
5
3. Occupation: *
Student, Yoga Instructor
4. Gender*
'This question is rrandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r1 Male
r Female
5. Experience and/or activities which you feel qualify you for this position:*
I would like to note that I am a gender non -conforming individual. I identify as non binary, not male or female.
Previously, I worked as a Regional Manager for Cold Stone Creamery and oversaw 4 locations in the 4 years I
held that position. I have also worked as a manager at Bruegger's Bagels and The Java House. Through these
experiences I have retained a great amount of knowledge and insight into the Iowa City Community, especially
the downtown district. This year, I returned to the University of Iowa to continue my education. I am currently a
double major in Ethics and Public Policy and Social Justice. In addition, I work with Fair Trade Campaigns USA
as a Chairperson for the Iowa City Fair Trade Campaign as well as a member of the Great Lakes Regional
Leadership Team. The Fair Trade Movement is one that aims to prioritize people and planet over profit by
increasing equity in international trade by creating greater transparency in trade operations and by securing
the rights of marginalized producers and workers.
6. What is your present knowledge of each advisory board you are interested in?*
I am knowledgable on the duties of the human rights commission and see a great value in this commissions
work. Educating the community and raising awareness of the various injustices and inequities in lows City is
the first step to making real change. I am familiar with the duties of organizing, creating public programs, and
working with city council members and making recommendations to better level the playing field in areas of
race, gender, culture, religion, etc.
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 familyties, during their tenure orfor one yearthereafter.
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
22
10. Country of Origin
United States
11. Sexual Orientation
Pansexual
12. Religion
Spiritual, Non-relig
13. Do you have a disability?
No
14. Ethnicity
Caucasian
15. Race
White
16. Gender identity
Non -Binary
*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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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*
oso6lds@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 CityAttorneyat 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 familyties, during their tenure orfor one year thereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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 currentlyserve 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*
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
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Advisory Bard/COmmission/C® mittee
CITY OF IOWA CITY Application Farm
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 pQ Ll ce kdvoe24
Date of Application ,f %
Name /Dmf!' ��/�'tP.11 5 Z i�%l a h�� �l'1
Home Address .253,1 Be���,ed ��
Contact phone number 31-q 5/,Z 9 T 33 Email Address
Your home address must be within the corporate limits of Iowa City?
How long have you lived in Iowa City?
Occupation:
o-px
Gender: Male Female f
im
Experiences and/or activities which you feel qualify you for this position:
What is your present knowledge of this advisory board?
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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 CommissfZ� is at the,
same
time. You will be asked to resign from one if appointed to another. ='' -I
—
Do you currently have a conflict of interest? YES NO
List potential conflicts of interest (See last for information
page regarding conflict'0finte est)
Please indicate if there are none. e
I BUSINESS NAME BUSINESS ADDRESS
Do you currently serve on another Iowa City board or commission? YES NO_4,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 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 sty Ddn
Sexual Orientation
Religion �,� �'✓/
Do you have a disability? YES NO t --
Race, Color or Ethnic Group�[�4/7 y�
*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.
w....n.
�n•.+MR1
.t.+aH'"
1 V
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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 rrandatory in order for the Oty to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" may
be provided in the Cerrographics sectionof the application below.
F Male
V Female
5. Experience and/or activities which you feel qualifyyou 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 lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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*
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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 who 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. 1 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 familyties, during their tenure orfor one yearthereafter.
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*
u K,si't�l�rrfrl �%l%rrr^✓rfr �`�.s'rFr�
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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 howto
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 familyties, during their tenure or for one yearthereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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*
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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 familyties, during their tenure orfor one yearthereafter.
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
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
Item Number: 20.c.
+ r
ui �1 lat
• yyrrmr��
CITY Ok IOWA CITY
www.icgov.org
November 20, 2018
Parks and Recreation Commission - Two vacancies to fill a four-year term,
January 1, 2019 - December 31, 2022. (Terms expired for Wayne Felt, Lucie
Lau rian )
ATTACHMENTS:
Description
,vacancy Notice & Coversheet
Board Demographic & Attendance
Bruss, Jessica -Application
Clausse, Claryton -Application
Foelsch, Lucas -Application
Smith, Angie - -Application
Urion, Sarah -Application
Wills, Brianna -Application
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
PARKS AND RECREATION COMMISSION
Two Vacancies — Four -Year Terms
January 1, 2019 — December 31, 2022
The duties of the members of the Parks and Recreation Commission are to: recommend
and review policies, rules, regulations, ordinances, CIP (Capital Improvement Program)
funds and budgets relating to parks, playgrounds, recreation centers, and cultural functions
of the City and make such reports to the City Council as the Commission deems in the public
interest; to exercise broad responsibility for the development of parks, recreation centers,
playgrounds, and cultural facilities to serve the City --including the creation and appointment
of advisory groups to make studies.
The Parks and Recreation Commission meets the second Wednesday 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, November 13, 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 Parks and Recreation Commission should be directed to Juli Seydell-
Johnson, Parks & Recreation Director at 356-5104.
Board/Commission Application Cover
Board/Commission: Parks and Recreation Commission
Two vacancies to fill four-year terms
1/1/2019 -12/31/2022
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: 10/02/2018
Application Deadline: 11/13/2018
Council Appointment Date: 11/20/2018
Date of Non -Gender Appointment: 01/02/2019
After date above Council may appoint without regard to gender
Gender Balance Requirement: 1- Male, 1 -None
Current Gender Balance: Female: 4 Male: 3
Gender
Name and Address
Female
Bruss, Jessica
2201 California Ave
Male
Claussen, Clayton
27 Green Mountain Dr
Male
Foelsch, Lucas
711 Streb St
Female
Smith, Angie
3310 Lower West Branch Rd
Female
Urion, Sarah
3156 Lower West Branch Rd
Female
Wills, Brianna
70 Hickory Place
Parks & Recreation Commissions - Current members
Name
Term ending
# yearsas
resident Of IC
Occupation
Country of Sexual
Gender Age* Orgin* Orientation* Religion*
Disability*
Ethnicity*
I Identity'
Race`
Unique Icentitiers
Cara Hamann
12/31/2019- 2nd Tern
7
F
Jamie Venzon
Joe Younker
Suzanne Bentler
12/31/2020 -1st Term
12/31/2019 -2nd Tern
12/31/2020- 2nd Terr
28
30
23
Event Director
Attorney
Asst Research
Scientist
F 28 USA Heterosexual Catholic
M
F 45 USA Heterosexual
Caucasian
Caucasian
Stephen Bird
12/31/2021 -lst Term
1
UI Supply Mgr
M 44 USA Straight Methodist
Caucasian
Ben Russell
12/31/2021 -1st Term
21
Bank Officer
South
M 31 Korea Male Catholic
Asian
Angie Smith
12/31/2021 -1st
Term + unexpired
16
Psychologist
F 43 USA
Vacant
12/31/2022
Vacant
12/31/2022
PIe= son.
* Information is voluntary
PARKS AND RECREATION COMMISSION
jt,^r 41 �n1R
PARKS AND RECREATION COMMISSION
ATTENDANCE
RECORD
KEY! X =
Present
O =
Absent O/E =
Absent/Excused
NAME
k-
n
ao
ao
ae
TERM
O
EXPIRES
"'
""
�
��'�
o
on
i
�
X
X
:TX
X
Suzanne
Bender
1 /1117
X
X
O/E
X
X
O/ENM
Steve Bird
1/1/22
*
*
X
X
O/E
X
NM
X
X
X
Larry Brown
1/1/18
X
X
+
+�
Clay
Claussen
1/1!18
X
X
Way7Felt1
/19
O/E
X
X
O/E
X
X
NM
X
Q/E
X
X
O/E
cera1/24
Q/EXX
X
X
K
NM
XHama
X
O/E
X
O/E
Lucie
Laurian
1/1110
O/E
K
X
X
O/E
X
NM
X
O/E
O/E
X
X
X
NM
X
X
X
Ben Russell
1/1/22
*
*
X
O/E
X
X
X
An Smith
111/i 8
X
X
X
X
O/E
X
NM
X
X
Jamie
Venzon
1/1/20
O/E
X
O/E
X
O/EX
NM
X
X
X
X
X
Joe Younker
111!20
X
O/E
X::
=X-
X
NM
X
X
X
X
X
NM —
No meeting
LQ
= No meeting due to lack
of quorum
* = Not a
member now
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live Within city limits of Iowa City to apply
Date of Application
11/8/2018
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*
319-621-1950
Email Address*
jrbruss@yahoo.com
Boards & Commissions
Select a Board or Commission you are interested in:*
Human Rights Commission
Select a Board or Commission you are interested in:
Parks and Recreation Commission
2. How long have you been a resident of Iowa City?*
19 years
3. Occupation:*
Client Services Professional
4. Gender*
`This question is rrandatory in order for the City to comply w ith the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" ray
be provided in the Derrographics sectionof the application below.
r Male
V Female
5. Experience and/or activities which you feel qualify you for this position:*
I was born and raised in the Iowa City Area. I participated in Iowa City Kickers and Iowa City Girls Softball as a
youth. My children both participated in Iowa City Kickers. I recently graduated with a BLS from the University of
Iowa with an Organizational studies emphasis. My husband had disabilities and my son has disabilities.
6. What is your present knowledge of each advisory board you are interested in?*
I understand that each advisory board meets one time per month. The parks and recreation board is
responsible for policies and budgets related to the parks and recreation department. The human rights
commission develops policies and information to help 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 familyties, during theirtenure orfor one year thereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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
38
10. Country of Origin
USA
11. Sexual Orientation
Heterosexual
12. Religion
Agnostic
13. Do you have a disability?
No
14. Ethnicity
European -American
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
10/9/2017
First Name
CLAYTON
Last Name
CLAUSSEN
Home Address*
27 Green Mountain Dr
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*
319-331-9911
Email Address*
clayclaussen@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:*
Parks and Recreation Commission
2. How long have you been a resident of Iowa City?*
Since 1966 w/periods out of
the area
3. Occupation:
REALTOR
4. Gender:*
Male
5. Experience and/or activities which you feel qualify you for this position:*
1981-2002, Management & Consulting, Fitness/Wellness/Recreation/Health Promotion. Managed private
health club for 4 years, Rockwell Recreation Center (60,000 SF corporate fitness/wellness on-site facility) for
14 years, consulted for Ertl Toy company, John Deere, Quaker Oats, Trilogy Softwar, Dell JCC and
Performance Fitness. Founded Core Fitness and created their original business plan in 2002-2003. Trained at
Cooper Aerobics Instiitute, Dallas,Tx as Health Promotion Director. Pioneered local multi-purpose health clubs
and integration of physical therapy and training in commercial & private fitness operations. Coached for 8
years and served on the Iowa City Girls Softball Board in the '70's &'80's.
6. What is your present knowledge of each advisory board you are interested in?*
I have had the privilege to serve on the Parks & Recreation Commission for the past eight years, seven as
Chair. I served on the selection committee for the current Director and participated in screening candidates for
City Manager when Tom Markus was hired. I have been involved with creation of the current Master Plan and
numerous individual projects including the Eastside Sports Park and all major projects over the past eight
years. I believe our Parks & Recreation facilities and services are a vital part of our community and must be
sustained and improved with a vision of a better future within budget constraints. And when we are obstructed,
I have a history as a problem solver in seeking innovative solutions, especially with finances, programming and
creating income streams..
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 familyties, during their tenure orfor one yearthereafter.
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?*
R.!
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
69
10. Country of Origin
USA
11. Sexual Orientation
Hetero
12. Religion
Catholic
13. Do you have a disability?
No
14. Ethnicity
Caucasian
*NOTE:
The Human Rights Commission strives to ensure the Commission is representative of the community.
Therefore, appointment shall take into consideration persons of various racial, religious, cultural, social and
economic groups in the city. (Ordinance)
The Housing and Community Development Commission strives to satisfy its purpose and intent, when
possible to have at least one person with expertise in construction, at least one person with expertise in
finance, and one person who receives rental assistance. (Resolution)
Signature of Applicant*
. 1
�-�rr�rrr � .ibTC -frrrf ,V r�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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
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 familyties, during their tenure orfor one yearthereafter.
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*
L IF— SGf
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
10/12/2017
First Name
Angie
Last Name
Smith
Home Address*
3310 Lower WEst Branch 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*
3196217734
Email Address*
angiesmith3310@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:*
Parks and Recreation Commission
2. How long have you been a resident of Iowa City?*
16 years
3. Occupation:
Psychologist
4. Gender:*
Female
5. Experience and/or activities which you feel qualify you for this position:*
Have been on the IC Parks and Rec Board since March 2017, Lemme PTA President 2012, serve on Little
Hawk Athletic Booster Board, IC Music Auxiliary 2014-2017, am the parent of three active children who enjoy
many activities offered through the IC Parks and Rec commission, am an active individual who enjoys the parks
in our community on a weekly basis
6. What is your present knowledge of each advisory board you are interested in?*
I have served on the board since March, so am beginning to develop a base knowledge of the board and the
responsibilities of the 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 familyties, during their tenure or for one year thereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-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
43
10. Country of Origin
United States
11. Sexual Orientation
heterosexual
12. Religion
Protestant
13. Do you have a disability?
No
14. Ethnicity
Iowa City
"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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
11/5/2018
First Name
Sarah
Last Name
Urion
Home Address*
3156 Lower West Branch 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*
319-325-2537
Email Address*
smsurion@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:
Parks and Recreation Commission
2. How long have you been a resident of Iowa City?*
25 Years
3. Occupation: *
Business Systems Consultant
4. Gender*
'This question is mandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r Male
17 Female
5. Experience and/or activities which you feel qualify you for this position:*
I was born and raised in Iowa City and utilized Parks and Rec services by frequenting local parks and taking
classes at the Rec Center. After college I moved away but my husband and I returned when our oldest son was
about 18 months old (in early 2016) because we love Iowa City and wanted to raise our children here. My two
sons are 4 years old and 9 months old and we are visiting local parks more and more and my 4 year old
started taking his first Rec Center class this fall and I know that they will use the Parks and Rec services more
and move over the next several years. I feel that I am qualified for this position as I have a vested interest in
the Parks and Recreation services due to having used them myself as a child and having my young children
now starting to use them. I am very interested in shaping local Parks and Rec plans and policies for my
children and other young folks of Iowa City.
6. What is your present knowledge of each advisory board you are interested in?*
I receive The Park Bench newsletter via e-mail and make sure to read through the Parks and Recreation
Activity Guide each new season. I also try to stay informed on the Master Plan with particular interest in the
City Park Adventure Play area and the East Side Sports Complex plans.
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 familyties, during their tenure orfor one yearthereafter.
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
32
10. Country of Origin
USA
11. Sexual Orientation
Heterosexual
12. Religion
Christian
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*
fel J 1. AN,
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
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
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
Brianna
Last Name
Wills
Home Address*
70 Hickory Place
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*
319 383-1025
Email Address*
brianna.wills@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:*
Parks and Recreation Commission
2. How long have you been a resident of Iowa City?*
7 years
3. Occupation:
Non-profit management
4. Gender:*
Female
5. Experience and/or activities which you feel qualify you for this position:*
I was a primary organizer for our neighborhood park. I helped organize the neighbors and collect data of the
wants and needs of neighbors for our park. I worked with Mike to design the park and playground.
6. What is your present knowledge of each advisory board you are interested in?*
I have visited every city park in research for our neighborhood park on the past two years. Our children have
also spent several summers participating in summer camps through the recreation department and various
other sports offered by the Rec department.
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 policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will
be asked to resign from one if appointed to another.
7. Do you currently have a conflict of Interest?*
No
8. Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
9. Age
40
10. Country of Origin
United States
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*
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
Item Number: 20.d.
+ r
tui�1r.�
• yyrrmr��
CITY Ok 10WA CITY
www.icgov.org
November 20, 2018
Public Art Advisory Committee - One vacancy to fill an unexpired term, Upon
appointment - December 31, 2019 (Erin Fitzgerald resigned) and One
vacancy to fill a three-year term, January 1, 2019 - December 31, 2021.
(Term expired for Tam Bodkin Bryk)
ATTACHMENTS:
Description
✓acancy Notice & Coversheet
Board Demographic & Attendance
Boyken, Edward - Apllication
Purington, Nancy L -Application
Truitt, Andrea - Application
Wilson, Katie -Application
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMITTEE:
PUBLIC ART ADVISORY COMMITTEE
Two Vacancies:
One Vacancy: Unexpired Term
Upon appointment — December 31, 2019
and
One Vacancy: Three -Year Term
January 1, 2019 — December 31, 2021
• The duties of the Public Art Advisory Committee include: developing by-laws and procedures
for the Iowa City Public Art Program;
• administering the Public Art Program by determining the placement of public art, the type of
art to be used in a specific project, and the artist to be engaged;
• overseeing the acceptance of gifts of art;
• overseeing the maintenance and disposition of public art;
• overseeing expenditures of the Public Art Program budget;
• overseeing the Poetry in the Public Program.
• The Public Art Advisory Committee meets the first Thursday of each month at 3:30 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, November 13, 2018. An application can be
completed and submitted on the City of Iowa City website at www.icaov.ora or by contacting the City
Clerk's office.
Questions about the Iowa City Public Art Advisory Committee should be directed to Marcia Bollinger,
Neighborhood Outreach Coordinator at 319- 356-5237 or Marcia-BollingerCcDiowa-citv.ora
Board/Commission Application Cover
Board/Commission:
Public Art Advisory Committee
Two vacancies:
One to fill an unexpired term
Upon appointment -12/31/2019
and
One to fill a three-year term
1/1/2019-12/31/2021
It is hereby established, as a formal policy of the City Council of Iowa City, that each application for reappointment to
a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be
limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve.
Council Announcement Date: 10/02/2018
Application Deadline: 11/13/2018
Council Appointment Date: 11/20/2018
Date of Non -Gender Appointment: 01/02/2019
After date above Council may appoint without regard to gender
Gender Balance Requirement: 1- Male, 1 -None
Current Gender Balance: Female: 2 Male: 1
Gender
Name and Address
Male
Boyken, Edward
711 Page St
Female
Purington, Nancy L.
1706 Prairie du Chien Rd
Female
Truitt, Andrea
815 N Johnson St
Female
Wilson, Katie
1718 California Ave
Public Art Advisory Committee - Current members
fl years as
Name Term ending resident of IC
Wendy Brown (At
Large) 12/31/2019 -1st Term 45
Occupation
Retired
Gender
F
Country of
Age* Orgin*
71 USA
Sexual
Orientation* Religion*
Unitarian
Disability
Gender
Ethnicity* Identity*
Caucasian
Race*
Unique Identifiers*
Vacant 12/31/2019- Unexpired
_
—
— — -.
Vero RoseSmith(Art
DesignProfessional) 12/31/2020.-..Sst Term 3
Curator
F
26 USA
Straight-ish Atheist
- ------
White
Steven Miller (Art
Design Professional) 12/31/2020 - 1st Term lArchitect
......12/31/2021I
Vacant
M
35 USA
-- --
Heterosexual
---
Caucasian
_ _
Please note: The on provided is the inf�ton
ion provided
thea application at
PP
the time of submission.
�—
Information s voluntary
_.... _�
—Y
Public Art Advisory Committee
Attendance Record
2018
Term 1/4 2/1 4/5 5/3 617 7/12 8/2 9/6 10/4
Name Expires
Bodkin
Bryk,
O/E
x
x
x
x
x
x
O/E
O/E
Tam
01/01/19
Brown,
Wendy
01/01/20
x
x
x
x
x
x
x
X
X
Erin
Fitzgerald
01/01/20
x
x
x
x
x
x
x
x
x
Knoche,
Ron
X
x
X
x
x
x
x
x
x
Seydell-
Johnson,
Juli
x
X
x
x
X
x
x
X
x
Vero
Rose
Smith
01101/21
x
O/E
x
x
O/E
X
O/E
x
X
Steve
Miller
02/01/21
--
x
x
x
O/E
x
x
x
x
Key_
X = Present
O = Absent
O/E = Absent/Excused
--- = Not a member
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
11/13/2018
First Name
Edward
Last Name
Boyken
Home Address*
711 Page 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*
3193253277
Email Address*
eddie.boyken@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:*
Public Art Advisory Committee
Public Art Advisory Committee Category*
Art or Design Professional
Select a Board or Commission you are interested in:*
Public Art Advisory Committee
Public Art Advisory Committee Category*
At -Large
2. How long have you been a resident of Iowa City?*
31 years
3. Occupation:
Prep cook
4. Gender*
'This question is rrandatory in order for the aty to corrply with the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" rray
be provided in the Demographics sectionof the application below.
V Male
F- Female
5. Experience and/or activities which you feel qualify you for this position:*
BFA degree in Painting
2012 and 2014 Benchmarks artist
2018 public art projects with Thomas Agran - hopscotch trail and Northside mural
6. What is your present knowledge of each advisory board you are interested in?*
The Public Art Committee's main goal is to enhance public spaces while preserving and supporting Iowa City's
rich cultural history and diverse citizens. Public art can make a city more attractive to move to.
The Public Art Committee approves art projects that are on city property by determining how much public
funding goes to which art project.
The committee is also involved in advocacy work.
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 familyties, during their tenure orfor one yearthereafter.
Section 362.5 of the Code of lowagenerally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will
be asked to resign from one if appointed to another.
7. Do you currently have a conflict of Interest?
No
8. Do you currently serve on another Iowa City board or commission?*
No
Demographic Information
The City Council values all types of diversity on its Boards and Commissions. Your responses on this page
provide valuable information to the Council in achieving that goal.
In order to ensure that the Board and Commission is representative of the community and the groups(s) which
it serves, please provide your information for the following:
9. Age
31
10. Country of Origin
United States
11. Sexual Orientation
Heterosexual
12. Religion
Agnostic
13. Do you have a disability?
No
14. Ethnicity
White
15. Race
White
16. Gender identity
Cis 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.
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
10/5/2018
First Name
Nancy L
Last Name
Purington
Home Address*
1706 Prairie du Chien 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*
3195946789
Email Address*
nancyLpurington@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:*
Public Art Advisory Committee
Public Art Advisory Committee Category*
Art or Design Professional
2. How long have you been a resident of Iowa City?*
4o years
3. Occupation:*
Art & Design Consultant
4. Gender*
`This question is rrandatory in order for the City to comply w ith the State's gender balance requirerrent, which treats gender as binary. "Gender Identity" ray
be provided in the Derrographics sectionof the application below.
r Male
V Female
5. Experience and/or activities which you feel qualify you for this position:*
BFA Painting, Kansas City Art Institute, Master of Fine Arts Design UI.
Art Education Certificate K-12, Taught K -graduate levels art, art, textiles and architecture histories.
Professional Art Consultant 25 years, Woman -Owned Small Business
Member, Board Member and Director of of Arts Iowa City for 40 years.
6. What is your present knowledge of each advisory board you are interested in?*
Was a Co-author of the Public Art Proposal via the Arts/Business Committee at the Iowa City Area Chamber of
Commerce. This 1997 proposal is the foundation of the Public Art Advisory Committee that exists today. It is an
important element in municipal government and community arts advocacy.
Please contact the CityAttorneyat 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 familyties, during their tenure orfor one year thereafter.
Section 362.5 of the Code of Iowa generally prohibits, with certain important exceptions, a member of a City
Board or Commission from having an interest in a City contract.
City Council Resolution # 15-300 established a policythat the following persons shall not be eligible for
appointment to Boards and Commissions:
A Council Member's spouse, domestic partner or partner by cohabitation, children, step -children, children
for whom the Council Member assumes parental responsibility, mother, father, son-in-law, daughter-in-law,
mother-in-law, father-in-law, step-parent, brother, sister, step -siblings and half -siblings, brother-in-law,
sister-in-law, grandparents and grandchildren, aunt, uncle, niece, nephew, first cousin, foster parent, foster
child, persons who are parents of the same child, and persons with whom the employee is in an intimate
relationship
Res. #15-300 states that each application for reappointment to a City Board or Commission will be
considered without regard to incumbency. If reappointed, an individual would be limited to one reappointment
to a full term in order to increase the opportunities for new applicants to serve.
Council policy is not to permit an individual to serve on two Boards or Commissions at the same time. You will
be asked to resign from one if appointed to another.
7. Do you currently have a conflict of Interest?*
No
8. Do you currentlyserve 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
Female
12. Religion
Buddhist
13. Do you have a disability?
No
14. Ethnicity
lowaish
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*
�,•�frrrr�.r�'°J{`,1 �rfrfrr���rr
Misrepresentations on this application will constitute just cause for removal of an
appointee. If you fail to answer all the questions, except demographics, Council will not
consider your application.
You are encouraged to contact individual Council Members to express your interest in
serving.
Drop-down
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
11/5/2018
First Name
Andrea
Last Name
Truitt
Home Address*
815 N. Johnson 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*
319-359-8388
Email Address*
andrea.m.truitt@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:*
Public Art Advisory Committee
Public Art Advisory Committee Category*
At -Large
2. How long have you been a resident of Iowa City?*
4 years
3. Occupation:*
Volunteer and Community Relations Manager
4. Gender*
*This question is rrandatory in order for the oty to comply w ith the State's gender balance requirement, which treats gender as binary. "GenderIdentity" ray
be provided in the Derrographics sectionof the application below.
r Male
rJ Female
5. Experience and/or activities which you feel qualify you for this position:*
By training, I am an historian of American art and architecture, focusing on vernacular architecture and mass-
produced media representations of domestic space. I understand the ways in which art and the built
environment interact with each other, creating a sense of community. Public art is uniquely positioned not only
to enhance the aesthetic appeal of Iowa City but also to call attention to the built environment in which we live.
It is also uniquely equipped to make art publicly accessible to everyone who encounters it, which is why I am
excited that the City of Iowa City champions creative projects as a form of public service. Access to art is a
right, not a privilege, and I happily work for an organization that provides arts and cultural programming in this
same vein: I am the Volunteer and Community Relations Manager at Summer of the Arts. I would like to be a
part of the Public Art Advisory Committee in order to continue this work to bring art into the public sphere,
because I think access to art of all media is crucial to the health of our community.
6. What is your present knowledge of each advisory board you are interested in?*
The Public Art Advisory Committee oversees the City's Public Art Program and advises the City on potential
projects/needs. The program provides grants and project opportunities to artists of all media, in order to build
upon Iowa City's reputation as an artistic center and to enhance the cultural resources that the city has,
bringing art to the community at large, and acknowledging that Iowa City itself can be interpreted in different
ways for different groups.
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 familyties, during their tenure orfor one yearthereafter.
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
34
10. Country of Origin
USA
11. Sexual Orientation
There's probably a whiff of queerness on me somewhere.
12. Religion
I don't practice.
13. Do you have a disability?
No
14. Ethnicity
Western European ancestry; nothing special to which I
particularly relate
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*
oftAw-h
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
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live within city limits of Iowa City to apply
Date of Application
11/12/2018
First Name
Katie
Last Name
Wilson
Home Address*
1718 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*
515-450-6619
Email Address*
katiemayme@gmail.com
Boards & Commissions
Select a Board or Commission you are interested in:*
Public Art Advisory Committee
Public Art Advisory Committee Category*
At -Large
2. How long have you been a resident of Iowa City?*
2 years
3. Occupation:*
SEIU Office Manager
4. Gender*
*This question is rrandatory in order for the City to comply w ith the State's gender balance requirement, which treats gender as binary. "GenderIdentity" ray
be provided in the Derrographics sectionof the application below.
r Male
rJ Female
5. Experience and/or activities which you feel qualify you for this position:*
My father is an artist who ran an art studio through our home when I was growing up, and also started and ran
the Biological and Pre -Medical Illustration program at Iowa State University. I grew up surrounded by art, and
was taught how to draw, paint, and throw pottery by my father an my art instructors. In college, I pursued an
education in written and performance art, majoring in both English and Theatre with an emphasis in creative
non-fiction writing. I chose to stay in the Iowa City area after graduating largely because of the vibrant culture
of arts and music here. I am qualified for this at -large position because I am passionate about keeping our
tradition in the arts alive and well in Iowa City.
6. What is your present knowledge of each advisory board you are interested in?*
I know that the Public Art Advisory Committee oversees decisions such as making by-laws for the Public Art
Program, where public art will be put, which artist will be chosen to create the art, and maintaining the budget
for public art.
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 familyties, during their tenure orfor one yearthereafter.
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
31
10. Country of Origin
United States
11. Sexual Orientation
Heterosexual
12. Religion
Agnostic
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*
Katz- ulopk
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
Senior Center Commission
2019 - December 31, 2021.
ATTACHMENTS:
Description
vacancy Notice & Coversheet
Demographic & Attendance
Crawford, Kathleen -Application
Dorfman, Lorraine -Application
Olmstead, Harry -Application
Item Number: 20.e.
+ r
ui �1 lat
• yyrrmr��
CITY Ok 10WA CITY
www.icgov.org
November 20, 2018
- One vacancy to fill a three-year term, January 1,
(Term expired for Lorraine Dorfman)
NOTICE
THE CITY COUNCIL OF IOWA CITY IS CONSIDERING APPOINTMENT TO THE FOLLOWING COMMISSION:
SENIOR CENTER COMMISSION
One Vacancy: Three -Year Term
January 1, 2019 - December 31, 2021
• The duties of members of the Senior Center Commission are to: serve in an advisory role to
the City Council with regard to needs of the Senior Center;
• make recommendations with regard to policies and programs at the Senior Center;
• join staff and other interested persons in seeking adequate financial resources for
operation of the Senior Center;
• encourage full participation by senior citizens in the programs of the Senior Center;
• ensure that the Senior Center is effectively integrated into the community and cooperates with
organizations with common goals in meeting the needs of senior citizens;
• serves in an advocacy role with regard to the needs of senior citizens in Iowa City.
• The Senior Center Commission meets the third Tuesday of each month at 3:00 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, November 13, 2018. An application can be
completed and submitted on the City of Iowa City website at www.icciov.org or by contacting the City
Clerk's office.
Questions about the Iowa City Senior Center Commission should be directed to LaTasha DeLoach Senior
Center Coordinator at 356-5225.
Board/Commission Application Cover
Board/Commission: Senior Center Commission
One vacancy to a three- year term
1/1/2019 -12/31/2021
It is hereby established, as a formal policy of the City Council of Iowa City, that each application for reappointment to
a City Board or Commission will be considered without regard to incumbency. If reappointed, an individual would be
limited to one reappointment to a full term in order to increase the opportunities for new applicants to serve.
Council Announcement Date: 10/02/2018
Application Deadline: 11/13/2018
Council Appointment Date: 11/20/2018
Date of Non -Gender Appointment: 01/02/2019
After date above Council may appoint without regard to gender
Gender Balance Requirement: 1 -Female
Current Gender Balance: Female: 1 Male: 4
Gender Name and Address
Female Crawford, Kathleen
401 Hawkridge Dr.
Female Dorfman, Lorraine
314 Magowen Ave
Male Olmstead, Harry
1259 Shannon Dr. Apt #102
Unexpired term ending 12/31/18
Current member Housing/Comm Dev.
Full Term 9/1/15 -6/30/18
Senior Center Commission - Current members
Name
Term ending
tt years as
yea's
resident of IC
Occupation
Gender
Age`
Country of
Orgin*
sexual--
exual
Orientation*
Retired
Religion*
Disability* Ethnicity*
Kenneth Bowen
-_
12/31/2019 -Unexpired
3
Telephone Co.
M
European-
66
USA
Heterosexual
White
Hiram R_Webb_er
12/31/2019 -1st Term
40
Retired
M
71
2heryllClamon
_
12/31/2020-2ndTerm
41
Retired
F
USA
Chronic Sciatica
iobert1,nlayson
— —
12/31J2020 -1st Term
24
Attorne Y
M
72
USA
Heterosexual
—
Caucasian
acharyGoldsmith
--
Unexpired+12/31/2021
_
39
Teacher
M
47
USA
Heterosexual
Christian
Caucasian
/scant
_
vhi"n"
42
USA
Straight
Jewish
Jewish
Please note: The information provided is the information provided on the application at the time of submission.
* Information is voluntary �T ....rte---
Race* 1 Identifiers*
White
Preliminary Minutes
August 16, 2018
Senior Center Commission
Attendance Record
Name
Term Expires
9/21/17
10/26/17
11/16/17
12/14/171/18/18
X
O/E
2/16/18
3/15/18
4/19/18
5/17/1
Kenn Bowen
12/31/20
X
X
NM
X
X
X
NIM
X
X
Cheryll Clamon
12/31/18
X
X
NM
X
X
O/E
N/M
X
X
Lorraine Dorfman
12/31/19
X
X
NM
X
X
X
N/M
X
X
Robert (Scott)
Finlayson
12/31120
--
""
--
--
--
--
--
X
X
Mark Holbrook
12/31/18
O/E
X
NM
X
Kathy Mitchell
12/31/19
X
X
NM
X
X
X
N/M
X
X
Margaret Reese
12/31/17
X
X
NM
O/E
X
X
N/M
X
X
Hiram (Rick)
Weber
12/31/20
X
X
NM
X
O/E
X
N/M
X
X
Key: X = Present
O = Absent
O/E = Absent/Excused
NM = No meeting
-- = Not a member
6/21118
X
7/19/18
X
8/16118
X
O/E
X
X
O/E
X
X
O/E
X
X
X
--
--
X
X
X
X
X
X
4
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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*
`This question is rrandatory in order for the Oty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Demographics sectionof the application below.
F Male
W Female
5. Experience and/or activities which you feel qualifyyou 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 familyties, during their tenure orfor one yearthereafter.
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?*
N
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*
Calf/.�-Ff �: jtrT�rlrr.�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.
Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 LITERATURE
NOTE: Must be 18 years of age and live Within city limits of Iowa City to apply
Date of Application
10/19/2018
First Name
Lorraine
Last Name
Dorfman
Home Address*
314 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*
319-337-5102
Email Address*
lorraine-dorfman@uowa.edu
Boards & Commissions
Select a Board or Commission you are interested in:
Senior Center Commission
2. How long have you been a resident of Iowa City?*
50 years
3. Occupation: *
Professor (retired)
4. Gender*
'This question is rrandatory in order for the aty to comply with the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Dermgraphics sectionof the application below.
r Male
17 Female
5. Experience and/or activities which you feel qualify you for this position:*
I have been filling an unexpired term on the Senior Center Commission for almost two years, a position I find
very interesting and worthwhile. I now wish to apply for my own three-year term. I have been an active
participant and volunteer at the Senior Center for the past eight years, and am currently a member of the
Program Committee, which I chaired for three years. In that capacity, I served on the Steering Council of the
Center for three years. My background is in the field of aging; I am an emeritus professor in the UI School of
Social Work and the Aging and Longevity Studies Program, where I taught classes and did research on aging
for many years. I am also a former director of the UI interdisciplinary Aging Studies Program. Related
community activities include my current membership on the Johnson County Task Force on Aging and serving
as patient advocate for the Specialized Program of Research Excellence (SPORE) Lymphoma grant at the UI
Holden Comprehensive Cancer Center, which has been ongoing for 17 years.
6. What is your present knowledge of each advisory board you are interested in?*
As stated above, I have been serving an unexpired term on the Senior Center Commission for almost two
years and feel I am well acquainted with its purpose and functions. I think the Commission plays an especially
valuable role now since there is new leadership at the Center and with it the potential for moving forward in a
number of new directions.
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 familyties, during their tenure orfor one yearthereafter.
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
83
10. Country of Origin
USA
11. Sexual Orientation
Heterosexual
12. Religion
Jewish
13. Do you have a disability?
No
14. Ethnicity
Polish/Ukrainian
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.
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Advisory Board/Commission Application Form
R. This application is a public document and as such can be reproduced and distributed for
ww®'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 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 rrandatory in order for the Oty to comply w ith the State's gender balance requirement, which treats gender as binary. "Gender Identity" rray
be provided in the Demographics sectionof the application below.
rJ Male
r Female
5. Experience and/or activities which you feel qualifyyou 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 familyties, during their tenure orfor one yearthereafter.
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
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)
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.
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