HomeMy WebLinkAbout2017 Climate Action Steering Committee -application-forweb
Climate Action Steering Committee
Application Form
This application is a public document and as such can be reproduced and distributed for the
public. This application will be considered for this committee only.
Date of Application _______________________________________________________
Name __________________________________________________________________
Home Address ___________________________________________________________
Contact phone number ___________________ Email Address ____________________
Is your home address within the corporate limits of Iowa City? ______________
How long have you lived in Iowa City? ______________
Occupation: ______________________________
Gender: Male _____ Female _____
What is your present knowledge of this steering committee?
Please summarize your employment history and education experiences which you feel qualify
you for this position.
Please list your experience with any organizations that you have participated in that might be
relevant to this steering committee and include your role in the organization (number of years
you have been a member, any positions held, etc.).
If chosen for this committee, how do you see yourself representing this work to others in the
community? What groups of people, places of employment, etc. are you connected to that you
could inspire others to begin some of the initiatives that the steering committee recommends?
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.
The City Council values all types of diversity on its boards and commissions. Your responses
on this page provide valuable information to the Council in achieving that goal.
In order to ensure that the board and commission is representative of the community and the
groups(s) which it serves, please provide your information for the following:
Age _____
Country of Origin ____________________________________
Sexual Orientation ____________________________________
Religion ____________________________________________
Do you have a disability? Yes____ No ____
Race, Color or Ethnic Group ____________________________
*Note:
The Climate Action Steering Committee strives to ensure the Committee 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)
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.