Updated Boards and Commissions Application and Demographic Information Copyrighted
December 2, 2024
City of Dubuque CONSENT ITEMS # 8.
City Council
ITEM TITLE: Updated Boards and Commissions Application and
Demographic Information
SUMMARY: City Clerk providing an updated application and
demographics information for boards and commissions.
SUGGUESTED Receive and File
DISPOSITION:
ATTACHMENTS:
1. Staff Memo
2. Updated Application
3. Updated Demographics Information
Page 148 of 645
DUbU Ue City Clerk's Office
THE CITY OF � City Hall
50 W. 13�h Street
DT T� � All-AmericaCity Dubuque, IA 52001-4864
U (563)589-4100 office
(563)589-0890fax
ctyderk@cityofdubuque.org
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TO: Mayor Brad M. Cavanagh and Members of the City Council
FROM: Adrienne Breitfelder, City Clerk
DATE: November 26, 2024
SUBJECT: Updated Boards and Commissions Application and Demographic
Information
The City Clerk's Office is providing a copy of the revised application and demographics
information for Boards and Commissions. With the elimination of state gender balance
requirements, the gender question has been removed from the application and remains
an optional question included in the demographics information. Additionally, the question
regarding occupation has been replaced with a more inclusive prompt asking applicants
to describe the experiences, including professional experiences, that have prepared them
for service on a board or commission. This update was made in consultation with Equity
and Human Rights staff, who recommended this approach as less intimidating,
particularly since most boards and commissions do not have specific job requirements.
Of note, the Building Code Advisory and Appeals Board does have requirements for
professional expertise, as most of its members must be professionals in residential
construction, commercial construction, electrical construction, plumbing construction, or
heating, ventilation, and air conditioning (HVAC) construction. For online applications,
applicants selecting this board will see an additional question asking them to indicate their
trade qualification. For paper applications, staff will follow up with applicants to confirm
their relevant qualifications.
The demographics information has been updated to include reworded and additional
questions. Providing demographic information is entirely optional and is kept confidential
by the City Clerk's Office. This information is collected to assess the current demographic
composition of boards and commissions, evaluate diversity, and inform potential
strategies for targeted recruitment.
This information is provided for City Council to receive and file.
cc: Michael Van Milligen, City Manager
Crenna Brumwell, City Attorney
Cori Burbach, Assistant City Manager
Trish Gleason, Assistant City Clerk
Page 149 of 645
Gisella Aitken-Shadle, Chief of Equity and Human Rights
Ann Marie Jannette, Equity and Human Rights Specialist
Page 150 of 645
Dubuque
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BOARD/COMMISSION APPLICATION
This application is a public document and as such can be reproduced and distributed for the public.
Specific attention should be directed to possible conflicts of interest. For further clarification, if a situation
arises, contact the City Clerk's Office or the City Attorney's Office.
The City Clerk's Office, City Hall, 50 West 13t" Street, Dubuque, IA. accepts applications for any Board
and/or Commission at any time. Applications stay active for one year from the date of receipt.
General Eliqibility Requirements for All Boards and Commissions
Note:Additional requirements may apply to certain boards and commissions. Please refer to the specific
board/commission details for more information.
• Residency within the corporate city limits
• Minimum age of 18
• Cannot be employed by the City of Dubuque
BOARD/COMMISSION APPLYING FOR:
NAME:
PRONUNCIATION:
**Example Name: Petrona Dominguez
**Pronunciation: [Peh-Tro-Nuh Dough-MlN-Gezz]
STREET ADDRESS: ZIP:
You must live within the corporate city limits of Dubuque to be eliqible for a citv board or commission
PREFERRED PHONE NUMBER: ( ) -
E-MAIL ADDRESS(ES):
1. HOW DID YOU HEAR ABOUT CITY OF DUBUQUE BOARDS AND COMMISSIONS?
❑ City of Dubuque Website, ❑ City Life or another City of Dubuque Program,
❑ City of Dubuque social media, ❑ Through a friend,
❑ Other: Please specify:
2. HAVE YOU PARTICIPATED IN THE CITY OF DUBUQUE CITY LIFE PROGRAM: ❑ YES ❑ NO
If so, when?
3. ARE YOU CURRENTLY SERVING ON A CITY BOARD OR COMMISSION: ❑ YES ❑ NO
If yes, which?
4. HAVE YOU SERVED ON A CITY BOARD OR COMMISSION BEFORE: ❑ YES ❑ NO
If yes, which?
Page 151 of 645
For this section, please feel free to attach additional pages if necessary.
WHY ARE YOU INTERESTED IN APPLYING FOR THIS BOARD OR COMMISSION?
DESCRIBE YOUR EXPERIENCES (PROFESSIONAL, PERSONAL, OR VOLUNTEER), SKILLS,
AND/OR EDUCATION THAT HAVE PREPARED YOU FOR SERVICE ON THIS BOARD/COMMISSION:
SHARE YOUR EXPERIENCE WORKING IN DIVERSE ENVIRONMENTS:
LIST TWO PROFESIONAL REFERENCES: (Examples: employer, coworker, client, vendor, mentor,
volunteer organizer, etc.)
NAME:
PHONE NUMBER:
RELATIONSHIP:
NAME:
PHONE NUMBER:
RELATIONSHIP:
ACKNOWLEDGEMENT
I acknowledge that I have accurately and truthfully completed the application to the best of my
knowledge. I also confirm that I meet the eligibility requirements for the board or commission to
which I am applying.
SIGNATURE:
DATE:
Page 152 of 645
INTRODUCING YOURSELF TO THE CITY COUNCIL:
Once there is a vacancy for the board or commission you are applying for, your application will be reviewed
by the City Council at a regular City Council meeting and appointed at a subsequent meeting.
1. You are encouraged to attend the Application Review meeting to briefly introduce yourself to the
City Council and be available for any questions regarding your application. The City Clerk's Office
will inform you of the meeting date via email.
2. If you are not able to attend the meeting to introduce yourself, please consider sending the City
Council an email to introduce yourself and state your reasons for applying. You can contact the
City Council directly at www.cityofdubuque.orq/councilcontacts Fill in the required sections and
select "City Council" as the department. Your message will be received by each of the council
members.
3. If attending in person, during the Boards and Commissions section on the agenda, the Mayor will
ask if there is anyone present to speak to the application.
4. Step to the podium, state your name and address and then tell the City Council a little bit about
yourself and why you would like to serve on the board or commission.
5. Please keep your comments to less than 5 minutes. City Council meetings begin at 6:30 p.m. in
the second-floor Council Chambers of the Historic Federal Building, 350 W. 6th Street.
At a subsequent City Council meeting, the City Council will appoint applicants to the vacant term(s). The
City Clerk's Office will notify you if you are appointed via email.
Please contact the City Clerk's Office, City Hall, 50 W. 13th St., Dubuque, IA 52001.
563-589-4120; ctyclerk(a�cityofdubuque.orq if you have questions.
Thank you for your interest in the City of Dubuque Boards and Commissions.
Page 153 of 645
TI-iL CITY C7F
Demographic Information DUB E
OPTIONAL
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The Dubuque City Council values diversity on its boards and commissions. Your responses on this page
provide valuable information to the Council to examine whether its boards and commissions are
representative of the community it serves and help the City Clerk's Office in examining whether we are
reaching a diverse audience with our vacancy notifications for the boards and commissions.
Providing the following information is optional. It is considered confidential and will not be
associated with individual applicant information nor used in the selection process.
1. GENDER (choose all that apply):
❑ Female ❑ Male ❑ Other
2. WHAT IS YOUR AGE RANGE?
❑ 18-24 ❑ 25-34 ❑ 35-44 ❑ 45-54 ❑ 55-64 ❑ 65 or older
3. PLEASE SPECIFY YOUR RACE AND/OR ETHNICITY (please check all that apply):
❑ American Indian/Alaskan native, ❑ Asian, ❑ Black/African American,
❑ Hispanic/Latino, ❑ Native Hawaiian/Other Pacific Islander, ❑ White,
❑ Other Please specify
4. HIGHEST EDUCATION ATTAINED:
❑ High school diploma ❑ Bachelor's degree or higher
5. DO YOU IDENTIFY AS LGBTQ+?:
❑ YES ❑ NO
6. DO YOU IDENTIFY AS A PERSON WITH A DISABILITY?
❑ YES ❑ NO
7. ARE YOU A MILITARY VETERAN?
❑ YES ❑ NO
8. WHAT IS YOUR PRIMARY LANGUAGE?
❑ ENGLISH ❑ SPANISH ❑ MARSHALLESE
❑ OTHER (PLEASE SPECIFY)
9. WHAT IS YOUR CURRENT OCCUPATION?
Federal law prohibits discrimination on the basis of race, color, religion, disability, sex, or national
origin, as well as discrimination on the basis of age against persons over the age of 40. Some
state and city legislation prohibits discrimination on the basis of age, marital status, sexual
orientation, gender identity, race, color, religion, sex, national origin, or any other basis prohibited
by law.
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