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2. Individuals serving on Boards and Commissions play an important role in advising the City Council on matters of interest to our community and its future. The City Clerk's Office, City Hall, 50 West 13th 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 in the Clerk's Office. Applications to multiple vacancies and/or reappointment requests requires separate applications.
4. Please complete the online application and separate optional demographic information below
6. Personal Information
8. Select the Board, Commission, or Committee applying for:*
   -- Select One --Airport CommissionAirport Zoning CommissionAirport Zoning Board of AdjustmentArts and Cultural Affairs Advisory CommissionBuilding Code Advisory and Appeals BoardCable Television CommissionCatfish Creek Watershed Management AuthorityCivic Center CommissionCivil Service CommissionCommunity and Police Relations CommitteeCommunity Development Advisory CommissionHistoric Preservation CommissionHousing Appeals and Mediation Board Housing CommissionHousing Trust Fund Advisory CommitteeEquity and Human Rights CommissionInvestment Oversight Advisory CommissionLibrary Board of TrusteesLong Range Planning Advisory CommissionPark and Recreation Advisory CommissionResilient Community Advisory CommissionTransit Advisory BoardZoning Advisory CommissionZoning Board of Adjustment
10. Please identify which opening on the Airport Zoning Commission your qualifications represent:*

    1. City Zoning Advisory Commission Representative
    2. At-Large
12. Please identify which opening on the Airport Zoning Board of Adjustment your qualifications represent:*

    1. City Zoning Board of Adjustment Representative
    2. At-Large
14. Please identify which opening on the Arts and Cultural Affairs Commission your qualifications represent :*

    1. At-Large Living or working in the cultural and entertainment district
    2. Arts Rep
    3. Business Professional
    4. Business Professional living or working outside of the Business District
16. Please identify which opening on the Advisory and Appeals Board your qualifications represent:*

    1. Residential Construction Professional
    2. Commercial Construction Professional
    3. Electrical Construction Professional
    4. Plumbing Construction Professional
    5. (HVAC) Construction Professional
    6. Multidisciplinary Representatives, an Architect
    7. Multidisciplinary Representatives, an Engineer
    8. Multidisciplinary Representatives, a Building Designer
    9. Multidisciplinary Representatives, a General Construction Professional
18. Please identify which opening on the Community Development Advisory Commission your qualifications represent:*

    1. At-Large
    2. Housing Commission Representative
    3. Low to Moderate Income Area Representative
20. Please identify which opening on the Historic Preservation Commission your qualifications represent:*

    1. Living within the W. 11th District
    2. Living within the Langworthy District
    3. Living within the Old Main District
    4. Living within the Cathedral District
    5. Living within the Jackson Park District
    6. At-Large
    7. Architect At-Large
22. Please identify which opening on the Housing Appeals and Mediation Board your qualifications represent:*

    1. I am a landlord and a resident of Dubuque, IA.
    2. I am a renter in Dubuque, IA.
    3. Other (please indicate below)
24. If other, please explain:
26. Please identify which opening on the Housing Commission your qualifications represent*

    1. I participate in the Section 8 Program
    2. Experience in real estate, banking, finance, accounting, funds management, or other related areas of expertise
    3. At-Large
28. Please identify which opening on the Housing Trust Fund Advisory Committee your qualifications represent:*

    1. Experience in real estate, banking, finance, accounting, funds management, or other related areas of expertise
    2. Housing Commission Representative
30. Please identify which required criteria you possess to qualify for the Resilient Community Advisory Commission*

    1. Interest and/or expertise in economic prosperity
    2. Interest and/or expertise in environmental integrity
    3. Interest and/or expertise in social/cultural vibrancy
    4. Think systemically and analyze data
    5. Current member of the Arts and Cultural Affairs Advisory Commission
    6. Current member if the Catfish Creek Watershed Management Authority
    7. Current member of the Community Development Advisory Commission
    8. Current member of the Historic Preservatiuon Commission
    9. Current member of the Housing Commission
    10. Current member of the Equity and Human Rights Commission
    11. Current member of the Long Range Planning Advisory Commission
    12. Current member of the Parks and Recreation Advisory Commission
    13. Current member of the Transit Advisory Commission
    14. Current member of the Zoning Advisory Commission
32. Name:*
34. Please enter the best way to pronounce your name below:

    Example Name: Petrona Dominguez
    Pronunciation: [Peh-Tro-Nuh  Dough-Mean-Gezz]

36. How did you hear about City of Dubuque Boards and Commission?*

    1. City of Dubuque Website
    2. City Life or another City of Dubuque Program
    3. City of Dubuque Social Media
    4. Through a Friend
    5. Other:
37. If other, please specify:
39. Gender (choose all that apply) Note: Some City Boards/Commissions are subject to the gender balance requirement in Iowa Code Section 69.16A*

    1. Man
    2. Woman
    3. Trans or transgender
    4. Another identity
40. If trans or transgender please specify:
41. If another identity please specify:
43. Street Address: PLEASE NOTE: you must live within the Dubuque city limits to apply/serve on a City of Dubuque board or commission. *
45. City*
46. State*
48. Zip Code:*
50. Preferred Phone Number:*
52. Email Address(es):*
54. Place of Employment:
56. Business Phone Number:
58. Job Title/ Duties:
60. Please list your experience, skills and or education that have prepared you for service on this board/commission:*
62. What contributions can you make or state reason for applying?*
64. Describe your experience working in diverse environments:*
66. Describe your experience engaging other community members to gather their input and opinions:*
68. List two references: (Include their name and phone number)*
70. Are you currently serving on other Boards, Commissions, or Committees?*

    1. Yes
    2. No
71. If yes, which?
73. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No
74. If yes, which?
76. Have you participated in the City Life program?*

    1. Yes
    2. No
77. If so, when?
79. Have you participated in the Intercultural Competency Program offered through the City of Dubuque or other organizations?*

    1. Yes
    2. No
80. If yes to the above question, please list the orginization that offered the program and the date of completion:?
82. This application is a public document and as such can be reproduced and distributed for the public. Each application for reappointment to a City Board or Commission will be considered without regard to incumbency. Misrepresentations on this application will constitute just cause for removal of an appointee. Specific attention should be directed to possible conflict of interest. For further clarification, if a situation arises, contact the City Clerk's Office or the City Attorney's Office.
84. Signature (type your name here as electronic verfication):*
86. Date:*
Leave This Blank:


88. 1. Receive an email copy of this form.
89. Email address

    This field is not part of the form submission.

90. Submit

* indicates a required field