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Beverly Heller Application package \A B A C".-o B=� r AN y :;� _TTXEE Pig t ,N OPI- .a4�r'-� ,.� V v:..t�4 3 i 3 L��'� t`i..1�7'��lt.i'i; ��.J��.9�� Last Name First ame Middle Initial 99 if LA Cmr2CE I)W�f M 4&\' , - 4 V L- V--0 Home Address City State Zip Code S �s 2 3 t3 4,�e 11Q(z®gym L•��► Home Telephone Work Telephone Cellular Telephone Email address Business Name Occupation Business Address City State Zip Code Professional License(describe): Expires: Please attach a copy of currently effective professional license. Pursuant to City Code section 2-22(4)a & b: Members of agencies, boards and committees shall be affiliated with the City; this requirement shall be fulfilled in the following ways: a. An individual shall have been a resident of the City for a minimum of six months; or b. An individual shall demonstrate ownershipCnterest for a minimum of six months in a business established in the City for a minimum of six months. ,�,� • Resident of Miami Beach for a minimum of six(6) months: Yes�or No • Demonstrates ownership/interest in a business in 'ami Beach for a minimum of six months: Yes[D or No • Are you a registered voter in Miami Beach: Yes[A or No • I am now a resident of: North Beach 1..J South Beach [Z] Middle Beach • I am a plying for F appoin ent because I have special abilities knowledg and exper'ence. Please list b low: t3 wl.�) l V C.Av� c `(- 111 " 0, (�, iCfy-��L 21 1k cl&aL,vr 42in C,�o uv� c p S oa •Are you presently a registered lobbyist with the City of Miami Beach?Yes 1:3 or No , Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three 3 choices will be observed by the City Clerk's Office. ❑Affordable Housing Advisory Committee ❑Fine Arts Board ❑Normandy Shores Local Government Neighborhood Improvement ❑Art in Public Places Committee ❑Disability Access Committee arks and Recreation Facilities Board ❑Beautification Committee ❑Gay, Lesbian, Bisexual and Transgender ❑ Personnel Board Enhancement Committee GLB ❑Bicycle-Pedestrian Advisory Committee ❑Golf Advisory Committee ❑Planning Board ❑Board of Adjustment* ❑Health Advisory Committee ❑Police Citizens Relations Committee ❑Budget Advisory Committee ❑Health Facilities Authority Board ❑ Production Industry Council ❑Capital Improvements Projects ❑ Hispanic Affairs Committee ❑Safety.Committee Oversight Committee ommittee on the Homeless ❑ Historic Preservation Board ❑Single Family Residential Review Panel ommittee for Quality Education in MB ❑Housing Authority ❑Sustainability Committee ❑Community Development Adviso ❑Loan Review Committee ❑Tennis Advisory Committee ❑Community Relations Board ❑Marine Authority ❑Transportation and Parking Committee ❑Convention Center Advisory Board Miami Beach Commission for Women 0 Visitor and Convention Authority ❑ Debarment Committee ❑Miami Beach Cultural Arts Council 'b Youth Center Advisory Board °O ❑Design Review Board* ❑Miami Beach Human Rights Committee ❑Waterfront Protection Committee ❑Miami Beach Sister Cities Program Page 1 of 4 °O Note: If applying for Youth Center AdvissorryyBo d,lplease indicate your affiliation with the Scott Rakow Youth Center: MCAMk-w% -T-KCm'J*—G7�,1. Past service on the Youth Center Advisory Board:Yes No Dates of Service: 2. Present participation in Youth Center activities by youF children:Yes No ED If yes, please list below the names++of++your`children,their ages and the programs in which they participate: Child's name: f1V\riej C C 1` Age: vin m' � g � Program: W C-2 Child's name: Age: Program: • Have you ever been convicted of a felony?Yes _.�. or No L0 If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach Code?Yes[.-:I or NZI If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money?Yes 1-D or No If yes,explain in detail: •Are you currently serving on any City Board or Committee?Yes Z)or No If yes,which board/committee? • In what organization(s)in the City of Miami^Beach do you currently hold membership? Name Position A f? -11 c- it NR-wy�,lk� Name Position • List all properties owned or in which you have an interest within the City of Miami Beach: ow�L 15 91 •Are you now employed by the City of Miami Beach?Yes ID or No _ Which department and title? • Pursuant to City Code Section 2-25 (b): Do you have a parent ID, spouse , child brother EJ or sister 1.1 who is employed by the City of Miami Beach?Check all that apply. If"Yes,"identify person(s) and department(s): The following information is voluntary and is neither part of your application nor has any bearing on your consideration for appointment.It is being asked to comply with City diversity reporting requirements. Gender: Male L=J Female LO Race/Ethnic Categories What is your race? African-American/Black EJ Caucasian/White ED Asian or Pacific Islander Native-American/American Indian ED Other—Print Race: Page 2 of 4 Do you consider yourself to be Spanish, Hispanic or Latino/a?Mark the "No"box if not Spanish, Hispanic, Latino/a. No Z)Yes Do yqu consider yourself Physically Disabled? No ED Yes NOTE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARDICOMMITTEE MEMBERS.THESE LAWS INCLUDE, BUT ARE NOT LIMITED TO: • Prohibition from directly or indirectly lobbying City personnel(Miami Beach City Code section 2-459). • Prohibition from contracting with the City(Miami-Dade County Code section 2-11.1). • Prohibition from lobbying before the board/committee you have served on for period of one year after leaving office(Miami Beach City Code section 2-26). • Requirement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11.1). • CMB Community Development Advisory Committee: prohibition, during tenure and for one year after leaving office, from having any interest in or receiving any benefit from Community Development Block Grant funds for either yourself, or those with whom you have business or immediate family ties (CFR 570.611). • Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic right of access to most meetings of boards, commissions and other governing bodies of state and local governmental agencies or authorities. • Voting conflict—Form 8B is for use by any person serving at the county, city or other local level of government on an appointed or elected board, council, commission, authority or committee. It applies equally to members of advisory and non-advisory bodies who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes. Upon request,copies of these laws may be obtained from the City Clerk. I HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION; AND I HAVE RECEIVED, READ AND WILL ABIDE BY CHAPTER 2, ARTICLE VII, OF THE MIAMI BEACH CITY CODE, ENTITLED "STANDARDS OF CONDUCT FOR CITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND STATUTES ACCORDINGLY." Applicant's Sig ature Date Name of Applica t(PLEASE PRINT) Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date PLEASE REMEMBER TO ATTACH A CURRENT RESUME, PHOTOGRAPH AND A COPY OF ANY APPLICABLE PROFESSIONAL LICENSE. ATTACH ADDITIONAL SHEETS, IF NECESSARY, TO PROVIDE REQUIRED INFORMATION. Page 3 of 4 i M 1 � \� B EACH City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK'S OFFICE CityClerkCmiamibeachfl.gov Telephone: 305.673.7411 Fax: 305.673.7254 Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami- Dade County Financial Disclosure Code Provision Code Section 2-11.1(1) (2) Board Member's Name: I understand that no later than July 1, of each year all members of Boards and Committees of the City of Miami Beach, including those of a purely advisory nature, are required to comply with Miami-Dade County Financial Disclosure Requirements. This means that the members of City Advisory Boards, whose sole or primary responsibility is to recommend legislation or give advice to the City Commission, must file, even though they may have been recently appointed. One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida, no later than 12:00 noon of July 1, of each year. 1. A"Source of Income Statement" For your convenience, the form is attached. The form can also be downloaded at: http://www.miamidade.gov/elections/Library/source of income statement.pdf 2. A"Statement of Financial Interests (Form 1)" For your convenience, the form is attached. The form can also be downloaded at: http://www.ethics.state.fl.us/ethics/forms.html 3. A Copy of your 2012 Federal Income Tax Return Failure to file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine of no more than $500, 60 days in jail or both. �&� �W� Signature Date F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application revised 5-22-13 FINAL.doc Updated:Tuesday,September 24,2013 Page 4 of 4 BEVERLY B. HELLER 5916 LaGorce Drive Miami Beach, FL 33140 305-864-1539 Experience Union Miami Dade,FL • Executive Board:Vice President Elementary Education • Steward: Fienberg-Fisher Elementary;Fienberg-Fisher Adult and Community School • Summer Intern • Chairperson:Jewish Education Labor Committee(UFT-National Labor Committee) • Co-Chairperson: Multi-Cultural Committee • Chairperson: Economic Services Committee • Convention Representative:NEA,AFT,AFL/CIO • District 3 Legislative Liaison Leader • Active Committee(s) Member: Internal Functions, Professional Issues, Contract Negotiations, Legislative, and Black and Hispanic Caucuses. School and Community Miami Dade,FL • Educator, 30 years,Pre-K through Adult • Project Initiator, Organizer and Director: 21St Century Community Program-3 years • Program Coordinator: DCPS Early Childhood Division • Grant Writer: Schools of Choice and Parental Involvement • Curriculum Writer: DCPS Advanced Academics-Gifted Division • Competency Based Curriculum Coordinator: DCPS Social Studies Department • Co-Producer/Writer: DCPS Parent/Child Activities Calendar • Media Representative/"Ambassador":Miami Beach,Mayor Doaud • Chairperson: Educational Excellence School Advisory Committee, DCPS Council of Advisory Committees, DCPS Magnets and Schools of Choice Advisory Committee,DCPS Magnets and Schools of Choice Advisory Committee,DCPS Oversight Committee,DCPS Citizens Advisory Committee,DCPS Gifted/Advanced Academics Advisory Committee,Dade County Council PTSA,and Miami Beach Feeder Pates. _ • Board Member: Miami Beach JCC,Jewish Federation,Jewish Family Service}D° -�'�''� 'l 1 15A • Member: Association of Supervision and Curriculum Development,American Association of University Women,Miami Beach 2yAlity Education,Jewish Community Relations Council,Phi Delta Kappa, Women's American ORT Deli`aZ pa Pi,UTD,Miami Beach Chamber of Commerce, Florida Association of Gifted,and National Association of Gifted • President: Homeowner's Association-Lz_Go-t,:a4 esj� . • State Membership Chairperson: Women's American ORT Recent Awards • Miami Beach Elayne Weisburd Award,Teacher of the Year • North Bay Village Optimist Club Educator of the Year • Feinberg-Fisher Math Teacher of the Year • Elementary School Teacher of the Year • Miami Beach Mayor's Key to the City • Various Community and Committee Awards including: PTSA,JCC,DCSAC,Homeowner's Association,FLAG • Who's Who Awards(State and National) Education Specialist--Educational Leadership,Nova University of Florida Master of Science--Education,Hunter College of New York Bachelor of Business Administration--Management and Salesmanship, City College of New York