Daniel VeitiaI
MIAMI BEACH
DIVERSITY STATISTICS REPORTING
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Name. ba �
Board / Committee: 4 �,
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Appointment Date: 3 /`.)
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Pursuant to City of Miami: Beach Ordinance 2`009-3632, the City is required to annually
prepare and present a report to the City Commission identifying the City's diversity
statistics. This form allows board and committee applicants and members to voluntarily
self-identify their race, ethnicity, disabled status and gender.
Please check the appropriate box for each category:
Gender: Male Female liD
Race/Ethnic Categories
What is your race?
La African-American/Black
1 Caucasian/White
Asian or Pacific Islander
U Native-American/American Indian
U Other— Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the t`No"box if not
Spanish, Hispanic, Latino/a.
o
Yes
Do your-consider yourself Physically Disabled?
0
U Yes
C:\Users\CENTFraN\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\NP4J9CNX\BC minority
information form 05-20-13 FINAL.doc
Updated: Monday,January 26,2015
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