Reagan Pace AA IAN\ I I
DIVERSITY STATISTICS REPORTING
Name: 14f.fayo, Pce_
Board / Committee:
ry V) ;. o
nt Date:
Appointment /
� .
Pursuant to City of Miami Beach Ordinance 2009-3632, 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:
rn
Gender: Male Femal-
Race/Ethnic Categories
What is your race?
frican-American/Black
aucasian/White
Asian or Pacific Islander
Native-American/American Indian
I:1 Other— Print Race: V
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish, Hispanic, Latino/a.
Yes
Do you consider yourself Physically Disabled?
Zji Flo
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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