Roberto Rovirar ,
1
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AA I A NI I 1.„,.,. 1""Act-1
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DIVERSITY STATISTICS REPORTING
Name:• j's-c-'';'•-)1-1"-) 12'°v1/2A
Board / Committee: . — .
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Appointment Date: /7 Tyi-- 70!.5"
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.
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Please check the appropriate box for each category:
Gender: Male Mc] Female I-- , , •
, • ...„
:, , •
_ , . , , i ?7-•
Race/EthniC Categories
What is your race?
IZ3 African-American/Black
Zi Caucasian/White
rja Asian or Pacific Islander
Native-American/American Indian •
Other— Print Race: - . 7 • , _
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish,Qtspanic)Latino/a.
ID No ..,
I,1-tYes .
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Do you,consider yourself Physically Disabled?
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LDi yes
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CAUsers\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