Brian Widerman ivt\ 1 AAA E j
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DIVERSITY STATISTICS REPORTING
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Board / Comm e: -7 c,e
Appointment Date: 2 Z- I
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:
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Gender: Male Female
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Race/Ethnic Categories .
What is your race?
ican-American/Black .
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Caucasian/White
Asian or Pacific Islander
Native-American/American Indian
La Other Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish, Hispanic, Latino/a.
No .
Yes .
Do y u consider yourself Physically Disabled? .
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No
La 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 •