Dawn L. McCall M ANA s,
•
DIVERSITY STATISTICS REPORTING
A-c,J/J L. Mc `. 4 LName.
Board / Committee (1c,11
(Arc.1 A r 1S 00ak,r,
Appointment Date:
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:
Gender: Male Li Female czi •
Race/Ethnic Categories
What is your race?
African-American/Black
Wi Caucasian/White
Ui Asian or Pacific Islander
Z Native-American/American Indian
IZI1 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
La Yes
Do you consider yourself Physically Disabled?
No
Ui Yes
•
C:\Users\CENTFraN\AppData\Local\Microsoft\Windows\Temporary.Internet Files\Content.Outlook\NP4J9CNX\BC minority
information form 05-20-13 FINAL.doc j
Updated: Monday,January 26,2015