Samuel J. Rabin, Jr. , • . ' - ■-
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D I vE RS riff STATIST!egi REPORTING
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Name: \_.) 0 rn Li e- I --J a P.---- a
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Board / Committee: H i a (n• 0 co di 0 i --1-urJ A cfs Gur)C. I
Appointment Date: 3 i I ( l 6
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 .J Female U
Race/Ethnic Categories
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What is your race?
. U African-American/Black .,,,,,,,,,i'' '''l':''i:71-''''' . •
Caucasian/White „--- .-• -13.t. — - - —
. , l Asian or Pacific Islander ,
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U Native-American/American Indian
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Zli Other— Print Race: . „..
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish, Hispanic„Latino/a.
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Yes /....
Do yqu-considerytiiiiiellf Physically Disabled?
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CAUsers\CENTFraN\AppData\Local\Microsoft\VVindows\Temporary Internet Files\Content.Outlook\NP4J9CNX\BC minority .
information form 05-20-13 FINAL.doc
Updated: Monday,January 26,2015 .
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