Chris P. Growaldr
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t\VA I A AA It AC
DIVERSITY STATISTICS REPORTING
Name: V s S 9
Gv-c,
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Board r / Committee: P` r 1 a. i tee; Co r e' / r v',ct1 r--a,c); r
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Appointment Date: a, f 4�
Pursuant to City of Miami- Beach Or..dinancet.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 Female
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Race/Ethnic Categories
What is your race?
i African-American/Black
`° -Caucasian/W hite
LI Asian or Pacific Islander •
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Native-American/American Indian
• Other Print Race: r. -
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish, Hispanic, Latino/a.
No
D Yes .
Do you consider yourself Physically Disabled?
NW No
Yes
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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