Janda E. Wetherington 4
i\A Ami
DIVERSITY STATISTICS REPORTING
•
Name.
Board / Committee: /11"
/
Appointment Date: // 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:
Gender: Male I i Female V3
Race/Ethnic Categories
What is your race?
•
La African-American/Black
• IZ3 Caucasian/White
Li Asian or Pacific Islander
Native-American/American Indian
LDI 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 you consider yourself Physically Disabled?
No .
D 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 .