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DIVERSITY STATISTICS REPORTING
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Board / Committee: C
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Appointment Date:
• Pursuant to City of Miami Beach Ordinance 2009-3632, the City is required to annually V
prepare and present a repOrt to the City Comm-isi6ri 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 Female,
Race/Ethnic Categories
• What is your race?
\t„ glAfriean-American/Black
-- iCaucasian/White
•
Ul 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.
RAI No
Yes
_ Do you consider yourself Physically Disabled?
No
Yes
•
CAUsers\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