Ricardo DopicoI
/4,0 Am I BEACH
DIVERSITY STATISTICS REPORTING
Name: + c_!f Cf vfi) f L U
Board / Committee: C.J '( (ir � �: i l 74c ( -
Appointment Date: / 2
Pursuant to City of MliamiLBeach �.rdinance\2009-3.632, tlw City is required to annually
prepare and present a report to the City Corrh ission`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. j
•
r .
Please check the appropriate box for each category:
Gender: Male /Female .
Race/Ethnic Categories
What is your race?
can-American/Black
Caucasian/White
Asian or;Pacific Islander
NativejAmerican/American Indian
Otherr! Print Race:
Do youlconsider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanis�h, Hispanic, Latino/a.
1-1 N��
es
Do you consider yourself Physically Disabled?
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