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DIVERSITY STATISTICS REPORTING
Name: It C '' ''#
Board / Committee: L)
Appointment Date: . 1 Ce"
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City of Miami Beac Ordinance 2009-3632, the City is required to annual)
Pursuant to C y Y q 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. e: ;:
Please check ther`appropriate.box for each category:
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Gender:rale ELFale� : .- ; : : „,_ t,, r> /4-:,./,./.2...
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Race/Ethnic Categories •
What is your race?
L African-American/Black
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Asian or Pacific Islander
Native-American/American Indian
EJ 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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Do you c .yourse.IL,lyrically Disabled?
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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