Michael Steffert •
I AM1 LAC tit
DIVERSITY STATISTICS REPORTING
Name: \C\1t,t
Board / Committee: 72R-5
Appointment Date:
"� • 5 � - !C
Pursuant to City of Miami Beach Ordinance 2009-3632, the City is required to annually
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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:
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Gender: Male4P Female LD
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Race/Ethnic Categories
What is your race?
• African-American/Black
Caucasian/White
La 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.
In No
kW Yes
Do you consider yourself Physically Disabled? V
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ArNo
Yes -
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C:\Users\CENTFraN\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\NP4J9CNX\BC minority
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information form 05-20-13 FINAL.doc
Updated: Monday,January 26,2015
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