Kathleen S. Phang "V"
•
AA I Ato I
K k
DIVERSITY STATISTICS REPORTING
Name: I C c h I e c/\ S . P hO nCJ
Board / Committee: nP s ,Jtr, is vi c.w (3�Cif-C1 •
Appointment Date:
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 LD Female Cei
Race/Ethnic Categories . 71
• What is your race? . ,w
African-American/Black
ucasian/White
..1 Asian or Pacific Islander
Native-American/American Indian
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 .
DYes
Do.you consider yourself Physically Disabled? .
No
DYes .
Signature:
Date: 2-1 3 41
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\MISC\BC minority information form05-20-13 FINAL.doc
Updated: Wednesday,June 25,2014 . _ -
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