Deena R. Bell •
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DIVERSITY STATISTICS REPORTING
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Board / Committee: -e- ' s'r 1 e v 600. {d
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Appointment Date: 5—
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:
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Gender: Male I,. II Female
• Race/Ethnic Categories
What is your race?
A�frcan-American/Black
L aucasian/White
Asian or Pacific Islander
.Native-American/American Indian
IZji Other— Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish, Hispanic, Latino/a.
Zqi"No
! Yes
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• Do you consider yourself Physically Disabled?
ro
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
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