Karen Edelstein Minority Report •
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DIVERSITY STATISTICS REPORTING
Name: ire r\ 54-e
Board / Committee: NYMAkcS ( n W0 v
Appointment Date: /////3
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 Female 1:RK-
Race/Ethnic Categories
What is your race?
A.rican-American/Black
Caucasian/White
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
Yes
Do.you consider yourself Physically Disabled?
No
Yes
Si natuDate: A3/3/////r
F:ICLER\$ALL1aFORMS\BOARD AND COMMITTEES\MISC\BC minority information form 05-20-13 FINAL.doc
Updated: Wednesday,June 25,2014