Regina Berman •
NAtt a8 :L--,4
DIVERSITY STATISTICS REPORTING
Name: /1) 3, f in�a 'OerrY)aK)pi
Board / Committee: U /1) 6,62 A „.-i) fri i .: ;Oil /of O . = ' '
•
pp
A ointment Date: 3/2 Y /5
Pursuant to City ofMiami -,)B each Ordinance 200/9-36`3'2, 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 Ui Female[ 1 1 .
Race/Ethnic Categories
•
What is your race?
. L African-American/Black
1:j1 Caucasian/White
La Asian or Pacific Islander ..
Native-American/American Indian
IZ3 Other— Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
. Spanish, Hispanic, Latino/a. .
LD No Cr, -
Yes ,-, E •
Do you consider yourself Physically Disabled? �' i
,,f1 0 <
[„--1I Yes • .. _ ._,.
u.,
C:\Users\CENTFraN\AppD'ata\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\NP4J9CNX\BC minority
information form 05-20-13 FINAL.doc .
Updated: Monday,January 26,2015.
•