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DIVERSITY STATISTICS REPORTING '
• Name:
ri/L ,6(Z_____
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, - Board I Committee: k- (' iileW L --k2„< (4-) ia—j le.,I Ci .0
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Appointment Date: \\-b0C- . ‘9 / <--
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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 forKallows board and committe,e_applicants and members to voluntarily
self-identify their race, ethnicity, disabled statuOgart,d igeder. •
Please checicthe,apprOpriate box for each category:
Gender: Male [,—Ii Female
Race/Ethnic Categories
What is your race?
P,Afrita-n-American/Black
-11---1 Caucasian/White
• D Asian or Pacific Islander
Native-American/American Indian
[: 1 Other– Print Race:
Do you consider rself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
• Spanish, Hispanic, tieStino/a.
• Ng,P46------ •
SI Yes
Do you consider yourself Physically Disabled?
„
Yes ...
CAUsers\CENTFraN\AppData\Local\MicrosoftWVindows\Temporary Internet Files\Content.Outlook\NP4J9CNX\BC minority
information form 05-20-13 FINAL.doc ,
Updated: Monday,January 26,2015