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DIVERSITY STATISTICS REPORTING
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Board / Committee: S ', .. C-..0 d'n i
Appointment Date: 61 19 S- - .
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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 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 i .
Race/Ethnic Categories
What is your race?
Ui African-American/Black
Caucasian/White .
Asian or Pacific Islander V
x.78 ' ative-American/American Indian J0,
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Other— Print Race: -I b a''" C
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish, Hispanic, Latino/a.
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Do you consider yourself Physically Disabled? :, ;; n�_-
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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 .