Monica Fluke /V\ bF :
DIVERSITY STATISTICS REPORTING
Name: HOnic_a
Board / Committee: v)() yy‘ ---Kk ry\A2,4,4,
•
Appointment Date: 11 1 c
pp
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 I I] Female[el
Race/Ethnic Categories
What is your race? `
A frican-American/Black .
Caucasian/White •
La 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 .
U Yes
Do you consider yourself Physically Disabled? •
!14. No
U Yes
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