Allison Stone NAIAM BEACH
. . .
DIVERSITY STATISTICS REPORTING
Name: 'A 1 cAr1 )
Board / Committee: "f" f vi sG,*7
T 77 E
Appointment Date:
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.Bnd gender.
Please check the appropriate box for each category:
Gender: Male IZJI Female 4
Race/Ethnic Categories
What is your race? •
African-American/Black
aucasian/White
Asian or Pacific Islander
LD Native-American/American Indialy
1,--J Other— Print Race:
... r j
�. `W
Do you-consider yourself to be Spanish, Hispanic or Latino/a? Mark the box if not
Spanish, Hispanic, Latino/a. 7 • s t'
j
No y . � .y . -'• .� -�,
�> y
Yes
Do you co.nsi.der yourse.lfPhysically Disabled?
{
• •-it No, _
•1 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
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