Deborah Ruggiero Minority Report ‘4
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DIVERSITY STATISTICS REPORTING
Name: i f
Board I Committee: a r /// f ( �_ / I
Appointment Date: / - / V
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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 City Commiss ion 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 b'
Race/Ethnic
Categories.
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What is your race?
African-American/Black
ral4 Caucasian/White
I` 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. 1
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Yes .
•
Do.you consider yourself Physically Disabled?
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LD Yes
•
• nature• 4 +' / / _l�` / , Date. 12/2- / 7 V
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F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\MISC\BC minority information form 05-20-13 FINAL.doc
Updated: Wednesday,June 25,2014