Christina LaBuzetta M I AM I BEACH
DIVERSITY STATISTICS REPORTING
Name: k Lc, r 'j Lv "v
Board / Committee: Y ) f�` �` �rl �'� �'' �� - c
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 and gender.
Please check the appropriate box for each category:
Gender: Male 0 Female I,
Race/Ethnic Categories
What is your race?
L African-American/Black
r aucasian/White
Asian or Pacific Islander
�I 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.
�l ► o
111 Yes
Do you consider yourself Physically Disabled?
No
Yes
6,)b Irk
41 up
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