Jonathan E. Fryd • •
MIAMLi : EACH_
DIVERSITY STATISTICS REPORTING •
•
Name: ( •
�� lnct �Cs � L, �Tr� i�'
Board I Committee: f u, so 7 0,0
A pp ointment Date: 5 /3 /5
� .
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: �ij
Gender: Male ZeFemale
. Race/Ethnic Categories `-` • `I
What is your race? ,
African-American/Black �.
[,D 1W.
Asian or Pacific Islander W.
La 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
Yes •
Do you consider yourself Physically Disabled?
•
No
La 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