Julio Magrisso "•a _ ,c v.-t,• :n:�fr fir,' r�F �;
x
mi Aty\ L„,„ E
DIVERSITY STATISTICS REPORTING
Name. .
B®ard / Committee: 4
Appointment Date:
•
Pursuant to City of Miami Beach Ordinance 20.09-3632, 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 Female LD
Race/Ethnic Categories
What is your race?
African-American/Black
Caucasian/White
•
Asian or Pacific Islander C/
Native-American/American Indian
• Other— Print Racer
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the-"No"box if not •
Spanish, Hispanic, Latino/a.
LD No
Yes •
Do.you consider yourself Physically Disabled?
No
Yes
/)/2.,/0
Signature:
v -- Date:
•
F:\CLER\$A L\aFORMS'•OARD AND COMMITTEES\MISc\BC minority information form 05-20-13 FINAL.doc
Updated: Wedn�s <June 25,2014 .