Brett A. HarrisI •
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AAA 111 ELr
DIVERSITY STATISTICS REPORTING
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Name: 13 re. C. ':
Board / Committee: / fr 1,121 .e.t7
Appointment Date: ---1)
Pursuant to City of Miami Beach Ordinance.2009736'32, the City is required to annually
prepare and present 'a rePerrt to the.tity Conirnis§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
Race/Ethnic Categories
What is your race?
PAffiCan-American/Black
Caucasian/White
LJi Asian or Pacific Islander
Native-American/American Indian V •
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==li No
\LS.11/Yies •
Do you consider-yourself-Physically Disabled?
11 No/ .),) 1,31
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CAUsers\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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