Carmen Browne •
MIAMI E c , ,
DIVERSITY STATISTICS REPORTING
Name: �rrl e r� I r0
./ Dr�iria ?1o,-es Lca7 60v J // )�? ✓e;Yep.,, f
hoard / Committee. y
Appointment Date: 314
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 I,--JI Female
Race/Ethnic Categories
•
What is your race?
African-American/Black
a
Caucasian/White
Cji Asian or Pacific Islander
Native-American/American Indian
IZJI Other— Print Race:'
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish, Hispanic, Latino/a.
Eta‘
DYes .
•
Do you consider yourself Physically Disabled?
H No
DYes .
•
•
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