James Weingarten . /VI I AM ' lk, E t C :
DIVERSITY STATISTICS REPORTING
Name: IM ,
Board / Committee. L CD .-- ( _
(-0 61 Yll 1 4R-Z.
Appointment Date: 6 .- c( - 15
pp .
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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.
r Please check the appropriate box for each category:
Gender: Male I Female LD
4,, Race/Ethnic Categories
What is your race? _ . . .
[
j African-American/Black
Zt
'Cau��casian/White ,'
•
I:a Asian or Pacific Islander ,•
LI Native-American/American Indian ,
I.Other— Print Race: ,
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish, Hispanic, Latino/a. :
< -
i /-
L"Yes T . .._ 1 -° C) �,;
Do you consider yourself\Physically Disabled? _ s :'
i ' . 121 :L
I. 1No co ' .
D Yes .
C:\Users\CENTFraN\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outibok\NP4J9CNX\BC minority •
information form 05-20-13 FINAL.doc
Updated: Monday,January 26,2015 '