Robin Schwartz AA AAA I EAC
DIVERSITY STATISTICS REPORTING
Name: J11N
Board / Committee: t ()-""8 ; A-11/15/vv14 Cbt,\A
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Appointment Date: /
F � .
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.
I ..
Please check the appropriate box for each category:
Gender: Male Female :
Race/Ethnic Categories
What is your race?
African-American/Black
21-6aucasian/VVhite =='
Asian or Pacific Islander --
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.
Z
Yes •
Do you co ides yourself Physically Disabled?
No
D 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
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