Gayle Durham . .
'MAN\ I BEACH ., ..,
,, r": A ., ..
DIVERSITY STATISTICS REPORTING
Name: ,.t Le_ t.,
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Board / Committee: . �r� . , .//:), ,---/c-4- ( (3-'1/ .7 vv?'''''' ' ',1- '''''' (4 fr' -
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Appointment Date: :-- /
Pursuant to City of Miami BecCh'Ordin ance 200.9136'02, fh`e it ly 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 1=3 Female ni
Race/Ethnic Categories
What is your race?
U African-American/Black
larCaucasiari/White
[ 1 Asian or Pacific Islander
ij Native-Amer'icari/American Indian . n
LD 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
�No4 '� 4./, --
Y.es i±
Do Do you consider yourself Physically/Disabled?
Nt No
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