Jordan W. Leonard •
AA 1 ANA I • /A i
DIVERSITY STATISTICS REPORTING
Name: 1 O l .. G.,., - (CO LA Gs* l c
1 � / T
Board / Committee: � � ? '/ �� L C r_ /01'
Appointment Date: ' ¢ ; r /
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 Female
Race/Ethnic Categories
What is your race?
African-American/Black •
OFCaucasian/White
L.—II-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.
uo •
Yes
•
Do you consider yourself Physically Disabled?
Yes
cri
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
•
•