Rosa Neely it\AIMAI
DIVERSITY STATISTICS REPORTING
• Name: Posa. IEE ; ,y
Board / Com mittee: t�° � af)i t� �-(
Gi ct1i vY3
•
Appointment Date: '• /7/// (7
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:
•
Female .-_..J
Gender: Male `7.
Race/Ethnic Categories
What is your race?
D African-American/Black
Caucasian/White
Asian or Pacific Islander
Ir, il 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.
4No
Yes
• Do.you consider yourself Physically Disabled?
10: NO No
Yes
Signature:-- t;L7 - Date: 3/17 5
•
F:\CLER\$ALL1aFORMS\BOARD AND COMMITTEES\MISC\BC minority information form 05 720-13 FINAL.doc
• Updated: Wednesday,June 25,2014