Elisa Leone M AAA I 'it pif H
DIVERSITY STATISTICS REPORTING
Name:
) Sa L ■
Board / Committee: Gu 2 1 c� a C-Onm v.`"‘
Appointment Date:
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?
La African-American/Black
Caucasian/White
Asian or Pacific Islander
Native-American/Ame ican Indian
Other— Print Race: II.S 117 In
. i
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
• Spanish, Hispanic, Latino/a. a
No • '�
-QYes •
Do you consider yourself Physically Disabled?
ja No
Yes
• C:\Users\CENTFraN\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\NP4J9CNX\BC minority
information form 05-20-13 FINAL.doc
A Updated: Monday,January 26,2015