Beverly Heller •
•
AA [AAA i !It
DIVERSITY STATISTICS REPORTING
Name: " C,,�•j.e,n
Board / Committee: \J 01/4-\. C LJ C--
Appointment Date: c )\ i.4 Z- 1 ,0 I
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 C.
What is your race?
African-American/Black
Et Caucasian/White :.
Asian or Pacific Islander
[=3 Native-American/American Indian ---
La Other— Print Race:
Do you consider yourself to be Spanish, Hispanic odr Latino/a? Mark the "No"box if not
Spanish,,Hispanic, Latino/a.
No
DYes
Do you•c-onsider yourself Physically Disabled?
LZII 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