Beth Edwards!P.
•
MIAMI FAci
DIVERSITY STATISTICS REPORTING
0
Name: („6/PL)1172-40E
Board / Committee:
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 [Z/ I,Female ` .
Race/Ethnic Categories
— r-:
What is your race?
[:a African-American/Black
Ll.
LCaucasian/White 3
IZEI Asian or Pacific Islander .�.
La ao �
Native-American/American Indian
r-�
Other— Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish, Hispanic, Latino/a.
No
Yes
Do you consider yourself Physically Disabled?
•
liEhNo
[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