Ivette Birba •
MIAMI AC `.P
,.. n
DIVERSITY STATISTICS REPORTING
Name: v.#-e r r b
Board / Committee: £12 c 7
- 7L( 'Iv vi C ���- („s k
Appointment Date: /-2 4-7/ /
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:
Gender: Male I I] Female Oi
Race/Ethnic Categories _ i
What is your race? f
_....
African-American/Black
-Caucasian/W hite
Asian or Pacific Islander i y
L3 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.
llNo
W Yes .
Do you consider yourself Physically Disabled?
No
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
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