Deborah Robins MIAMI 10. EAto.,4 ,„
DIVERSITY:STATISTICS REPORTING
Name:
Board / Committee:
, .
Appointment Date: . C3
t.
Pursuant to City of Miami Beac i-Ord nanc'e=20'09-3632,it—he City,is required to annually
prepare and present a report to the City Commissions idea ifying'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 1Z3 Female
•
Race/Ethnic Categories
What is your race?
Aft' an American/Black
l'Caucasian/White v'
Asian or Pacific Islander
Native-American/American Indian
:Other'= Print Race:
Do you c . ider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spani ', Hispanic.`Latino/a,
I No
Yes
•
Do y u'consider yourself Physically Disabled?
1;3 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