Laura Colin AA AAA 3 E
DIVERSITY STATISTICS REPORTING
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Name: • `,��c,� (e(2. -
i/' •. /?
Board / Committee: e ,r1 i ".6 c?cs e -t i /E c ///)r
Appointment Date: 21 y//5-
Pursuant to City of Miami rBeach Ordinan,ce32009-3632, 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 i� A: ,
Race/Ethnic Categories
•
What is your race?
Aft' an-American/Black •
M.l aucasian/White
Asian or Pacific Islander
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, ispanic, Latino/a.
•
o
DYes
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