Rachel Schuster •
•
•
IAMI r
DIVERSITY STATISTICS REPORTING
Name: ( CA (L1/1 ` J L U 6 l .
v-r? I
:: ��'C) :
Board / Committee: I-� �.. i �' U! U LI L'"
Appointment Date: C(2 \ 0\ \!c
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 L_II ;Female
_ Race/Ethnic Categories
What is your race?
African=A herican/Black
I L Caucasian/W hite..
LD 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, Hispanic, Latino/a.
' No
U Yes
Do you consider yourself Physically Disabled?
123 No
U 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 '.C2015