Mark Rabinowitz M I Am 1 t E ;
DIVERSITY STATISTICS REPORTING -
Name: r 1'n� w'
Board / Committee: A i s3e.1
Appointment Date: 1
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 Q' Female •
Race/Ethnic Categories "
What is your race? _
s 1 �
, African-American/Blackr y - F
ff,'r"
Caucasian/White V V
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. V
No •
Ej Yes V
Do you consider yourself Physically Disabled? V
No
'
Yes Y
•
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C:\Users\CENTFraN\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\NP4J9CNX\BC minority
information form 05-20-13 FINAL.doc w
Updated: Monday,January 26,2015 .