Stacey Kruger , -• . _ _ .
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DIVERSITY STATISTICS 'REPORTING •
Name: -1){ 1
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a I ✓� c; r iii lei Board/.Committee. �
Appointment Date: f 1 15
Pursuant to City of Miami:B;e,ach2Qrdinance.-.20.09-3632,rthe 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:
. f
M
- Gender: Male Female ►A ,
Race/Ethnic Categories _b
What is your\race? "-- ,
Mil African-American/Black .
a
Caucasian/White ,,
ll Asian or Pacific Islander
ZLI 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.
1
IH\No. ' '. ? .
Yes,`. i
Do you consider yourself Physically Disabled? .,
P21 No \ '
D 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