Stephen Fox, Jr. 11
DIVERSITY STATISTICS REPORTING
Name: r 90 i--0 X • r `
Board /Committee: ,'t 1 Ad /$ rc'J 0/ ///ee
Appointment Date: / 2S 2/�
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 Et Female
Race/Ethnic Categories
What is your race?
rican-American/Black
i Caucasian/White
Ui 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
La Yes
Do yo consider yourself Physically Disabled?
La 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