J.P. Morgan Minority Report 1ECH
DIVERSITY STATISTICS REPORTING
Name: ^� R e UDr ait' •
Board / Committee: /ça i D G 1621 ji—ty-- /A9.
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Appointment Date: '( Z r /��--
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 Female
Race/Ethnic Categories
What is your race?
African-American/Black
Caucasian/White
Li Asian or Pacific Islander
Native-American/American Indian •
La Other— Print Race: Ha AI 4 k/
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish, Hispanic, Latino/a.
No
Yes
Do you consider yourself Physically Disabled?
R No
LD 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