Regina Suarez Minority Report M AMI r d
DIVERSITY STATISTICS REPORTING
Name: I r�� -fZ�--Z
Board / Committee: - sio.A r- t �S
Appointment Date: 1 �'I I
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 C3 Female Ler
Race/Ethnic Categories
What is your race?
La African-American/Black
Caucasian/White
Di Asian or Pacific Islander
LD Native-American/American Indian
BOther— Print Race: I-1 s p 19- )11 Q - A rY--)
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish, Hispanic, Latino/a.
I " Yes
Do you consider yourself Physically Disabled?
�No
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