Tiva Leser Minority Report MIAMI EAcH
DIVERSITY STATISTICS REPORTING
Name: /NA_
L '
Board / Committee: i�j CCO4 `L" r
Appointment Date: !C 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 LJl Female 1`-'1i
Race/Ethnic Categories
What is your race?
Zji A frican-American/Black
Caucasian/White
Asian or Pacific Islander
Native-American/American Indian
La Other— Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the 0,"box if not
Spanish, Hispanic, Latino/a.
[1 No
DYes
Do yo consider yourself Physically Disabled?
U No
L 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