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Suzanne Hollander 12.31.2017 MIAMIBEACH City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk Tel:(305)673-7411,Fax:(305)673-7254 December 22, 2015 • Ms.Suzanne Hollander • P.O. Box 398595 Miami Beach, Florida 33239 SUBJECT:Affordable Housing Advisory Committee Dear Ms. Suzanne Hollander: - • Congratulations!You have been reappointed by the City Commission to the above referenced board or committee,for a term ending: 12/31/2017. If you are unable to accept this appointment or have any questions, please call the Office of the City Clerk at 305.673.7411. Please read the enclosed materials carefully. Congratulations and good luck. Respectfully, fael Gra ado City Clerk cc: Saul Frances, Parking Director Richard Bowman, City Liaison ATTACHMENTS: Letter of Appointment Oath City Code/Ordinance section applicable to agency, board or committee City Code Section 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459 Ordinance No. 2006-3543-Amendment to City Code Section 2-22 Miami-Dade County Code Section 2-11.1 -Conflict of Interest and Code of Ethics Ordinance City Wide Permit Application-(Parking Department Form) Booklet-Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community. MIAMIBEACH City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk Tel:(305)673-7411,Fax:(305)673-7254 TO: Ms. Suzanne Hollander RE:Affordable Housing Advisory Committee I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the United States, the State of Florida, and the City of Miami Beach, and to perform all the duties of a member of the above-mentioned board or committee of the City of Miami Beach to which I have been appointed for a term ending: 12/31/2017. I have been issued a copy of section 2-11.1 of the Miami-Dade County Code (Conflict of Interest and Code of Ethics Ordinance), as well as Florida Commission on Ethics Guide to the Sunshine Amendment and Code of Ethics for Public Officers and understand that as a member of a City of Miami Beach Board and/or Committee, I must comply with the financial disclosure*requirements of Miami-Dade County or the State of Florida (depending on the board or committee on which I serve) on July 1st, following the closing of the calendar year on which I have served. \,--covv\ sUOkitAdLe/,_ s. Suzanne Hollander Sworn to and subscribed before me this (at- day of iA-A) , 2015. /Gferra+alltoes o N Deputy Clerk SPti-V 2 *Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Committees for additional information regarding the Financial Disclosure Requirements. We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community. MIAMI•DADE COUNTY SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last Name D First Name Middle Name/Initial 2014 /1o// rnr 6v m4niie 5' . Mailing Address%Street Number,Street Name,_or P D.Box _(....__City,State,Zip ID Number VI FC---- -S°. . If your home address is your mailing address,and your home address is exempt from public records pursuant to Fla.Stat.§119.07,read instructions on the following page and check here.❑ - -....-- .-. - ---__-___—._.-- ._ ...-___-__–_:.___..__-.__-..:_ _:.: Filing a�an Employee County Employee [1 Municipal Employee, Name of Municipality: Position held or sought Department where employed Work address Work telephone Term began on Filing as a Board Member = County Board Member _ Municipal Board Member, Name of Municipality: )41Q1tiLt 6,2-eta-t) - Board nwhere serving a,..,-7.116=e, Work address y Work telephone Term began on List below every source of income you received,along with the address and the principal activity of each source. Include your public salary. Place the sources of income in descending order,with the largest source first.Also, include any source of income received by ariother person for your benefit. However,the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet,check here. Name of Source of Income Address Description of the Principal Business Activity _Eli.9 HO r IC1 ,i I fir - _ :e r---- i(450 LANCOIWk_t_______4LiaA2f--F - , ___Inues4J6 ,AJCS 07-51S1 ki_c"."--- . __±_t_v_e.Mag.A.L - I hereby swear(or affirm)that the information above is a true and correct statement. I RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy c- . , ./ , . , ❑ Electronic Copy — 0 Signature of person disclosing 5(}--etp,NN Lk- ti �� - I r! 2 o/CP Print name Dat,sign d OFFICE USE ONLY Accepted: Y i N Deficiency: Processed Date/Initials: Scanned Date/Initials: 138 SP-14 2/13 (3.,-:1 MAMJBEACH CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME: Hollander Suzanne S Last Name First Name Middle Initial HOME ADDRESS: PO BOX 398595 Miami Beach FL 33239 Apt No, Home No. /Street PHONE: 7862020587 7862020587 City State Zip Code suzanne.hollander @gmail.com Home Work Fax Business Name: FIU - Hollo School of Real Estate Position: Visiting Instructor - Professor Address: 1101 Brickell Ave PH Miami Beach FL Email Address 33131 Street City State Zip Code Pursuant to City Code section 2 -22(4) a and b: Members of agencies, boards, and committees shall be affiliated with the city; this requirement shall be fulfilled in the following ways: a) an individual shall have been a resident of the city for a minimum of six months; or b) an individual shall demonstrate ownership /interest for a minimum of six months in a business established in the city. • Resident of Miami Beach for a minimum of six (6) months Yes • Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: No • Are you a registered voter in Miami Beach: Yes • (Please circle one): I am now a resident of: South Beach • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: • Are you presently a registered lobbyist with the City of Miami Beach? No Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three (3) choices will be observed by the City Clerk's Office. (Regular Boards of City) Choice 1: Planning Board* Choice 2: Design Review Board* Choice 3: Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center: 1. Past service on the Youth Center Advisory Board: No Years of Service: 2. Present participation in Youth Center activities by your children No if yes, please list the names of your children, their ages, and which programs. List below: • Have you ever been convicted of a felony: No If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: No If yes, please explain in detail: • Do you currently owe the City of Money Beach any money: No If yes, please explain in detail: • Are you currently serving on any City Boards or Committees: No If yes, which board? • What organizations in the City of Miami Beach do you currently hold membership in? • List all properties owned or have an interest in, which are located within the City of Miami Beach: Secretary of the Sunset Islands III and IV Homeowners Association Member of Sunset Harbour Yacht Club Member of Miami Beach Leadership Academy Alumni Association Property 1450 Lincoln Rd 602 1450 W 21 Street, Miami Beach, FL • 1 am now employed by the city of Miami Beach: No Which department? The following information is voluntary and is neither part of your application nor has any bearing on your consideration for appointment. It is being asked to comply with federal equal opportunity reporting requirements. Gender: Female Race /Ethnic Categories What is your race? Mark one or more races to indicate what you consider yourself to be. Other Other Description: Are you Spanish /Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino. No Physically Challenged: No NOTE: If appointed, you will be required to follow certain laws which apply to city board /committee members. These laws include, but are not limited to, the following: o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2 -459). o Prohibition from contracting with the city (Miami -Dade County Code section 2- 11.1). o Prohibition from lobbying before board /committee you have served on for period of one year after leaving office (Miami Beach Code section 2 -26). o Requirement to disclose certain financial interests and gifts (Miami -Dade County Code section 2- 11.1). (re: CMB Community Development Advisory Committee): prohibition, during tenure and for one year after leaving office, from having any interest in or receiving any benefit from Community Development Block Grant funds for either yourself, or those with whom you have business or immediate family ties (CFR 570.611). Upon request, copies of these laws may be obtained from the City Clerk. "I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, Article VII — of the City Code "Standards of Conduct for City Officers, Employees and Agency Members." I Suzanne Hollander agreed to the following terms on 1/5/2014 12:46:37 PM Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date Member Search Page 1 of 1 Suzanne Shanie Hollander Member in Good Standing ID Number: - 413607 Address: PO Box 398595 Phone: E -Mail: vCa rd : The Florida Bar www.floridabar.org Eligible to practice in Florida Miami Beach, Florida 332398595 United States 786.202.0587 suzanne.hollander @gmail.com County: Miami -Dade Circuit: 11 Admitted: 10/12/2000 10 -Year Discipline None History The Find a Lawyer directory is provided as a public service. The Florida Bar maintains limited basic information about attorneys licensed to practice in the state (e.g., name, address, year of birth, gender, law schools attended, admission year). However, through this directory The Florida Bar allows individual attorneys the opportunity to provide for public information certain expanded personal and professional data. It is the attorney's responsibility to routinely review and update those expanded listings. The information contained in those expanded listings is presented by the Bar "as is" with no warranty of any kind, express or implied. The Florida Bar, its Board of Governors, employees, and agents thereof are not responsible for the accuracy of that additional data. Publication of attorneys' contact information within this listing should not be construed as their consent to receive unsolicited communications in any form. Certain unauthorized uses of this data may result in civil or criminal penalties. The Find a Lawyer directory is not a lawyer referral service. [Revised; 12 -14 -2013] © 2014 The Florida Bar 1 Disclaimer I Top of page I Get Adobe Acrobat http: / /www.floridabar.org/ names. nsf /0/23 C23E510BE6C00585256A830081 E3E9 ?OpenDo... 1/5/2014 SUZANNE HOLLANDER P.O. Box 398595. Miami Beach, FL 33239 • Direct: 786.202.0587 •suzanne.hollander @gmail.com EDUCATION UNIVERSITY OF MIAMI SCHOOL OF LAW, SOIA MENTSCHIKOFF SCHOLAR • J.D. 2000 Magna Cum Laude; LLM Real Estate Courses in Commercial Leasing and Loan Work Outs • Soia Mentschikoff Scholar - Awarded full tuition scholarship & stipend for 3 years of law school; Inter - American Law Review DARTMOUTH COLLEGE • B.A. Government. 1995 Cum Laude; Awards for Academic Excellence; Awarded Mellon and Rockefeller Grants for Senior Research LONDON SCHOOL OF ECONOMICS • Fall 1993 ACADEMIC EXPERIENCE VISITING INSTRUCTOR - FLORIDA INT'L UNIVERSITY ( "FIU ") TIBOR AND SHEILA HOLLO SCHOOL OF REAL ESTATE '10- Present INDUSTRY LIAISON FOR FIU'S JEROME BAIN REAL ESTATE INSTITUTE TO THE REAL ESTATE COMMUNITY • Develop and teach "Legal Environment of Real Estate" to undergraduate & graduate students, topics include U.S. Constitutional basis of property rights, contracts, commercial leasing, land use, zoning, entitlements, mortgages, distressed property, landlord tenant law, credit, financing, foreclosures, planning, development, property management, property tax, ownership structures, dispositions and acquisitions, brokerage and analysis of state, federal and local law and case law compared against laws of other countries • Engage real estate community industry leaders with students in the classroom; bring students to the "street" via real estate events • Develop & lead real estate educational industry events including the Bi- Annual Jermone Bain Developer Luncheons and the Annual Downtown Miami River Tour with real estate leaders attended by hundreds of students, alumni & stakeholders • Teach graduate courses in live, on -line and hybrid formats using the latest on -line synchronous teaching and grading softwares Blackboard & Turnitin and Panthersoft REAL ESTATE ADJUNCT INSTRUCTOR - NEW YORK UNIVERSITY ( "NYU ") SCHACK INSTITUTE OF REAL ESTATE '12-1 3 • Educated professionals around the world in Contract to Closing and Commercial Leasing (each an 8 -10 week course- 2 hours per week) • Taught courses in real time using latest on -line synchronous teaching softwares, including Wimba, Collaborate, Classroom & Epsilen ADJUCNT INSTURCTOR - FLORIDA INT'L UNIVERSITY ( "FIU ") '09-'10 • Developed and taught "Legal Environment of Real Estate" to undergraduate students, topics including contracts, commercial leasing, land use, zoning, entitlements, mortgages, distressed property, landlord tenant law, credit, financing, foreclosures, planning, development, property management, property tax, ownership structures, dispositions and acquisitions, brokerage PROFESSIONAL EXPERIENCE PRINCIPAL, REAL ESTATE ADVISORY AND REPRESENTATION LLC 10- Present • Provide real estate consulting services to owners, investors and purchasers regarding zoning, land use, entitlements, sales, purchases, commercial leases, condominium structures, property positioning, property tax, tax certificates, valuations, financing • Managed leases, tenants, rent collection of City of Miami Beach -owned property, including office buildings & retail spaces as outside consultant REAL ESTATE BROKER, HOLLANDER REALTY LLC • Real Estate Broker of Florida licensed real estate brokerage `12- Present CORPORATE COUNSEL + PROJECT DEVELOPER - PARADISE INT'L DEV. & ITS SUCCESSORS IN INTEREST `11 -'13 and `07 —'08; `05 -'06 • Directed entitlement process, permitting, replat and MUPSs for 3 mixed use towers, managed city, state & federal gov't relations • Reviewed and drafted contracts purchase /sale agreements, corporate documents and leases; Managed tenants and outside counsel • Prepared for and participated in hearings /meetings at City, State and Federal level • Provided market data to assist with decisions regarding dispositions and valuations /appraisals • Provided zoning guidance regarding entitlements under Miami's new zoning code v.s. the previous code ATTORNEY, REAL ESTATE- CORPORATE - FERRELL SCHULTZ LLP '02-'04 • Drafted and negotiated commercial office leases, letters of intent, purchase and sale contracts, mortgage documents ATTORNEY, CORPORATE- COMMERCIAL LITIGATION - HOLLAND & KNIGHT LLP '00-'02 • Drafted contracts, pleadings and memoranda; Attended hearings; Generated clients through presentations MENTOR OF THE YEAR 2013, COMMERCIAL REAL ESTATE WOMEN ( "CREW ") Dec. '13 • Awarded Mentor of the Year by peers for connecting students with real estate industry leaders - Honored at Four Seasons Luncheon DELEGATE, MERCOSUR BUSINESS TRIP TO BRAZIL, CHILE & ARGENTINA • Only real estate educator selected to participate in 2 week business trip as one of 20 business educators world -wide FIU FACULTY DEVELOPMENT FUNDS RECIPIENT FOR EXCELLENCE IN TEACHING • Awarded funds in recognition of excellence in providing real estate education NEW MEMBER OF THE YEAR 2012, COMMERCIAL REAL ESTATE WOMEN ( "CREW ") • Awarded New Member of the Year by real estate peers — Honored at Four Seasons, Miami Luncheon REAL ESTATE COMMUNITY OUTREACH May `13 Mar. `13 Dec, `12 MODERATOR, JEROME BAIN DEVELOPER LUNCHEON FEATURING MALCOM BUTTERS Oct. `13 • Moderated luncheon on topic of industrial development ownership and management w Developer & 100 students & alumni LEADER/MODERATOR CREW UNIVERSITY PROGRAM Oct. `13 • Developed, led and moderated Commercial Real Estate Women (CREW) CREW U University networking and outreach program at University of Miami attended by approximately 50 graduate, undergraduate students and CREW real estate industry leaders LEADER, DOWNTOWN MIAMI URBAN PROPERTY DEVELOPMENT MIAMI RIVER BOAT TOUR Sept. `13 • Developed and led property boat tour attended by 100 undergraduate /graduate students, alumni, urban property stakeholders /owners, property developers, lenders and decision makers including the City of Miami Planning Department and Miami River Commission MODERATOR, RETAIL FINANCE PANEL - CRITTENENDEN NATIONAL REAL ESTATE FINANCE CONFERENCE Sept. `13 • Moderated, led national real estate finance panel with Total Bank, Stiles (fee developer /owner) and regional shopping center owner • Secure invitation for graduate and undergraduate students to attend panel free of charge — approximately 35/40 students attended MODERATOR, JEROME BAIN DEVELOPER LUNCHEON FEATURING ALAN OJEDA March `13 • Moderated luncheon regarding the development of office building 1450 Brickell with Developer, Architect and 100 students and alumni LEADER/MODERATER CREW UNIVERSITY PROGRAM March 13 • Developed, led and moderated Commercial Real Estate Women (CREW) CREW U University networking and outreach program at FIU College of Business attended by approximately 100 graduate, undergraduate students and CREW real estate industry leaders MODERATOR, JEROME BAIN DEVELOPER LUNCHEON FEATURING MICHAEL ADLER Oct 1 2 • Moderated luncheon on topic of multifamily development and Developer and approximately 100 students /alumni MODERATOR, RETAIL FINANCE PANEL - CRITTENENDEN NATIONAL REAL ESTATE FINANCE CONFERENCE Sept. `12 • Moderated, led retail real estate finance panel with Wal -Mart's VP of Real Estate, Stiles VP Acquisitions & BB &T Commercial Lender LEADER, DOWNTOWN MIAMI URBAN PROPERTY DEVELOPMENT MIAMI RIVER BOAT TOUR Sept. '12 • Developed and led property boat tour attended by 100 undergraduate /graduate students, alumni, urban property stakeholders /owners, property developers, lenders and decision makers including the City of Miami Planning Department and Miami River Commission LEADER, DOWNTOWN MIAMI URBAN PROPERTY DEVELOPMENT MIAMI RIVER BOAT TOUR Sept. `11 • Developed and led property boat tour attended by 100 undergraduate /graduate students, alumni, urban property stakeholders /owners, property developers, lenders and decision makers including the City of Miami Planning Department and Miami River Commission LEADER, DOWNTOWN MIAMI URBAN PROPERTY DEVELOPMENT MIAMI RIVER BOAT TOUR Sept. '10 • Developed and led first annual property boat tour attended by 100 undergraduate /graduate students, alumni, urban property stakeholders /owners, property developers, lenders and decision makers including the City of Miami Planning Department and Miami River Commission and Miami Dade Property Appraiser COMMERCIAL REAL ESTATE CONTRIBUTOR, SCOTSMAN GUIDE — LEADING NATIONAL MORTGAGE ORIGINATOR PUBLICATION `12- Present • Author `Exploring Opportunities in Urban Cores: The Rise of Cities Brings New Development and Funding Possibilities" • Author "Making Sense of the SNDA — Subordination, Non Disturbance and Attornment Agreement" • Author "Is a Steal for Real — Look at the Pros and Cons of Distressed Property Purchases" • Author "Between the Lease Lines: Know How Lenders Review a Property's Lease Agreements" • Author "Feel Secure About Your Deal's Collateral: Know Which Aspects of the Property Lenders Will Scrutinize" • Author "Set the Foundation for a Solid Relationship: Know What it Takes to Keep the Lender Borrower Connection Healthy" • Author "The Other Side of Natural Disasters: Expect Lender's Concerns over Collateral Damage and Loss of Income Streams" PEER REAL ESTATE REVIEWER, ROUTLEDGE PUBLISHERS Fall 12 • Selected by Associate Editor of Property and Real Estate to peer review proposed book "Legal Aspects of Built Environment" CONTRIBUTING REAL ESTATE WRITER, COMMUNITY NEWSPAPERS GOVERNMENT ACTIVITY CITY OF MIAMI QUALIFIED LOBBYIST '10 • Invited by City of Miami to qualify as a lobbyist for zoning and entitlement advocacy on behalf of real estate clients CITY OF MIAMI BEACH REAL ESTATE EVALUATION SELECTION COMMITTEE `09 • Selected by City of Miami Beach Real Estate /Development Office to choose commercial brokers to lease City owned property LEADERSHIP MIAMI BEACH & LEADERSHIP MIAMI '01 and `09 • Selected by City of Miami Beach and City of Miami to participate in leadership programs about practices of the City MEDIA MENTIONS BIZ NEWS "Developer Malcolm Butters Shares Insights with Students" mentioned re moderating Developer Luncheon BIZ NEWS "Real Estate Students Tour the Miami River with Team of Experts" quoted re leading the property Tour MERCADO DE DINERO USA "Comprar o no comprar, he ahi la decision" quoted about distress property sales and purchase BIZ NEWS "Developer Luncheon Features Alan Ojeda" quoted re program about Development Process BIZ NEWS "Three FIU Business Women Recognized by CREW" quoted re winning CREW New Member of the Year BIZ NEWS "Heavy Hitters Visit Int'l Real Estate Class" quoted re bringing real estate leaders to the classroom Miami Herald "Omni Area Enjoying Revival Spurred by Genting" quoted re increase in Miami Real Estate Market PROFESSIONAL MEMBERSHIPS Nov. ' 13 Oct, `13 May `13 Mar. `13 Dec. `12 Dec. `11 Sept. '11 COMMERCIAL REAL ESTATE WOMEN • Chair - CREW University Outreach Programs — Develop and Lead networking programs on University campus • Member - Scholarship Committee — Develop and Award Annual Miami CREW Scholarship to recognize Miami's diverse student base Museum of Contemporary Art (MOCA) • Founder of Leadership Circle — An educational and charitable group that has grown to 150 members PROFESSIONAL LICENSES Florida Bar Attorney, Florida Real Estate Broker, Maryland Licensed Real Estate Salesperson TEACHING SOFTWARE Blackboard, Turnitin, Panthersoft, Epsilen, WIMBA, Classroom, Collaborate SKILLS AND INTERESTS Skills: Excel, Powerpoint, Loopnet- Commercial Real Estate Data Base, MLS, Wordpress, Spanish Interests: Kickboxing, Running, Art, Education, Property Rights and Property Freedoms - 4 A Y t / } L Vie- City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK'S OFFICE CityClerk @miamibeachfl.gov Telephone: 305.673.7411 Fax: 305.673.7254 Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami- Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2) 9 ` Board Member's Name: �(.) -Q n r"?c /Jc //n c4r . I understand that no later than July 1, of each year all members of Boards and Committees of the City of Miami Beach, including those of a purely advisory nature, are required to comply with Miami-Dade County Financial Disclosure Requirements. This means that the members of City Advisory Boards, whose sole or primary responsibility is to recommend legislation or give advice to the City Commission, must file, even though they may have been recently appointed. One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida, no later than 12:00 noon of July 1, of each year. 1. A "Source of Income Statement" For your convenience, the form is attached. The form can also be downloaded at: http://www.miamidade.gov/elections/Library/source of income statement.pdf 2. A"Statement of Financial Interests (Form 1)" For your convenience, the form is attached. The form can also be downloaded at: http://www.ethics.state.fl.us/ethics/forms.html 3. A Copy of your 2013 Federal Income Tax Return Failure to file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine of no more than $500, 60 days in jail or both. //,1/4'.;, S. nature ate Updated:Wednesday,April 09,2014 Page 4 of 4 F:\CLER\SALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx AA 1 Ami BEAcH DIVERSITY STATISTICS REPORTING Name: 6 _1nv\e c) ik hd-e-r- Board / Committee: I�Fr® r l�PJ �- C� vs k'i'1 a 01 a1� 6 60 r �� rn rna .11-rec Appointment Date: la/2- /6 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 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 I, h Yes Do you consider yourself Physically Disabled? No 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