Self-Identification Survey
The City of Little Rock and the Racial and Cultural Diversity Commission seeks to increase diversity in
applicants for City Boards and Commissions. Your demographic information will be used to track and
enhance diversity in our Boards or Commissions.
Race/Ethnic Group:
White
Black or African American
Hispanic or Latino (of any race)
Asian
American Indian or Alaskan Native
Native Hawaiian or Other Pacific
Other
Gender:
Male Female
Age:
18-25 26-35 36-45 46-55 56+
How did you learn of this Board/Commission vacancy?
City Website Newspaper
Community Agency Referred by Board/Commission Member
Local Government Access Channel Referred by City Director or Staff
Other
The City Code of Ethics prohibits any the member of any City Board, Commission or Authority, form voting
on a matter in which the member has an interest, or the member's family or business has an interest. If
such a matter comes before the body to which you are appointed, and there is any question about recusal,
you should contact the City Attorney's Office for an informal or formal opinion as to the propriety of your
participation.