Employee Equal Opportunity & Affirmative Action Survey

The University is required to keep a record of the ethnic background of its employees. You are requested to complete this form voluntarily. If you choose not to provide the information, your employer will make a "best guess" and forward it to the Human Resources Office.

Required fields are marked.

Submitter:

This form was filed by: Appointee Employer

Appointee Information:

Date:	(MM/DD/YYYY)
Name:
Email:
Department:
Position Number:
Position Title:
Sex:	Male Female

Ethnic Background:

Please select only one.

	American Indian or Alaskan Native; A person having origins in any of the original peoples of North America, and who maintains cultural identification through community recognition or tribal affiliation.
	Black; not of Hispanic origin. A person having origins in any black racial groups of Africa.
	Hispanic; A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish cultures or origins.
	Caucasian; not of Hispanic origin. A person having origins in any of the original peoples of Europe(except Spain and Portugal), North Africa, or the Middle East.

Asian or Pacific Islander

	Asian Indian (India, Pakistan, Bangladesh, Sri Lanka, Nepal, Sikkim, and Bhutan).
	Chinese
	Filipino
	Hawaiian or Part Hawaiian
	Japanese or Okinawan
	Korean
	All other Asian or Pacific Islanders

Other

Please specify other ethnic background if none of the above: