EEO Self-Identification and Data Collection Form
Full Name
Date
Gender
Male
Female
Non-Binary
I do not wish to answer
Race/Ethnicity
Hispanic or Latino
White (Not Hispanic or Latino)
Black or African American (Not Hispanic or Latino)
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
Asian (Not Hispanic or Latino)
American Indian or Alaska Native (Not Hispanic or Latino)
Two or More Races (Not Hispanic or Latino)
I do not wish to answer
Disability Status
Yes, I have a disability (or previously had a disability)
No, I do not have a disability
I do not wish to answer
Veteran Status
Protected Veteran
Not a Protected Veteran
I do not wish to answer