Lake Michigan College Educational Opportunity Center
Ethnicity/Race Questionnaire (Supplement to EOC Application)
Please read and respond to the questions. Definitions are provided to clarify each category.
Are you, the applicant, Hispanic/Latino?
Check only one: Yes No
To which racial group(s) do you belong?
Check all that apply: (see definitions to right)
American Indian or Alaska Native
Black or African-American
Native Hawaiian or Other Pacific Islander
Definitions (as determined by the U.S Department of Education)
Hispanic/Latino: A person of Cuban, Mexican, Puerto Rican, South or
Central American, or other Spanish Culture or origin, regardless to
American Indian or Alaska Native: A person having origins in any of
the original peoples of North and South American (including Central
America and who maintains a tribal affiliation or community
Asian: A person having origins in any of the original peoples of the Far
East, Southeast Asian, or the Indian subcontinent including, for
example Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the
Philippine Islands, Thailand, and Vietnam.
Black or African-American: A person having origins in any of the Black
racial groups of Africa
Native Hawaiian or Other Pacific Islander: A person having origin in
any of the original peoples of Hawaii, Gran, Samoa, or Pacific Islands.
White: A person having origins in any of the original peoples of
Europe, the Middle East, or North Africa
Name (Printed) Signature Date