Equal Employment Opportunity Form
Please return this form to the
Office of Human Resources
Fisk University is subject to certain governmental recordkeeping and reporting requirements for the
administration of civil rights laws and regulations. In order to comply with these laws, we invite you to
voluntarily self-identify your race or ethnicity. Submission of this information is voluntary and refusal
to provide it will
subject you to any adverse treatment. The information obtained will be kept
confidential and will only be used in accordance with applicable laws, executive orders and
regulations, including those that require the information to be summarized and reported to the
federal government for civil rights enforcement.
’s date:
Full Name:
Middle Last
Telephone Number:
Home Work Cell
Gender: Male Female
at is your racial or ethnic heritage?
American Indian or Alaskan Native
- A person having origins in any of the original peoples of
North and South America (including Central America), and who maintain tribal affiliation or
community attachment.
- A person having origins in any of the original peoples of the Far East, Southeast Asia, or
the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia,
Pakistan, the Philippine Islands, Thailand, and Vietnam.
Native Hawaiian or Other Pacific Islander
- A person having origins in any of the peoples of
Hawaii, Guam, Samoa, or other Pacific Islands.
Black or African American
A person having origins in any of the black racial groups of Africa.
Hispanic or Latino
- A person of Cuban, Mexican, Puerto Rican, South or Central American, or
other Spanish culture or origin regardless of race.
- A person having origins in any of the original peoples of Europe, the Middle East, or North
Two or more races
-All persons who identify with more than one of the above five races.
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