Fillable Ethnic Disclosure Form 4 (University of Hawaii at Hilo)

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Ethnic Disclosure Form 4 (University of Hawaii at Hilo)

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Please return the completed form to UH Hilo Human Resources. CONFIDENTIAL
_____________________________________________________________________________
University of Hawai‘i at Hilo
Employee Self-Identification
Last Name First Name Middle Initial UH Employee ID Number Sex
The University of Hawai‘i at Hilo complies with recordkeeping requirements under federal and State civil
rights laws and regulations. In accordance with these laws, the University invites employees to voluntarily
self-identify their sex and race or ethnicity. Submission of this information is voluntary and refusal to
provide it will not subject you to any adverse treatment. The information obtained will be kept confidential
and may only be used in accordance with the provisions of applicable laws, executive orders, and
regulations.
Are you Hispanic/Latino?
Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin regardless of race.
yes no
Please select one or more racial categories to describe yourself:
White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa (e.g., persons
who identify as Portuguese, German, Lebanese, Arab, Egyptian).
American Indian or Alaska Native - A person having origins in any of the original peoples of North, Central, and
South America and who maintains tribal affiliation or community attachment.
Black or African American - A person having origins in any of the black racial groups of Africa.
Native Hawaiian/Part Hawaiian or Other Pacific Islander:
Native Hawaiian or Part Hawaiian
Guamanian or Chamorro
Micronesian (not Guamanian or Chamorro)
Samoan
Tongan
Other Pacific Islander
Asian:
Chinese Laotian
South Asian and Asian Indian: A person having origins in any
of the original peoples of the Indian subcontinent (e.g., India,
Pakistan, Afghanistan, Bangladesh, Bhutan, Nepal, Sri Lanka).
Filipino Thai
Japanese Vietnamese Other Asian
Korean
Note: Race/ethnic designations as used by the U.S. Equal Employment Opportunity Commission (EEOC) do not denote scientific
definitions of anthropological origins. Self-identification is the preferred method of obtaining this information. If an employee de-
clines to identify his or her race/ethnicity, Personnel Officers or departments may use observer identification or personnel records.
(EEO/AA) rev. 07/09
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Ethnic Disclosure Form 4 (University of Hawaii at Hilo)

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Completed 23 July 2020

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