Rev 10/2008 Ethnicity and Race Identification.docx
Ethnicity and Race Identification
Name:
Last First Middle Initial
Banner I.D. #: Date:
Privacy Act Statement:
Ethnicity and race information is requested under the authority of 42 U.S.C. Section 2000e-16 and in compliance with the
Office of Management and Budget’s 1997 Revision to the Standards for the Classification of Federal Data on Race and
Ethnicity. Providing this information is voluntary and has no impact on your employment status, but in the instance of
missing information, the university will attempt to identify your race and ethnicity by visual observation.
Specific Instructions:
The two questions below are designed to identify your ethnicity and race.
Regardless of your answer to question 1, go to question 2.
Question 1: Are you Hispanic or Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or
other Spanish culture or origin, regardless of race.)
Question 2: Please select the racial category or categories with which you most closely identify by marking in the
appropriate box.
RACIAL CATEGORY
(Check as many as apply)
American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander
A person having origin in any of the original peoples of North and South
America (including Central America), and who maintains tribal
affiliation or community.
A person having origins in any of the original people 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.
A person having origins in any of the black racial groups of Africa.
A person having origins in any of the original peoples of Hawaii, Guam,
Samoa, or other pacific Islands.
A person having origins in any of the original peoples of Europe, the
Middle East, or North Africa.
