A
VOLUNTARY SELF-IDENTIFICATION FORM FOR EMPLOYEES
It is CSU policy to provide equal employment opportunity and to advance in employment all qualified individuals without
regard to race, color, religion, national origin, ancestry, physical or mental disability, medical condition, genetic
information, marital status, sex, gender identity, gender expression, age (over 40), sexual orientation, or protected veteran
status.
The CSU is interested in monitoring the diversity of our workforce. This form has been developed to assist us in these
efforts and in collecting data that is required for University, State, and Federal reporting requirements.
This form, and any data submitted on the form, will be kept separate from your personnel file and will not be accessible by
anyone involved with making recommendations or decisions regarding your employment. While your reply will be most
helpful to us in reporting accurate data, completing this form is entirely voluntary; refusal to complete the form will not
affect your employment.
Ethnicity. 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.)
Race. Regardless of your answer to the above question you may select one or more of the following categories that apply
to you:
☐ American Indian or Alaska Native
A person having origins in any of the original peoples of North and
South America ( Including Central America) who maintains cultural
identification through tribal affiliation or community attachment.
☐ Asian
☐ Asian Indian
☐ Cambodia
☐ Chinese
☐ Filipino
☐ Japanese
☐ Laotian
☐ Vietnamese
☐ Other Asian
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.
☐ Black or African American
A person having origins in any of the black racial groups of Africa.
☐ Native Hawaiian or Other Pacific Islander
☐ Guamanian
☐ Hawaiian
☐Samoan
☐Other Native Hawaiian or
Other Pacific Islander
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.
Gender. Please select one of the following:
☐
Nonbinary
