TENNESSEE BOARD OF REGENTS
HIGHER EDUCATION SYSTEM
Minority/Ethnicity Form
In order to comply with reporting regulations as required by the State of Tennessee and
the United States federal income tax laws, it is necessary that the following information
be provided prior to the issuance of any University contract.
1. Name of Contractor
Federal ID/Social Security Number
2. Is the Contractor a US citizen?
Yes
No
If no, state country of citizenship:
(If not a US Citizen, please include a copy
of Visa with this form.)
3. Kind of Ownership (Check all that apply):
Govt. (GO)
Agency of the State of Tennessee (SA)
Non-Profit (NO)
Majority (MJ)
Minority * (see reverse side for definition)
Woman (WO)** (see reverse side for definition)
Small (SM)*** (see reverse side for definition)
4. Minority / Ethnicity Code (Check one):
African American (MA)
Native American (MN)
Hispanic American (MH)
Asian American (MS)
Other Minority (MO)
Specify: ____________________
5. Preference for reporting purposes: (Note: If Contractor qualifies in multiple categories as a
small, women-owned and/or minority, Contractor is to specify in which category he/she is to
be considered for reporting and classification purposes.)
Small Minority Woman-Owned
6. Certification: I certify that all the information as completed above is accurate and true.
Signature Date
Name (Printed): ____________________________________________________________
Title: ____________________________________________________________________
* Minority Ownership Clarification:
“Minority owned business” means a business that is a continuing, independent, for profit business which
performs a commercially useful function, and is at least fifty-one percent (51%) owned and controlled by
one (1) or more minority individuals who are impeded from normal entry into the economic mainstream
because of past practices of discrimination based on race or ethnic background.
“Minority” means a person who is a citizen or lawful permanent resident of the United States and who is:
a) African American (a person having origins in any of the black racial groups of Africa);
b) Hispanic (a person of Mexican, Puerto Rican, Cuban, Central or South American, or other
Spanish culture or origin, regardless of race);
c) Asian American (a person having origins in any of the original peoples of the Far East,
Southeast Asia, the Indian subcontinent, or the Pacific Islands); or
d) Native American (a person having origins in any of the original peoples of North America).
** Woman-Owned Business Clarification:
A “woman-owned business” means a woman owned business that is continuing, independent, for profit
business which performs a commercially useful function, and is at least fifty-one percent (51%) owned
and controlled by one or more women; or, in the case of any publicly owned business, at least fifty-one
percent (51%) of the stock of which is owned and controlled by one (1) or more women and whose
management and daily business operations are under the control of one (1) or more women.
*** Small Business Ownership Clarification:
A “small business” means a business that is independently owned and operated for profit, is not dominant
in its field of operation and is not an affiliate or subsidiary of a business dominant in its field of operation.
The Governor’s Office of Diversity Business Enterprises establishes small business guidelines on industry
size standards. The criteria guidelines are required to be met in order for a business to be considered
small. The annual receipts or number of employees indicates the maximum allowed for a small business
concern and its affiliates to be considered small.
TYPE OF BUSINESS ANNUAL GROSS
SALES
NO. OF
EMPLOYEES
Agriculture, Forestry, Fishing $500,000 9
Architectural / Design / Engineering $2,000,000 30
Construction $2,000,000 30
Educational $1,000,000 9
Finance, Insurance, & Real Estate $1,000,000 9
Information Systems / Technology $2,000,000 30
Manufacturing $2,000,000 99
Marketing / Communications / Public Relations $2,000,000 30
Medical / Healthcare $2,000,000 30
Mining $1,000,000 49
Retail Trade $750,000 9
Service Industry $500,000 9
Transportation, Commerce & Utilities $1,000,000 9
Wholesale Trade $1,000,000 19