Veteran Status 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 veteran status. 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.
Today’s date:
Full Name:
First Middle Last
What is your veteran status?
Vietnam Era Veteran
Disabled Veteran
Other Protected Veteran
Both Vietnam/Other Protected Veteran
I will notify Fisk’s Office of Human Resources in the event there is any change in my status
while I am an employee at the university.
Name Date
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