Voluntary Self-Identification of Race and Ethnicity
In order to comply with certain federal recordkeeping and reporting requirements, the University invites academic
and administrative staff to identify their ethnicity and race. Please visit my.columbia.edu (log in with your UNI and
password) and provide this information under the “Faculty & Staff” tab in the “Self-Service” section. If you do not have
access to a computer, please complete, sign and return this form to your hiring manager.
Name
:
Title:
Providing the information below is optional and based on your self-identification. If you choose to participate, please
answer both questions by checking the appropriate box(es). If you prefer not to disclose, please check the appropriate box.
Thank you for your cooperation.
Questions
Answer Choices
Are you Hispanic or Latino? Yes, Hispanic or Latino.
No, not Hispanic or Latino.
What is your race?
(If you are two or more races,
please check all that apply).
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
If you do not wish to disclose
your race or ethnicity, please
check this box.
I do not wish to disclose
What do these categories mean?
These categories are determined by the federal government. Definitions, as provided by the U.S. Department of
Education, are as follows:
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or or
igin,
regardless of race.
American Indian or Alaska Native
A person having origins in any of the original peoples of North and South America (including Central America)
who mai
ntains cultural identification through tribal affiliation or community attachment.
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 Hawa
iian or Other Pacific Islander
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White
A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
How does Columbia use this information?
The University uses race and ethnicity information for annual reports to the U.S. Department of Education, to apply for
certain grants, and to meet its Affirmative Action goals. Columbia University does not share specific race and ethnicity or
other personal information with outside agencies. The ethnicity and race data you choose to provide here will be used
only in accordance with applicable laws, executive orders, and government regulations. As per Columbia's
Nondiscrimination Policies, Columbia University does not discriminate or permit harassment on the basis of race, color,
alienage and citizenship, gender, or any other legally protected status.
Date:
Signature:
V.09/22/20
