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Texas Tech University
Voluntary Self-Identification Form
The information requested is optional and is being collected for the purpose of reporting to Federal and Equal Opportunity Agencies and will
not be considered
as part of the application for employment. It will be separated from the application.
*
1.
Full Name
(Required.)
2.
Sex
Female
Male
3.
Ethnic Origin (see definitions below)
White
Black
Hispanic
Asian
American Indian or Alaskan Native
Native Hawaiian or Other Pacific Islander
Two or More Races
White — a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Black — a person having origins in any of the black racial groups of Africa.
Hispanic — a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
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.
American Indian or Alaskan Native — a person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
Native Hawaiian or Other Pacific Islander — a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Two or More Races — a person who primarily identifies with two or more of the above race/ethnicity categories.
4.
Veteran
Yes
No
5.
Surviving Spouse of Veteran who has not remarried
Yes
No
6.
Orphan of Veteran
Yes
No
7.
Spouse of a member of the US armed forces or Texas National Guard serving on active duty
Yes
No
8.
Spouse and primary source of income for a veteran who has a total disability rating based on having a service-connected disability with a rating of at least 70 percent or on individual unemployability
Yes
No
9.
Former Texas Foster Youth 25 years of age or younger
Yes
No
Texas Tech University is an Equal Opportunity Employer