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University of North Carolina at Charlotte, Director of Undergraduate Admissions
Voluntary Self-Disclosure Form

Introduction

This information is requested on a voluntary basis. In order to help us comply with Federal Equal Opportunity record keeping and legal requirements, we encourage you to answer the questions below. This pre-employment information will be kept in a confidential database separate from employment applications/resumes. Electing not to provide this information will not disqualify your application..

**Reminder: This is voluntary information.**
1.Are you a protected Veteran? (please select one of the options below)
2.Disability Status: (please select one of the options below)

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Please see the U.S. Department of Labor Voluntary Self-Identification of Disability Form CC-305 for additional information to answer the question below.
3.Name (Optional):
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