Welcome X

In order for University Y to be in compliance with 
the new federal mandate on collecting 

and reporting race and ethnicity data, it is important 
that we have accurate information 

on our employees. Below are the questions with the 
ethnic and racial categories 

presented in the new 2-question format, with the 
federal definitions. For each 

question, please select the categories that best 
describe your race/ethnicity 

and how you self-identify. Additionally, we are 
requesting that you please complete 

the supplemental gender and veteran status questions. 
Your responses will be kept 

confidential and reported in aggregated form only. 
Completion of this form is 

voluntary, but your participation will help Y 
remain in compliance with 

the new requirements.

Please review each question below and select the 
categories that best describe you.

A. Ethnicity (please check if applicable)     

Hispanic or Latino

A person of Cuban, Mexican, Puerto Rican, Central 
or South American, or other 

Spanish culture or origin, regardless of race 
(note: does not include persons 

of Brazilian or Portuguese culture or origin).

B. Race (please check one or more races)      

American Indian or Alaska 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.

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 Hawaiian 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.

 C. Gender      

Female Male