RACE/ETHNICITY
|
Please mark on box that describes the race/ethnicity category with which you primarily
indetify:
|
|
Hispanic or Latino |
A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish
culture or origin, regardless of ethnicity.A person of Mexican, Puerto Rican, Cuban, Central or South American
or other Spanish culture or origin, regardless of ethnicity. A person of Mexican, Puerto Rican, Cuban, Central
or South American or other Spanish culture or origin, regardless of ethnicity.
|
|
White |
A person having origins in any of the original peoples of Europe, North Africa or the Middle East.
|
|
Black or African American |
A person having origins in any of the black ethnic groups of Africa.
|
|
Native Hawaiian or Other Pacific Islander |
A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
|
|
Asian |
A person having origins in any of the peoples of Hawaii, Indian Subcontinent, including, for example, Cambodia,
China, India, Japan, Korea, Malaysia, Pakistan, the Phillippine Islands, Thailand and Vietnam.
|
|
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 maintain tribal affiliation or community attachment.
|
|
Two or More Races (Not Hispanic or Latino) |
All persons who identify with more than one of the five races listed above.
|
|
Decline to state |
|
VETERAN STATUS – please check all that apply:
|
|
No Veteran Status
|
|
|
Special Disabled Veteran |
(A) A veteran who is entitled to compensation (or who, but for receipt of military retired pay, would be
entitled to compensation) under laws administered by the Dept. of Veteran Affairs for a disability rated
at 10 or 20% in the case of a veteran who has been determined to have a serious employment disability OR
(B) A person who was discharged or released from active duty because of a service-connected disability
|
|
Vietnam |
A person who:
(A) Served on active duty for a period of time more than 180 days, any part of which occurred between 8/10/64
and 5/07/75 and was discharged or released with other than a dishonorable discharge OR
(B) Was discharged or released from active duty for a service connected disability if any part of such active
duty was performed between 8/10/64 and 5/07/75 OR
(C) Served on active duty for more than 180 days and served in the Republic of Vietnam between 2/28/61 and
5/07/75.
|
|
Other Protected Veteran |
A veteran in one of the following groups:
(A) Veterans who served in a “war”;
(B) Veterans whose service in a campaign or expedition for which a campaign badge has been authorized or
an expeditionary medal has been awarded. This includes a number of engagements.
|