When you have completed this form, please press the "Submit Request" button.
Please Note: The personal information you provide below, including ethnicity, gender,
and date of birth, is used only to prevent duplication and ensure accuracy.
This information will remain confidential. Asterisks denote required fields.
and SHOULD NOT be a PO Box or Dorm address)
(Please include area code)
Colleges and universities are asked by many, including the federal
government, accrediting associations, college guides, newspapers,
and our own college/university communities, to describe the racial/ethnic
backgrounds of our students and employees. In order to respond to these
requests, we ask you to answer the following questions: