AFFIRMATIVE ACTION DATA SHEET
The federal government requires the university to compile certain
demographic information for all applicants. Accordingly, we ask that
you complete this form and return it with your Statement of Purpose.
No information presented hereon will be used in the selection
procedure and the form will be maintained separately from your
application file and is completely optional.
Date:
Program Applying To:
Ethnicity:
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American Indian/Alaskan
Black/African American
Mexican American/Mexican
Central American
South American
Cuban
Puerto Rican
Other Latino/Spanish
Chinese
Japanese
Korean
Asian Indian
Other Asian
Cambodian
Laotian
Vietnamese
Thai
Other Southeast Asian
Guamanian
Hawaiian
Samoan
Other Pacific Islander
White
Filipino
Other
Quarter Applying:
Residency:
[ ] CA Resident
[ ] Out of State Resident
[ ] International
Sex:
[ ] Male
[ ] Female
Disability:
Citizenship:
[ ] U.S.
[ ] Other
Visa Status:
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Permanent Status
H-1
F-1
J-1
Other
[ ] Handicapped/Disabled
[ ] Disabled Veteran
[ ] Disabled Vietnam Veteran