EQUAL EMPLOYMENT OPPORTUNITY INFORMATION REQUEST
Blinn College is required by federal statute to maintain records as part of its Affirmative Action effort.
The information you supply on this form is used for statistical reporting purposes only and is strictly
confidential.
Sex:
M or
Ethnicity:
F
Are you Hispanic or Latino?
Yes
No
Race:
If you have identified yourself as Hispanic or Latino, you are not required to select and additional
category.
White
Black or African American
Native Hawaiian or Other Pacific Islander
Asian
American Indian or Alaskan Native
Two or More Races
A “Disabled Veteran” is a veteran of the U.S. military who (i) is entitled to compensation (or who but
for the receipt of military pay would be entitled to compensation) under laws administered by the
Secretary of Veteran Affairs, or (ii) was discharged or released from active duty because of a serviceconnected disability.
Are you a Disabled Veteran?
Yes No
An Active Duty, Wartime or Campaign Badge Veteran means a veteran who served on active duty in the
U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a
campaign badge has been authorized, under the laws administered by the Department of Defense.
Are you an Active Duty, Wartime or Campaign Badge Veteran?
Yes No
An “Armed Forces Service Medal Veteran” means any veteran who, while serving on active duty in the
U.S. military, ground, naval or air service, participated in a United States military operation for which an
Armed Forces service medal was awarded pursuant to Executive Order 12985 (61FR 1209).
Are you an Armed Forces Service Medal Veteran?
Yes
No
A “Recently Separated Veteran” means a veteran who served on active duty in the U.S. military, ground,
naval or air service hired during the three-year period beginning on the date of your discharge or release
from active duty.
Were you separated from the military within the last three years?
Yes No If “Yes,” date of separation:
Information concerning your status will be kept confidential except to the extent necessary to provide
special accommodations or emergency treatment. Government officials may be informed where
required. Your participation is voluntary; failure to respond will not result in adverse treatment.