Human Resources

Personal Data Form

Please complete and submit this form to Office for Equal Opportunity.

(If known)

Employee Name

Date of Birth


The university is required to collect the following information from all employees. Completing the form is considered a condition of employment. This information will be kept confidential to the extent allowed by law. When used for state and federal reporting purposes, names will not be used and statistics will be reported in such a way as to not reveal individual responses. If you have questions about completing this form, please contact the Office for Equal Opportunity at 963-2205.



Do you have a physical, sensory, or mental impairment which substantially limits one or more life activities (e.g., walking, seeing, hearing, breathing, or learning)?

Do you have a physical, mental, or other health condition that has lasted for six or more months and which limits the kind or amount of work you can do at a job?


Military Status

Are you an United States veteran?

U.S. Veteran Status: