CWU banner, your future is Central.  
Skip navigation menu. CWU Home Admissions Academic Programs Alumni/Friends Life at Central Administration
SITE MAP
Pictures from around campus

Office for Equal Opportunity: Personal Data Form
Back to OEO

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

Personal Data Form

Employee ID Number:      (If known)
Employee Name:
      Last Name:     First Name:     MI:
Sex:
      Male     Female
Date of Birth :
      Month:     Day:     Year:

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.

Definitions

Are you of Spanish/Hispanic/Latino origin:
Yes No

Which race do you consider yourself?
Definitions

Physical, Sensory or Mental Impairment:
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?
Definitions

Military Status:    Are you an United States veteran?

Yes No

     If yes, complete next question.

U.S. Veteran Status:
 
 
 
Recently Separated  

 

Racial/Ethnic Origin(s):
Groups identified in state and/or federal affirmative action guidelines are:
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 maintains tribal affiliation or community attachment.
Asian:
A person having origins in any of the original people of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Black or African American:
A person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black" or "African American."
Hispanic or Latino:
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term, "Spanish origin," can be used in addition to "Hispanic" or "Latino."
Native Hawaiian or Other Pacific Islander:
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White:
A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Back to form

Vietnam-era Veteran:
A person who served on active duty for more than 180 days. Veterans who served in the Republic of Vietnam between February 28, 1961 and May 7, 1975 are eligible. All other veterans who served between August 5, 1964 and May 7, 1975. Veterans must have been discharged or released with other than a dishonorable discharge, or discharged or released from active duty for a service-connected disability if any part of such active duty was performed during the Vietnam-era.
Special Disabled Veteran:
(1) A veteran who is entitled to compensation (or who, but for the receipt of military retired pay, would be entitled to compensation) under laws administered by the Department of Veteran Affairs for a disability (i) rated at 30% of more, or (ii) rated at 10% or 20% if it has been determined that the individual has a serious employment disability; or (2) a veteran who was discharged or released from active duty because of a service-connected disability.
Other Protected Veteran:
A person who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized, under laws administrated by the Department of Defense.
Recently Separated Veteran :
Any veteran during the one-year period beginning on the date of such veteran's discharge or release from active duty.
 

Back to form

Disabling Condition:
A person who (1) has a physical, sensory, or mental impairment which substantially limits one or more major life activity; (2) has a record of such an impairment; or (3) is regarded as having such an impairment.

Back to form
Contact Information
Office for Equal Opportunity
400 E. University Way
Ellensburg, WA 98926
Phone: (509) 963-2205
Fax: (509) 963-2203
Email: oeo@cwu.edu
Central Washington University 400 E. University Way, Ellensburg WA 98926 This Site Optimized For Newer Browsers.
Go back to Central's main page