Affirmative Action Form

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Affirmative Action Information Form

This information is requested for statistical purposes only. Your application will not be adversely affected by your responses nor by your nonresponse should you choose not to provide the information. The form will be kept separate from your application. We ask for your name and date of birth solely to identify your information with the appropriate recruitment effort.

* Indicates required field

Name *

First

Last

Date of Birth (mm/dd/yyyy) *

Sex *

Male Female

Citizenship *

U.S. Citizen Non-resident Alient Resident Alient

What is your race or ethnic identification? *

White, not of Hispanic origin: All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East. Black, not of Hispanic origin: All persons having origins in any of the Black racial groups of Africa. Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South America or other Spanish Culture or origin, regardless of race. Asian or Pacific Islander: All persons having origins in any of the original peoples of the Far East, Southeast Asia, Indian Sub-continent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands, and Samoa American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America and who maintain cultural identification through tribal affiliations or community recognition.

Submit

NONDISCRIMINATION NOTICE
The University of Alabama complies with applicable laws prohibiting discrimination, including Titles VI and VII of the Civil Rights Act of 1964, the Age Discrimination in Employment Act, Executive Order 11246, Title IX of the Education Amendments of 1972, Sections 503 and 504 of the Rehabilitation Act of 1973, the Vietnam Era Veterans Adjustment Assistance Act, the Age Discrimination Act of 1975, and the Americans with Disabilities Act of 1990, and does not discriminate on the basis of race, color, religion, national origin, sex, age, disability or veteran status in admission or access to, or treatment of employment in, its programs and services. Inquiries and concerns may be directed to Gwendolyn Hood, University Compliance Officer, 171 Rose Administration Building, Box 870300, Tuscaloosa, AL 35487-0300, (205) 348-5855 (Voice/TDD).

Home
About Us
Join Us
- Applicant Profiles
- Ongoing Support
Application
Resources
Meet the 2021 Cohort
Contact Us