Office of Diversity and Inclusion

Self Identification Form

Voluntary Invitation to Self-Identify Race/Ethnicity/Gender

PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM

Anti-Discrimination Notice: It is an unlawful employment practice for an employer to fail or refuse to hire or discharge any individual, or otherwise to discriminate against any individual with respect to that individual’s terms and conditions of employment, because of such individual’s race, color, religion, sex, or national origin.

The University of Massachusetts Boston is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws and regulations, it is important that our recordkeeping and reporting information is accurate.

Submission of this information is voluntary, and refusal to provide it will not subject you to any adverse treatment.

PLEASE ANSWER THE FOLLOWING QUESTIONS

Gender:*

Race/Ethnicity - You may mark only one box:*