Self-Identification Survey

For a list of definitions please visit the Ames webpage.

Question Title

1. Disability Status
Please check one of the boxes below:

Yes, I have a disability (or previously had a disability)

No, I don't have a disability

I don't wish to answer

Question Title

2. Protected Veteran Status
Please check one of the boxes below:

I identify as one or more of the classifications of protected veteran listed

I am not a protected veteran

I do not wish to answer

Question Title

3. Gender
Please check one of the boxes below:

Male

Female

Non-Binary

Question Title

4. Race
Please check one of the boxes below:

American Indian/Alaskan Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

White

More than one race

Question Title

5. Please enter your date of birth (month and day only)

Question Title

6. Legal Full Name (First and Last)

Question Title

7. Date

Date

Self-Identification Survey

Question Title

* 1. Disability StatusPlease check one of the boxes below:

Question Title

* 2. Protected Veteran StatusPlease check one of the boxes below:

Question Title

* 3. GenderPlease check one of the boxes below:

Question Title

* 4. RacePlease check one of the boxes below:

Question Title

* 5. Please enter your date of birth (month and day only)

Question Title

* 6. Legal Full Name (First and Last)

Question Title

* 7. Date

1. Disability Status
Please check one of the boxes below:

2. Protected Veteran Status
Please check one of the boxes below:

3. Gender
Please check one of the boxes below:

4. Race
Please check one of the boxes below:

5. Please enter your date of birth (month and day only)

6. Legal Full Name (First and Last)

7. Date