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: