Self-Identification Form

Purdue University Calumet is an Equal Opportunity/Equal Access/Affirmative Action Employer and complies with all applicable federal and state regulations. We are required to solicit the information indicated below. This information is kept for statistical reporting and federal EEO/AA requirements. Your responses are voluntary and your cooperation in providing this information is appreciated. Failure to provide the following information will not result in any adverse treatment.

* Gender

Note: Hispanic or Latino is a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.


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 peoples 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.

Race (select all that apply)





Veteran Status (select all that apply)





* How did you learn about Purdue as a possible place of employment?