Michigan Technological University is an equal opportunity employer. In order to meet this commitment, it is necessary to collect information concerning applicants. Your response to this request is voluntary and refusal to provide it will not subject you to any adverse treatment. Please be assured this information will be kept confidential, will be kept separately from your application form and will be used only in accordance with the regulations (41CFR60-250 and 41CFR60-741) by the Affirmative Action Office. Please reply to: RMJUNTUN@MTU.EDU

SOCIAL SECURITY NUMBER:

LAST NAME:

FIRST NAME:

DATE OF BIRTH:
(mm/dd/yy)

SEX:

ETHNIC ORIGIN:________

• 1 = WHITE - (not of Hispanic Origin) - A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.
  
  
• 2 = BLACK or AFRICAN AMERICAN - (not of Hispanic Origin) - A person having origins in any of the Black racial groups of Africa.
  
  
• 3 = HISPANIC or LATINO - A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
  
  
• 4 = ASIAN - A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, for example, China, Japan, Korea, the Philippine Islands, Thailand, and Vietnam.
  
  
• 5 = NATIVE HAWAIIAN or OTHER PACIFIC ISLANDER - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, OR other Pacific Islands.
  
  
• 6 = 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 cultural identification through tribal affiliation or community recognition.