Common use of Ethnicity Clause in Contracts

Ethnicity. (Select one): 12b. Race (Select one or more, regardless of ethnicity): 12c. Are you a Military Vetera D Hispanic, Latino, or Spanish Origin D Not Hispanic, Latino, or Spanish 1D American Indian or Alaskan Native D Black or African American D Asian D White Active Duty Military? Yes 12d. Do you have a disability? Yes 0 No 0 No Origin D Native Hawaiian or Other Pacific Islander EMERGENCY CONTACT INFORMATION 13. NAME (Last, First) 14. PHONE 15. EMAIL ADDRESS 16. STREET ADDRESS, XXX# 00. CITY 18. STATE 19. ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. NAME OF AGENCY/ BUREAU 21. AGREEMENT# 22. AGENCY CONTACT NAME (Last, First) 23. AGENCY CONTACT EMAIL & PHONE 24. REIMBURSEMENTS APPROVED: D Yes Type and Rate of Reimbursement: D No

Ethnicity. (Select one): 12b. Race (Select one or more, regardless of ethnicity): 12c. Are you a Military Vetera Veteran or D Hispanic, Latino, or Spanish Origin 1D American Indian or Alaskan Native D Asian Active Duty Military? D Yes 0 No D Not Hispanic, Latino, or Spanish 1D American Indian or Alaskan Native D Black or African American D Asian D White Active Duty Military? Yes 12d. Do you have a disability? D Yes 0 No 0 No Origin D Native Hawaiian or Other Pacific Islander EMERGENCY CONTACT INFORMATION 13. NAME (Last, First) 14. PHONE 15. EMAIL ADDRESS 16. STREET ADDRESS, XXX# 00. CITY 18. STATE 19. ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. NAME OF AGENCY/ BUREAU 21. AGREEMENT# 22. AGENCY CONTACT NAME (Last, First) 23. AGENCY CONTACT EMAIL & PHONE 24. REIMBURSEMENTS APPROVED: D Yes Type and Rate of Reimbursement: D No

Ethnicity. (Select one): 12b. Race (Select one or more, regardless of ethnicity): 12c. Are you a Military Vetera D Hispanic, Latino, or Spanish Origin D Not Hispanic, Latino, or Spanish 1D American Indian or Alaskan Native D Black or African American D Asian D White Active Duty Military? Yes 12d. Do you have a disability? Yes 0 No 0 No Origin D Native Hawaiian or Other Pacific Islander EMERGENCY CONTACT INFORMATION 13. NAME (Last, First) 14. PHONE 15. EMAIL ADDRESS 16. STREET ADDRESS, XXX# 00. CITY 18. STATE 19. ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. NAME OF AGENCY/ BUREAU 21. AGREEMENT# 22. AGENCY CONTACT NAME (Last, First) 23. AGENCY CONTACT EMAIL & PHONE Xxxxx_Xxxxxx@xxx.xxx 24. REIMBURSEMENTS APPROVED: D Yes Type and Rate of Reimbursement: D No

Ethnicity. (Select one): 12b. Race (Select one or more, regardless of ethnicity): 12c. Are you a Military Vetera D Hispanic, Latino, or Spanish Origin D Not Hispanic, Latino, or Spanish 1D American Indian or Alaskan Native D Black or African American D Asian D White Active Duty Military? Yes 12d. Do you have a disability? Yes 0 No 0 No Origin D Native Hawaiian or Other Pacific Islander EMERGENCY CONTACT INFORMATION 13. NAME (Last, First) 14. PHONE 15. EMAIL ADDRESS 16. STREET ADDRESS, XXX# 00. CITY 18. STATE 19. ZIP CODE Xxxxxx GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. NAME OF AGENCY/ BUREAU 21. AGREEMENT# 22. AGENCY CONTACT NAME (Last, First) 23. AGENCY CONTACT EMAIL & PHONE 24. REIMBURSEMENTS APPROVED: D Yes Type and Rate of Reimbursement: D No