Common use of Ethnicity Clause in Contracts

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. STREET ADDRESS 19. CITY, STATE, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XXXXX, XXXXXXX 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE: PATC VIP

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. STREET ADDRESS 19XXXXXX XXXXXXX 00. CITYXXXX, STATEXXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XXXXXXxxxxx, XXXXXXX Xxxxxx 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 000-000-0000 xxxxxx_xxxxxx@xxx.xxx 22. REIMBURSEMENTS APPROVED: Yes No Type and Rate of Reimbursement: Yes No N/A 23. VOLUNTEER POSITION/GROUP PROJECT TITLE: PATC VIP:

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. STREET ADDRESS 19. CITY, STATE, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XXXXXXxxxxx, XXXXXXX Xxxxxx 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 xxxxxx_xxxxxx@xxx.xxx 000-000-0000 22. REIMBURSEMENTS APPROVED: Yes X No Type and Rate of Reimbursement: Yes No N/A 23. VOLUNTEER POSITION/GROUP PROJECT TITLE: PATC VIPIce Age NST Volunteer

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. STREET ADDRESS 19XXXXXX XXXXXXX 00. CITYXXXX, STATEXXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XXXXXXxxxxx, XXXXXXX Xxxxxx 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 000.000.0000/xxxxxxx@xxx.xxx 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes ✔ No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE: PATC VIPIFNM Restoration

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. STREET ADDRESS 19XXXXXX XXXXXXX 00. CITYXXXX, STATEXXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XXXXXXxxxx, XXXXXXX Xxxxx – Volunteer and Community Engagement Director 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 xxxxxx@xxxxxxx.xxx, 000-000-0000 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE: PATC VIP2021 Days of Service

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. STREET ADDRESS 19XXXXXX XXXXXXX 00. CITYXXXX, STATEXXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XXXXXXxxxxx, XXXXXXX Xxxxxxxx 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 xxxxxxxx.xxxxxx@xxxx.xxx; (000)000-0000 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes ✔ No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE: PATC VIPTrail Maintenance

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. STREET ADDRESS 19XXXXXX XXXXXXX 00. CITYXXXX, STATEXXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XXXXXXxxxxxxx, XXXXXXX Xxxxx 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 Xxxxx_Xxxxxxxx@xxx.xxx 000-000-0000 22. REIMBURSEMENTS APPROVED: Yes No Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE: PATC VIPColonial Night Watch 2019

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. STREET ADDRESS 19XXXXXX XXXXXXX 00. CITYXXXX, STATEXXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XXXXXXxxxxxxx, XXXXXXX Xxxxx 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 Xxxxx_Xxxxxxxx@xxx.xxx 000-000-0000 22. REIMBURSEMENTS APPROVED: Yes No Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE: PATC VIPColonial Night Watch 2018

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. STREET ADDRESS 19XXXXXX XXXXXXX 00. CITYXXXX, STATEXXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XXXXXXxxxx, XXXXXXX Xxxxx – Director of Volunteer Services 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 xxxxxx@xxxxxxx.xxx, 000-000-0000 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE: PATC VIP2019 Days of Service

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. STREET ADDRESS 19XXXXXX XXXXXXX 00. CITYXXXX, STATEXXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XXXXXXxxxxxxxx, XXXXXXX Xxxxx 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 xxxxx_xxxxxxxxx@xxx.xxx 000-000-0000 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE: PATC VIPXxxx Blind Preparation

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. STREET ADDRESS 19XXXXXX XXXXXXX 00. CITYXXXX, STATEXXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XXXXX, XXXXXXX Xxxxx Xxxxxx 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 xxxxx_xxxxxx@xxx.xxx 000-000-0000 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE: PATC VIP:

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. STREET ADDRESS 19XXXXXX XXXXXXX 00. CITYXXXX, STATEXXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XXXXXXxxxxxx, XXXXXXX Xxxx 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 Xxxx_Xxxxxxx@xxx.xxx 510-792-0222, x 361 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes ✔ No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE: PATC VIPCleanup Volunteer

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. STREET ADDRESS 19XXXXXX XXXXXXX 00. CITYXXXX, STATEXXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XXXXXXxxxx, XXXXXXX Xxxxx 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 Xxxxxxxxxxx_Xxxxx@xxx.xxx; 000-000-0000 x 0 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE: PATC VIPHabitat Restoration- (circle the Habitat Restoration position below)

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. STREET ADDRESS 19. CITY, STATE, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XXXXXXxxxxx, XXXXXXX Xxxxxx 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 000-000-0000 xxxxxx_xxxxxx@xxx.xxx 22. REIMBURSEMENTS APPROVED: Yes No Type and Rate of Reimbursement: Yes No N/A 23. VOLUNTEER POSITION/GROUP PROJECT TITLE: PATC VIPIce Age NST Volunteer

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. STREET ADDRESS 19XXXXXX XXXXXXX 00. CITYXXXX, STATEXXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XXXXXXxxx, XXXXXXX Xxxxx 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 Xxxxx_xxxx@xxx.xxx 510/792-0222 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes X No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE: PATC VIPXxxx Blind Repair and Cleanup Volunteer

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. STREET ADDRESS 19XXXXXX XXXXXXX 00. CITYXXXX, STATEXXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XXXXXXxxxxx, XXXXXXX Xxxxxx 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 000-000-0000 xxxxxx_xxxxxx@xxx.xxx 22. REIMBURSEMENTS APPROVED: Yes No Type and Rate of Reimbursement: Yes No N/A 23. VOLUNTEER POSITION/GROUP PROJECT TITLE: PATC VIPIce Age NST Volunteer