Dear Applicant:
No person is excluded from admission to Lewis-Clark State College or otherwise treated differently on the basis of any legally protected factor, including but not limited to, gender, race, color, citizenship, national origin, religion, sexual orientation, status as a disabled veteran, Vietnam veteran or other veteran, pregnancy, exercise of legally protected rights, age, or any disability which Lewis-Clark State College can reasonably accommodate without undue hardship. To help us comply with Federal and State equal employment opportunity laws, please answer the questions below.  This information card will be kept separate from your application and will be used for only affirmative action purposes.  Completion of this card is voluntary.

Applicant Name:  

Date of Application:  

Gender:                     Please Select Male Female

Position #:  

Position Title:

Is your race or ethnicity Hispanic/Latino?  Please Select No Yes

Select the appropriate racial group if your race or ethnicity is from one of the following five racial groups.

Please Select White American Indian or Alaska Native Black or African American Native Hawaiian or Other Pacific Islander Asian

Please Select U.S. Citizen Permanent U.S. Resident Non-Resident Alien

Do you wish to declare yourself as a disabled individual?  Please Select No Yes

(Disabled individual means any person who (1) has a physical or mental impairment which substantially limits one or more of such person's major life activities, (2) has a record of such impairment, or (3) is regarded as having such an impairment.)

Are you a veteran of the Armed Forces? 

Please Select No Yes

Do you qualify as a Vietnam Era Veteran (Had active duty for over 180 days between 2/28/61 and 5/7/75)? 

Please Select No Yes

Are you a disabled veteran (disability incurred in line of duty, rated at 30% by the Veterans Administration)?

Please Select No Yes

I am an "Other Eligible Veteran"?

Please Select No Yes