Invitation to Self-Identify AA-1 Revised: 05/10/2012

As part of our application process, we request that you provide information about your gender, race, ethnicity, disability, and veteran’s status. This is to assist us in assessing our efforts to attract qualified, diverse applicants and to be consistent with federal and state laws and regulations.

Submission of this information is entirely voluntary. Failure to provide such information will in no way affect your candidacy or chances of getting a position with the University.

If you have questions or concerns about this request, please contact the Kansas State University Office of Affirmative Action (affact@k-state.edu or 785-532-6220). Thank you for your interest in a position at our University.

  • Position Information
  • Demographic Information
    • Gender
    • Ethnicity
      • A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
    • Race (check all that apply)
      • A person having origins in any of the original peoples of North or South America (Including Central America), and who maintains tribal affiliation or community attachment.
      • 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 or Vietnam.
      • A person having origins in any of the black racial groups of Africa.
      • A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific islands.
      • A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
    • Disability
      • Are you an individual with a disability?
        For self-identification purposes, an individual with a disability means any person who: (a) has a physical or mental impairment which substantially limits one or more major life activities, such as, reading, walking or speaking; or (b) has a record of such impairment.
    • Veteran Status
      • Are you a veteran?
        If yes, please check all that apply.
      • Are you a special disabled veteran?
        Special Disabled Veteran means (i) a veteran of the United States military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans' Affairs for a disability (A) rated at 30 percent or more, or (B) rated at 10 or 20 percent in the case of a veteran who has been determined under Section 38 U.S.C. 3106 to have a serious employment handicap or (ii) a person who was discharged or released from active duty because of a service-connected disability.
      • Are you an other protected veteran?
        Other Protected Veterans means veterans who served on active duty in the United States military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized. For those with Internet access, the information required to make this determination is available at http://www.opm.gov/staffingportal/vgmedal2.asp. A copy of the list also may be obtained by calling (301) 306-6752 and requesting that a copy of the list be mailed to you.
      • Are you a recently separated veteran (veteran within 12 months from discharge or release from active duty)?
        Recently Separated Veterans means any veteran who served on active duty in the United States military, ground, naval or air service during the one-year period beginning on the date of such veteran’s discharge or release from active duty.
      • Are you an Armed Forces Service Medal Veteran?
        Armed Forces Service Medal Veteran" refers to a person who, while serving on active duty in the United States military, ground, naval, or air service, participated a United States military operation for which an Armed Forces service medal was awarded pursuant to Executed Order 12985.
      • Are you a Vietnam Era Veteran?
        Veteran of the Vietnam Era means a person who: (i) served on active duty in the United States Military, ground, naval or air service for a period of more than 180 days, and who was discharged or released there from with other than a dishonorable discharge, if any part of such active duty was performed: (A) in the Republic of Vietnam between February 28, 1961 and May 7, 1975; or (B) between August 5, 1964 and May 7, 1975, in all other cases; or (ii) was discharged or released from active duty in the U.S. Military, ground, naval or air service for a service connected disability if any part of such active duty was performed (A) in the Republic of Vietnam between February 28, 1961 and May 7, 1975; or (B) between August 5, 1964 and May 7, 1975, in any other location.

You may also print this form and return it to: Office of Affirmative Action
214 Anderson Hall
Kansas State University
Manhattan, KS 66506