Texas EducationAgency

Texas Public SchoolStudent/StaffEthnicityandRace DataQuestionnaire

TheUnitedStatesDepartmentofEducation(USDE)requiresallstateandlocaleducationinstitutionstocollectdataonethnicityandraceforstudentsandstaff.ThisinformationisusedforstateandfederalaccountabilityreportingaswellasforreportingtotheOfficeofCivilRights(OCR)andtheEqualEmploymentOpportunityCommission(EEOC).

Schooldistrictstaffandparentsorguardiansofstudentsenrollinginschoolarerequestedtoprovidethisinformation.Ifyoudeclinetoprovidethisinformation,pleasebeawarethattheUSDErequiresschooldistrictstouseobserveridentificationasalastresortforcollectingthedataforfederalreporting.

Pleaseanswerbothpartsofthefollowingquestionsonthestudent’sorstaffmember’sethnicityandrace.

UnitedStatesFederalRegister(71FR44866)

Part1.Ethnicity:IsthepersonHispanic/Latino?(Chooseonlyone)

Hispanic/Latino-ApersonofCuban,Mexican,PuertoRican,SouthorCentralAmerican,orotherSpanishcultureororigin,regardlessofrace.

NotHispanic/Latino

Part2.Race:Whatistheperson’srace?(Chooseoneormore)

AmericanIndianorAlaskaNative-ApersonhavingoriginsinanyoftheoriginalpeoplesofNorthandSouthAmerica(includingCentralAmerica),andwhomaintainsatribalaffiliationorcommunityattachment.

Asian-ApersonhavingoriginsinanyoftheoriginalpeoplesoftheFarEast,SoutheastAsia,ortheIndiansubcontinentincluding,forexample,Cambodia,China,India,Japan,Korea,Malaysia,Pakistan,thePhilippineIslands,Thailand,andVietnam.

Blackor AfricanAmerican-ApersonhavingoriginsinanyoftheblackracialgroupsofAfrica.

NativeHawaiianorOtherPacificIslander-ApersonhavingoriginsinanyoftheoriginalpeoplesofHawaii,Guam,Samoa,orotherPacificIslands.

White-ApersonhavingoriginsinanyoftheoriginalpeoplesofEurope,theMiddleEast,orNorthAfrica.

Student/StaffName(pleaseprint) / (Parent/Guardian)/(Staff) Signature
Student/StaffIdentificationNumber / Date
ThisspacereservedforLocalschoolobserver–uponcompletionandenteringdatainstudentsoftwaresystem,filethisforminstudent’spermanentfolder.
Ethnicity–chooseonlyone:
Hispanic/Latino
NotHispanic/Latino / Race–chooseoneormore:
AmericanIndianorAlaskaNative
Asian
BlackorAfricanAmerican
NativeHawaiianorOtherPacificIslander
White
Observersignature: / CampusandDate:

TexasEducationAgency–March 2017