Ethnic Origin - Ethnicity - Race Update Form

UAMS is instituting new racial classifications used by the US Census Bureau that allows self-identification by people according to the race or races with which they most closely identify. Employees may choose their ethnic origin, their ethnicity and up to as many as five races. To update your record please complete the form below. It will be submitted to Human Resources who will update your employee file. If you have questions, please contact Human Resources at 686-5650.

Ethnic Origin - Ethnicity - Race

Update Form

Name:

Last Four Numbers of Social Security Number:

Ethnic Origin: (Select Only One)

White/Not Hispanic		Black/Not Hispanic
Hispanic		Asian or Pacific Islander
American Indian/Alaskan		Native Hawaiian
Hispanic White Only		Unknown

Ethnicity: (Select Only One)

Not Hispanic/Latino

Hispanic/Latino

Race: (Select All That Apply)
American Indian or Alaskan Native		Native Hawaiian or Pacific Islander
Asian		White
Black or African American		Some Other Race

When data is entered by someone other than employee (managers, supervisors, business officers..) please include the following:

Name: Telephone Number:

email:

Office of Human ResourcesCopyright © 2003 University of Arkansas for Medical Sciences. All rights reserved. Revised: April 02, 2003

Office of Human Resources
Copyright © 2003 University of Arkansas for Medical Sciences. All rights reserved.
Revised: April 02, 2003