Office of Affirmative Action


You recently applied for a position at Arkansas Tech University. Please complete the information requested on the form below. Upon completion, click submit and the information will be forwarded to the Affirmative Officer at Arkansas Tech University.

Submission of the requested information is completely VOLUNTARY and WILL HAVE NO bearing on your employment opportunities at Arkansas Tech University. The information is vital to the University's Affirmative Action compliance with Titles VII and IX of the Civil Rights Act, the Rehabilitation Act of 1973, and the Vietnam Era Veterans Readjustment Act of 1974.

Thank you for your cooperation.

Position Number:

Position for which you are applying:






State: Zip:



The following information will be used for statistical reporting purposes only.

Sex: Female Male

Veteran Status: Disabled US Veteran Veteran from Vietnam Era Other Eligible Veteran

ADA Accommodations:Do you have a disability that requires accommodations? Yes No

Racial-Ethic Background: Black or African American American Indian or Alaskan Native Hispanic Asian White Native Hawaiian - Pacific IslandOther/UnknownU.S. CITIZEN? Yes NoNon-resident Alien? Yes NoIf Yes, type of visa: How did you learn of this position opening? (check all that apply) Democrat Gazette Personal Referral Other Newspaper: (specify) The Chronicle for Higher Ed. Arkansas Tech Website Other: ( Explain) Thank you for completing this form. Your input is greatly valued. If you are satisfied with your answers, click SUBMIT. If you wish to start over, click RESET.

Once you click the submit button, the form will be saved to the database. Should you have any questions about the survey, please contact Jennifer Fleming at (479)498-6020 or