Verification Of Student Admission Information (For Student Residing With Parent Or Guardian)/proof Of Residency Form Page 6
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13Texas Education Agency
Texas Public School Student/Staff Ethnicity and Race Data Questionnaire
The United States Department of Education (USDE) requires all state and local education
institutions to collect data on ethnicity and race for students and staff. This information is used
for state and federal accountability reporting as well as for reporting to the Office of Civil Rights
(OCR) and the Equal Employment Opportunity Commission (EEOC).
School district staff and parents or guardians of students enrolling in school are requested to
provide this information. If you decline to provide this information, please be aware that the USDE
requires school districts to use observer identification as a last resort for collecting the data for
federal reporting.
Please answer both parts of the following questions on the student’s or staff member’s ethnicity
and race. United States Federal Register (71 FR 44866)
Part 1. Ethnicity: Is the person Hispanic/Latino? (Choose only one)
Hispanic/Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or
other Spanish culture or origin, regardless of race.
Not Hispanic/Latino
Part 2. Race: What is the person’s race? (Choose one or more)
American Indian or Alaska Native - A person having origins in any of the original peoples of
North and South America (including Central America), and who maintains a tribal affiliation or
community attachment.
Asian - 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, and Vietnam.
Black or African American - A person having origins in any of the black racial groups of
Africa.
Native Hawaiian or Other Pacific Islander - A person having origins in any of the original
peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White - A person having origins in any of the original peoples of Europe, the Middle East, or
North Africa.
________________________________
________________________________
Student/Staff Name (please print)
(Parent/Guardian)/(Staff) Signature
________________________________
________________________________
Date
Student/Staff Identification Number
This space reserved for Local school observer – upon completion and entering data in student software
system, file this form in student’s permanent folder.
Ethnicity – choose only one:
Race – choose one or more:
_____ American Indian or Alaska Native
_____ Hispanic / Latino
_____ Asian
_____ Black or African American
_____ Not Hispanic/Latino
_____ Native Hawaiian or Other Pacific Islander
_____ White
Observer signature:
Campus and Date:
Texas Education Agency
ENR-03(b)
Rev. 6.4.2013
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal