Affirmative Action Program Data
Human Resources 360-650-3774 		#New Form
Western Washington University (WWU) is an equal opportunity and affirmative action employer committed to assembling a diverse, broadly trained faculty and staff. In compliance with applicable laws and in furtherance of its commitment to fostering an environment that welcomes and embraces diversity, WWU does not discriminate on the basis of race, ethnicity, color, national origin, age, citizenship or immigration status, pregnancy, use of protective leave, genetic status, sex, sexual orientation, gender identity, gender expression, marital status, creed, religion, veteran or military status, disability or the use of a trained guide dog or service animal by a person with a disability, or any other characteristic protected by federal, state, or local law. This includes University programs or activities, including employment, admissions, and educational programs. See WWU's Policy on Ensuring Equal Opportunity and Prohibiting Discrimination and Retaliation.
 
Date:
:
 
Ethnicity, Race and Sex
 
Are you Hispanic or Latino?
No Yes
(See definitions)
 
With which race(s), if any, do you self-identify? Check all that apply. (See definitions)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
 
Sex:
 Woman   Man   Other, or prefer not to answer
 
Veteran Status
 
Government contractors are required to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined here.
 
As a Government contractor subject to VEVRAA, we are required to submit a report to the United States Department of Labor each year identifying the number of our employees belonging to each specified "protected veteran" category. If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below.
 
I belong to one or more of the following classifications of protected veterans (choose all that apply):
 
Disabled Veteran
Active Wartime or Campaign Badge Veteran
Armed Forces Service Medal Veteran
 
 
 
*NOTE: If the Date of Discharge entered is within the past three years, then you are
selecting a classification as a 'recently separated veteran.'
 
I am a protected veteran, but I choose not to self-identify the classifications to which
  I belong.
I am a veteran, but I do not identify with any of the classifications of protected veterans
  listed above.
I am not a veteran.
 
If you are a disabled veteran, you are encouraged to contact Disability Services in Human Resources at (360) 650-3771 or hr.disability@wwu.edu to inform the University if there are reasonable accommodations we could make that would enable you to perform the essential functions of your job.
 
Disability
 
Voluntary Self-Identification of Disability
Form CC-305
OMB Control Number 1250-0005
Expires 4/30/2026
 
Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal
employment opportunity to qualified people with disabilities. We have a goal of having
at least 7% of our workers as people with disabilities. The law says we must measure
our progress towards this goal. To do this, we must ask applicants and employees
if they have a disability or have ever had one. People can become disabled, so we
need to ask this question at least every five years.
 
Completing this form is voluntary, and we hope that you will choose to do so.
Your answer is confidential. No one who makes hiring decisions will see it.
Your decision to complete this form and your answer will not harm you in any way.
If you want to learn more about the law or this form, visit the U.S. Department
of Labor's Office of Federal Contract Compliance Programs (OFCCP)
website at www.dol.gov/ofccp.
 
How do you know if you have a disability?
A disability is a condition that substantially limits one or more of your
"major life activities." If you have or have ever had such a condition,
you are a person with a disability.
 
Disabilities include, but are not limited to:
item bullet Alcohol or other substance use disorder (not currently using drugs illegally)
item bullet Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
item bullet Blind or low vision
item bullet Cancer (past or present)
item bullet Cardiovascular or heart disease
item bullet Celiac disease
item bullet Cerebral palsy
item bullet Deaf or serious difficulty hearing
item bullet Diabetes
item bullet Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
item bullet Epilepsy or other seizure disorder
item bullet Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
item bullet Intellectual or developmental disability
item bullet Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
item bullet Missing limbs or partially missing limbs
item bullet Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
item bullet Nervous system condition, for example, migraine headaches, Parkinson's disease, multiple sclerosis (MS)
item bullet Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
item bullet Partial or complete paralysis (any cause)
item bullet Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
item bullet Short stature (dwarfism)
item bullet Traumatic brain injury
 
Please check one of the boxes below:
 
Yes, I have a disability, or have had one in the past
No, I do not have a disability and have not had one in the past
I do not want to answer
 
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