Invitation to Self-Identify
Voluntary Self-Identification Form for Employees
Office for Civil Rights & Title IX Compliance
360-650-3307 | crtc@wwu.edu 		#New Form
Western Washington University (WWU) is an equal opportunity employer. In compliance with applicable laws, 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 (including a service animal in training) by a person with a disability, or any other characteristic protected by federal, state, or local law. Submission of the following information is voluntary and refusal to provide the requested information will not subject you to any adverse treatment. The information obtained will be kept confidential and is requested for purposes of the University ensuring compliance with relevant federal, state, and local laws as well as University policy, which prohibit discrimination.
 
Date:
:
 
Ethnicity, Race and Sex

Review definitions for the ethnicity and race categories referred to in the following questions.

 
Are you Hispanic or Latino?
No Yes
 
Select one or more of the following race categories with which you identify.
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
 
This employer is a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors 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 as follows:
 
  • A "disabled veteran" is one of the following:
    • a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
    • a person who was discharged or released from active duty because of a service-connected disability
  • A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
  • An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
  • An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
 
Protected veterans may have additional rights under USERRA-the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL.
 
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 the above "protected veteran" categories. 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 classification(s) 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 it would assist us if you tell us whether there are accommodations we could make that would enable you to perform the essential functions of the job, including special equipment, changes in the physical layout of the job, changes in the way the job is customarily performed, provision of personal assistance services or other accommodations. This information will assist us in making reasonable accommodations for your disability. You are encouraged to contact Disability Services in Human Resources at (360) 650-3751 or hr.disability@wwu.edu.

Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended.

The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.

Please refer to this organization's equal opportunity programs for more information.

 
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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