Common use of Ethnicity Clause in Contracts

Ethnicity. (Select one): 12b. Race (Select one or more, regardless of ethnicity): 12c. Are you a Military Vetera 1D American Indian or Alaskan Native Active Duty Military? Yes 12d. Do you have a disability? Yes Origin 13. NAME (Last, First) 14. PHONE 15. EMAIL ADDRESS 16. STREET ADDRESS, XXX# 00. CITY 18. STATE 19. ZIP CODE 20. NAME OF AGENCY/ BUREAU 21. AGREEMENT# 22. AGENCY CONTACT NAME (Last, First) 23. AGENCY CONTACT EMAIL & PHONE 24. REIMBURSEMENTS APPROVED: D Yes Type and Rate of Reimbursement:

Ethnicity. (Select one): 12b. Race (Select one or more, regardless of ethnicity): 12c. Are you a Military Vetera Veteran or 1D American Indian or Alaskan Native Active Duty Military? Yes 12d. Do you have a disability? D Yes Origin 13. NAME (Last, First) 14. PHONE 15. EMAIL ADDRESS 16. STREET ADDRESS, XXX# 00. CITY 18. STATE 19. ZIP CODE 20. NAME OF AGENCY/ BUREAU 21. AGREEMENT# 22. AGENCY CONTACT NAME (Last, First) 23. AGENCY CONTACT EMAIL & PHONE 24. REIMBURSEMENTS APPROVED: D Yes Type and Rate of Reimbursement:

Ethnicity. (Select one): 12b. Race (Select one or more, regardless of ethnicity): 12c. Are you a Military Vetera 1D American Indian or Alaskan Native Active Duty Military? Yes 12d. Do you have a disability? Yes Origin 13. NAME (Last, First) 14. PHONE 15. EMAIL ADDRESS 16. STREET ADDRESS, XXXAPT# 0017. CITY 18. STATE 19. ZIP CODE 20. NAME OF AGENCY/ BUREAU 21. AGREEMENT# 22. AGENCY CONTACT NAME (Last, First) 23. AGENCY CONTACT EMAIL & PHONE 24. REIMBURSEMENTS APPROVED: D Yes Type and Rate of Reimbursement:

Ethnicity. (Select one): 12b. Race (Select one or more, regardless of ethnicity): 12c. Are you a Military Vetera 1D American Indian or Alaskan Native Active Duty Military? Yes 12d. Do you have a disability? Yes Origin 13. NAME (Last, First) 14. PHONE 15. EMAIL ADDRESS 16. STREET ADDRESS, XXX# 00. CITY 18. STATE 19. ZIP CODE 20. NAME OF AGENCY/ BUREAU 21. AGREEMENT# 22. AGENCY CONTACT NAME (Last, First) 23. AGENCY CONTACT EMAIL & PHONE Xxxxx_Xxxxxx@xxx.xxx 24. REIMBURSEMENTS APPROVED: D Yes Type and Rate of Reimbursement:

Ethnicity. (Select one): 12b. Race (Select one or more, regardless of ethnicity): 12c. Are you a Military Vetera Veteran or 1D American Indian or Alaskan Native Active Duty Military? Yes 12d. Do you have a disability? D Yes Origin 13. NAME (Last, First) 14. PHONE 15. EMAIL ADDRESS 16. STREET ADDRESS, XXXAPT# 0017. CITY 18. STATE 19. ZIP CODE 20. NAME OF AGENCY/ BUREAU 21. AGREEMENT# 22. AGENCY CONTACT NAME (Last, First) 23. AGENCY CONTACT EMAIL & PHONE 24. REIMBURSEMENTS APPROVED: D Yes Type and Rate of Reimbursement: