Common use of Ethnicity Clause in Contracts

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00. XXXX, XXXXX, ZIP CODE 20. AGENCY CONTACT NAME (Last, First) 21. AGENCY CONTACT EMAIL & PHONE 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No 15. EMERGENCY CONTACT INFORMATION NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXXX XXXXXX XXXXXXX 00. XXXX, XXXXX, ZIP CODE 20. AGENCY CONTACT NAME (Last, First) 21. AGENCY CONTACT EMAIL & PHONE 22. REIMBURSEMENTS APPROVED: Yes No Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00. XXXX, XXXXX, ZIP CODE 20. AGENCY CONTACT NAME (Last, First) 21. AGENCY CONTACT EMAIL & PHONE 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00. XXXX, XXXXX, ZIP CODE 20. AGENCY CONTACT NAME (Last, First) 21. AGENCY CONTACT EMAIL & PHONE 22. REIMBURSEMENTS APPROVED: Yes No Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00STREET ADDRESS 19. XXXXCITY, XXXXXSTATE, ZIP CODE 20. AGENCY CONTACT NAME (Last, First) XXXXX, XXXXXXX 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:: PATC VIP

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00. XXXX, XXXXX, ZIP CODE 20. AGENCY CONTACT NAME (Last, First) Xxxxx Xxxxxx 21. AGENCY CONTACT EMAIL & PHONE xxxxx_xxxxxx@xxx.xxx 000-000-0000 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:

Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00STREET ADDRESS 19. XXXXCITY, XXXXXSTATE, ZIP CODE 20. AGENCY CONTACT NAME (Last, First) 21. AGENCY CONTACT EMAIL & PHONE 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE: