Equal Opportunity and Affirmative Action Program
 

It is the continuing policy and commitment of the University of Colorado Denver to provide equal opportunity for employment to all jop applicants, for advancement of all employees, and for education of all students, without discrimination with regard to race, religion, sex, age, national origin, handicap or veterans status. In line with our Equal Opportunity Affirmative Action Program, we would appreciate it very much if you would complete this form. The information is necessary for our reports to the National Institute of Mental Health. Providing this information is voluntary and will be kept confidential except as provided under regulations.
 

(   )  Male                                         U.S. Citizen:  Yes(    )      No(    )
 

(   )Female                                        Are you a Vietnam Era Veteran?

Ethnicity:      (    )        Black, non-Hispanic Disabled Veteran: ______________  Handicapped: ____________________
Do you have a physical or mental impairment which substantially limits one or more major life activities?   (   )Yes        (   )No
Will you need special accomodations?
Please specify:

______________________________________________________________
 

How did you hear of this position?
 
 
 
 

Have you ever had NRSA funding in the past?  If so, please list grant # and whether pre-doc or post-doc: