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Voluntary Self-Identify Forms


The University of Louisiana at Lafayette prohibits discrimination of federal, state, and local laws, including Title VI and Title VII of the Civil Rights Act 1964, the Age Discrimination in Employment Act of 1967, Age Discrimination Act of 1975, the Equal Pay Act of 1963, Title IX of the Education Amendments of 1972, Executive Order 11246, Section 503 and 504 of the Rehabilitation Act of 1973, Section 402 of the Vietnam Era Veterans Readjustment Assistance Act of 1974 and the Americans with Disabilities Act of 1990.

The University is subject to certain nondiscrimination and affirmative action recordkeeping and reporting requirements in accordance with the Americans with Disabilities Act, and Sections 503 and 504 of the Rehabilitation Act of 1973 (as amended), for civil rights enforcement purposes.  As a result of new regulations, the University is required to survey our current employees.

It is the policy of the University not to discriminate against any employee or applicant for employment because he or she is a qualified individual with a disability. It is also the policy of the University to take affirmative action to employ all persons regardless of their status as qualified individuals with disabilities, and to base all employment decisions only on valid job requirements.

This policy applies to all employment actions, including but not limited to, recruitment, hiring, transfer, promotion, demotion, layoff, recall, termination, rates of pay or other forms of compensation, at all levels of employment.
The University invites applicants and employees to self-identify their status as an individual with a disability. The submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. Any information obtained will be kept confidential and may only be used in accordance with the provisions of applicable federal, state and local laws and regulations.

Applicants and employees may voluntarily self-identify their disability status at any time.  Applicants may provide this information through the University’s online application process.  Employees may voluntarily provide this information by filling out the form below.  Once you have filled out your form, you can bring it to Buchanan Hall, Rm 301, fax it to The Office of Human Resources 337-482-1452, ATTN: HR Compliance or complete through employee self service accessible through ULINK.

We are required to periodically resurvey our employees.

If you would like to request a reasonable accommodation, please contact the Director, Human Resources Compliance and Equal Opportunity Programs at 337-482-2921 or via email at 

Why am I being asked to fill out this form?

The University of Louisiana at Lafayette is considered a federal contractor and is required to maintain and analyze data on the race, ethnicity, veteran, and disability status of employees in compliance with the provision of Executive Order 11246 to the Office of Federal Contract Compliance Programs (OFCCP).

Federal contractors and subcontractors must use a form developed by OFCCP to survey for disability- “Voluntary Self-identification of Disability Form” (Form CC 305-OMB Control Number 1250-0005).  The agency mandates the use of this form to survey disability status at both pre and post-offer stages.



Voluntary Self-identification of Disability Form

Post-Offer Voluntary Self-Identification Form

How will this information be stored?
Your “Voluntary Self-identification of Disability Form” will be stored separately from your personnel file.

Do I have to fill out this form?
No.  Completing this form is voluntary, but we hope that you will choose to fill it out. Because the University is considered to be a government contractor, we must document our efforts to provide equal opportunity to qualified people with disabilities. To help us measure our efforts, we are asking you to tell us if you have a disability or if you ever had a disability. Your individual information will be kept confidential.

What if I need to update my disability status?
Because a person may become disabled at any time, you may submit an updated form as needed.

Who can I contact for more information?
Lelanya Douet
Director, Human Resources Compliance, Equal Employment Opportunity Programs
Phone:  (337) 482-2921