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Date of Birth (MM/DD/YYYY)
First Name
Middle Initial
Last Name
Email address
Additional Contact Info
Gender
Ethnicity
Hispanic or Latino
Prefer not to disclose
Not Hispanic or Latino
Race
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Other
Prefer not to disclose
Do you have a disability to disclose?
Yes
No
The University of Nebraska does not discriminate based on race, color, ethnicity, national origin, sex, pregnancy, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, marital status, and/or political affiliation in its education programs or activities, including admissions and employment. The University prohibits any form of retaliation being taken against anyone for reporting discrimination, harassment, or retaliation for otherwise engaging in protected activity.
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