Race & Ethnicity Standards Form

Race & Ethnicity Data Standards

Student Name*
School Name*
This form is to be completed by the parent or guardian and both questions must be answered. Part A asks about the student’s ethnicity and Part B asks about the student’s race. If you decline to respond to either question, the school district is required to provide missing information by observer identification. This race and ethnicity data will be used in the same manner as previously collected data, e.g. in reporting and analyzing test results by race and ethnicity. The information will not be used to check immigration status and the confidentiality of the individual student information is protected.*
Part A: Is this student Hispanic/Latino? (Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race). Choose only one.*

No, not Hispanic/Latino

Yes, Hispanic/Latino
Part B: What is the student's race? (Choose one or more.)
American Indian or Alaska Native (A person having origins in any of the original peoples of North and South America, including Central America, and who maintains tribal affiliation or community attachment.)
Asian (A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.)
Black or African American (A person having origins in any of the black racial groups of Africa.)
Native Hawaiian or Other Pacific Islander (A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
White (A person having origins in any of the original peoples of Europe, the Middle East or North Africa
Student Signature*

(by signing/typing your name, you understand and agree with all of the information that is in this form)
Parent Signature*

(by signing/typing your name, you understand and agree with all of the information that is in this form)

Race & Ethnicity Data Standards

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