Form FORM 168A FORM 168A Elementary-Secondary Staff Information EEO-5 Report

Elementary-Secondary Staff Information (EEO-5)

EEO-5 FORM REVISED.8.24.12_1_1

Elementary-Secondary Staff Information (EEO-5)

OMB: 3046-0003

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EQUAL EMPLOYMENT OPPORTUNITY COMMISSION

ELEMENTARY-SECONDARY STAFF INFORMATION (EEO-5)


Public school systems


FORM APPROVED BY OMB

NO. 3046-0003

APPROVAL EXPIRES

This is a joint requirement of the EEOC and the Office for Civil Rights, U.S. Department of Education and the U.S. Department of Justice.

DO NOT ALTER INFORMATION PRINTED IN THIS BOX.










NOTE: ALL EMPLOYEES IN YOUR SCHOOL DISTRICT MUST BE INCLUDED ON THIS FORM. Additional Copies of this form may be obtained from the address

below. Send your full report to:










PART I. IDENTIFICATION

A. TYPE OF AGENCY WHICH OPERATES THE REPORTING SCHOOL SYSTEM


Local Public School  Special Regional Agency  State Education Agency


Other (Specify) ____________________________________


B. SCHOOLS SYSTEMS IDENTIFICATION (OMIT IS SAME AS LABEL)

NAME




STREET AND NO. OR POST OFFICE BOX

CITY/TOWN

COUNTY

STATE

ZIP



C. GENERAL STATISTICS

NUMBER OF SCHOOLS OPERATED

NUMBER OF ANNEXES OPERATED

OCTOBER 1ST ENROLLMENT



  1. REMARKS





















EEOC FORM 168A Page 1



PART II. Staff Statistics of (DATE) ________________________

DO NOT INCLUDE ELECTED/APPOINTED OFFICIALS (SEE DEFINITION IN APPENDIX)

DISTRICT NAME: _______________________________________





Activity

Assignment

Classification

A. FULL-TIME STAFF

Race/Ethnicity

Hispanic or Latino

Non -Hispanic or Latino


Total

Col

A - N

Male

Female

Male

Female

White

Black or African American

Asian

Native Hawaiian or Other Pacific Islander

American Indian or Alaska

Native

Two or more races

White

Black or African American

Asian

Native Hawaiian or Other Pacific Islander

American Indian or Alaska Native

Two or more races

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O

1. Officials, Administrators, Managers
















2. Principals
















3. Assistant Principals, Teaching
















4. Assistant Principals, Non-teaching
















5. Elementary Classroom Teachers
















6. Secondary Classroom Teachers















7. Other Classroom Teachers
















8. Guidance
















9. Psychological
















10. Librarians/

Audiovisual Staff
















11. Consultants & Supervisors of Instruction
















12. Other Professional Staff
















13. Teachers Aides
















14. Technicians
















15. Administrative Support Workers
















16. Service Workers
















17. Skilled Crafts
















18. Laborers and Helpers
















19. TOTALS (1-18)



















Activity

Assignment

Classification

B. PART-TIME STAFF

Race/Ethnicity

Hispanic or Latino

Non -Hispanic or Latino


Male Female

Male

Female

White

Black or African American

Asian

Native Hawaiian or Other Pacific Islander

American Indian or Alaska

Native

Two or more races

White

Black or African American

Asian

Native Hawaiian or Other Pacific Islander

American Indian or Alaska Native

Two or more races

20. Professional Instructional
















21. All Other
















22. TOTALS (20-21)
















C. NEW HIRES FULL-TIME (JULY THRU SEPT. OF THE SURVEY YEAR)

23. Officials, Administrators, Managers
















24. Principals/Assistant Principals
















25. Classroom Teachers
















26. Other Professional Staff
















27. Nonprofessional Staff
















28. TOTALS (23-27)
















CERTIFICATION: I certify that the information given in this report is correct and true to the best of my knowledge and was prepared in accordance with accompanying instructions. Willfully false statements on this report are punishable by law, U.S. Code, Title 18, Section 1001.

Date

Phone:


Fax:


Email:

Typed Name/Title of Person Responsible for Report

Signature

EEOC FORM 168A




PREVIOUS EDITIONS ARE OBSOLETE


File Typeapplication/msword
File TitlePART II
AuthorDRUSSEL
Last Modified ByLucius L Brown Jr
File Modified2012-08-28
File Created2012-08-28

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