Name of Form



Equal Employment Opportunity Requirements | | |

|Suite 101 Harbourt Hall • 615 Loop Road • PO Box 5190 • Kent, Ohio 44242-0001 |OFFICE OF THE |

|v: 330-672-3880 • f: 330-672-2648 • web site: kent.edu/universityarchitect |UNIVERSITY ARCHITECT |

|Architect / Engineer (A / E) Information | |Kent State University Project Information |

|A / E Name |      | |Project No. |      |

|Address |      | |Project Name |      |

|City, State, Zip |      | | |      |

|Phone Number |      | |Project Location |      Campus, Kent State University |

|Tax I.D. Number |      | | | |

| |

|Composition of Firm (insert number of individuals in appropriate spaces. See Notes 1 and 2 below). | | |Previous EEO Reporting |

| |Ohio| | |

| |Only| | |

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| |-Pro| | |

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|Note 1: |Include the number of minority group individuals in the Total and Women columns, as applicable. Minorities include: African | | |Signature |

| |American, American Indian/Alaskan Native, Asian or Pacific Islander, Hispanic, Other (Specify). | | | |

|Note 2: |Include the number of Women in both the Total and Minorities columns, as applicable. | | |      | |   -    -   |

| | | |Typed Name / Title | |Date |

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