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str'-181
I{rR 194
Illotu Froprio
Popo's Apolryr to tk Americas
Pope's Mxsage of Peaee
Amqricm Declration m the Rights oflndigmosPeoples
EPSON
rrF-3540
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{Please read the Privacy Act Statement and insiructions before completing form.}
Social Security Number
entru .,TcLlDitv\a fr
Agency Use
{tclbwq?
onl/
DLt
/ nhc
Plivacyl&t Statement
Ethnicity and race information is requested under the authority of 42 U.S.C. Section 2000e-16 and in compliance with
the Office of Management and Budget's 1997 Revisions to the Standards for the Classification of Federal Data on Race
and Ethnicity. Providing this information is voluntary and has no impact on your employment status, but in the instance
of missing information, your employing agenry will attempt to identiff your race and ethnicity by visual observation.
This information is used as necessary to plan for equal employment opportunity throughout the Federal govemment. lt
is also used by the U. S. Office of Personnel Management or employing agency maintaining the records to locate
individuals for personnel research or survey response and in the production of summary descriptive statistics and
analytical studies in support of the function for which the records are collected and maintained, or for related workforce
studies.
Social Security Number (SSN) is requested under the authority of Executive Order 9397, which requires SSN be used
for the purpose of uniform, orderly administration of personnel records. Providing this information is voluntary and failure
to do so will have no effect on your employment status. lf SSN is not provided, however, other agency sources may be
used to obtain it.
Specific lnstructions; The two questions
question 1, go to question 2.
Question
1.
Are You Hispanic or Latino? (A person of Cuban, Mexican, Puertrc Rican, South or Central American, or other
flYes
Question 2. Please select the racial category or categories with which you most dosely identify by placing an )C in the appropriate
box. Checkas manyas apply.
RACIAL CATEGORY
(Check as many as apply)
DEFINITION OF CAIEGORY
A person having origins in any of the original peoples of North and South America
(including Central Amedca), and who maintains tribal affiliation
or
community
attacfiment.
nsian
A person having origins in any of the original peoples of the Far East, Southeast
Asia, or the Indian subcontinent induding, for example, Cambodia, China, lndia,
Japan, Korea, Malaysia, Pakistan, the Philippine lslands, Thailand, and Vietnam.
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or
o&er Pacific lslands.
Ef wtrite
A person having origins in any of the original peoples of Europe, the Middle East, or
North Africa.
Standard Form 181
Revised August 2005
Previous editions not usable
1l'lrereas millions
onslaverl
nieu
in the
lirlu
dcsrendarrts
$-e.r?
llhercas slaterS in Amcliea resemhletl no otlrer for.m of irnnlurttary ssrrttruk knau,n in liistorl,, ;ls Afrirarls $(,r.e taptured arrd sold at aurtior like ilarrirnate olrjer.ts or anirnais;
\l-hereas ^\fricaus lorced irrtti slar-er1- r:erc lnrltaliz-td, lrnuiiliated. clelurnrarrizerl, alrtl srrlliet,ted to the incliglit5 of
beinpr strillped of
of Afi'ir:an deserrt ul)on n'hir:h it dtlxrnrhrrl lrt:rzlule.errtrerclterl ill tlre Nation's strial falrric:
persons
l\'hereas after cnianr.ilration fl'om 2rl{i year',r of sliu'eryi Afi"ican-;lmcrirans s$on slu' thc flceting political, sorial, anrl
er,onondr. gaitrs thel- rrtade rluring lleulstnlr.tiou er-iset'ra
r-a
Rlark
{r
L)cxles.
lYhereas a (entury
still
tlrr.$ughoilt 1}rr.ts of thc Natiurr, though its Yestigex
lingcr to tlrix tlal-;
l\'lnt,eas Afu.ican-Amtri*ilnx tottfutut' to snfti'r front thr cntuplex interpla.r lletn'eetr sltntry autl Jinr Crtlu-*lottg altt1
lxrtlr s}-str:ms $'*lt frrrrnalll- alrolishetl-tlrougli euormou$
dailuge and lass, lxrth tangiblt' trnrl intangible, ifi*luding
t}e loss of l*ruurt digrrit.r-" tlre firrst,atitnr of eareet's tttlti
professiorrerl liyes, antl tlrt' lotrgtelm loss of incoprc atid
ollllortrtIril.r-:
11'hereas
t|e
jure
segr'egatigrr
of
duriug a trip to Gorce Islanti' Serat'egal, a tbrmer slagt' p0rt, Pyesirlept {icoyge 1Y' Bls}r
lifb
krroHiedged xlarer1"s rotttitllrirrg ]egat1" itr fttterit'arr
statetl that
aDtl tlre $eed to eotlfl'ont tliat legaey ${rcn }re
,.1Tils ollt of tlrt, gt'eatest criues of l*storl'
slar-r,r1,
. . The raeiirl }:igotrl' fetl b.v slar-ery ditl llot eiltl 'rritlt
tE1
:l
sli*.et1' or
rritll
l\'herrus Presidelrl .Bili Clintou also aeknot'letlgctl the deeps(rated pru|le1rs (.alrsed lr1- tltt. turrtimritrg lt'gary ttf rat:ism agairr.st ,\f'ritarr-,\net"iralrs tltat begalr witft slirlerl*
rthet he initiatetl a national tlialogue about raee;
.frst
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f:
THE GENERAL ASSEMBLY,
RECALLING also the '?eclaration on the Rights of the Indigenous Peoples in the
Americas," document AGIDEC. 79 (XLfV-O/14), which reaffrrms that progress in promoting and
effectively protecting the rights of the indigenous peoples of the Arnericas is a priority fot the
Organization of American States;
RECOGNIZING the valuable support provided by &e naember stats, observer states, the
organs, agencies, and eatities of the Organization of American States for &e process within the
Workiag Group to Prepare the Draft Amsrican Declaration on &e Rights of lrdigenous Peoples;
RECOGNIZING
as
TAKING INTO ACCOUNT the significant contibution that the indigenous peoples of the
Americas have made to humanity,
RESOLVES:
To adopt the following Draft American Declaration on the Rights of Indigenous Peoples'1l2t
I.
The United States remains committed to addressing the urgent issres of concem to indigenous peoples
across the Americas, including combating societal discrimination agaitrst indigenous peoples and...
2.