Form EEOC-168A EEO-5

FORM APPROVED BY OMB
NO. 3046-0003 APPROVAL EXPIRES
12/31/2004

EQUAL EMPLOYMENT OPPORTUNITY COMMISSION
ELEMENTARY-SECONDARY STAFF INFORMATION (EEO-5)

This is a joint requirement of EEOC, and
the Office for Civil Rights and National
Center for Education Statistics of the
Department of Education.

Public school systems
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 (the original and one copy of this form) to:

PART 1. IDENTIFICATION
PART A. TYPE OF AGENCY WHICH OPERATES THE REPORTING SCHOOL SYSTEM
 Local Public School System

 Special or Regional Agency

 State Education Agency

 Other (Specify)________________________________

B. SCHOOL SYSTEM IDENTIFICATION (OMIT IF SAME AS LABEL)
NAME
STREET AND NO. OR POST OFFICE BOX

CITY/TOWN

COUNTY

NUMBER OF SCHOOLS OPERATED

NUMBER OF ANNEXES OPERATED

STATE

ZIP

C. GENERAL STATISTICS
OCTOBER 1ST ENROLLMENT

D. REMARKS

AUTHORIZATION
THE NATIONAL CENTER FOR EDUCATION STATISTICS WILL PUBLISH INFORMATION APPEARING IN PART II, TOTAL
COLUMN “A” UNLESS THE DISTRICT SPECIFICALLY WITHHOLDS AUTHORITY TO DO SO. IF THE DISTRICT WISHES
TO WITHHOLD SUCH AUTHORITY, CHECK HERE.
AUTHORITY WITHHELD

EOC FORM 168A
April 96

EEOC-ORIGINAL

PAGE 1

PART II. STAFF STATISTICS AS OF (DATE)__________________
DISTRICT NAME: ______________________________

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

DISTRICT ID #:________________
STAFF TOTALS

MALE
ACTIVITY
ASSIGNMENT
CLASSIFICATION

OVERALL
TOTALS
(SUM OF
COL. B
THRU K)

WHITE
(NOT OF
HISPANIC
ORIGIN)

BLACK
(NOT OF
HISPANIC
ORIGIN)

HISPANIC

A

B

C

D

FEMALE
ASIAN
OR
PACIFIC
ISLANDER

AMERICAN
INDIAN
OR
ALASKAN
NATIVE

WHITE
(NOT
HISPANIC
ORIGIN)

BLACK
(NOT OF
HISPANIC
ORIGIN)

HISPANIC

ASIAN
OR
PACIFIC
ISLANDER

AMERICAN
INDIAN
OR
ALASKAN
NATIVE

E

F

G

H

I

J

K

A. FULL-TIME STAFF
1. Officials,
Administrators,
Managers

2. Principals
3. Assistant Principal,
Teaching

4. Assistant Principals,
Non teaching

5. Elementary
Classroom Teachers

6. Secondary classroom
Teachers

7. Other Classroom
Teachers

8. Guidance
9. Psychological
10. Librarians /Audio
Visual Staff

11. Consultants &Supervisors of Instruction

12. Other Professional
Staff

13. Teachers Aids
14. Technicians
15. Clerical/Secretarial
Staff

16. Service Workers
17. Skilled Crafts
18. Laborers, Unskilled
19. TOTAL (1-18)

B. PART-TIME STAFF
20. Professional
Instructional

21. All Other
22. TOTAL (20-21)

C. NEW HIRES (JULY THRU SEPT. OF THE SURVEY YEAR)
23. Officials,
Administrators,
Managers

24. Principals/Asst.
Principals

25. Classroom Teachers
26. Other Professional
Staff

27. Nonprofessional
Staff

28. TOTAL (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, and Section 1001.
Date

Phone (Include Area Code)

EEOC FORM 168A EEOC-Original Page 2 April 96

Typed Name/Title of Person Responsible for
Report

Signature