Please read before processing. Completing this form is completely voluntary. You are not required to provide the information requested to participate in this meeting.

Information provided herein is subject to public disclosure laws of the State of Washington (RCW 42.56).

Purpose: In accordance with Title VI of the Civil Rights Act of 1964 and related authorities, the City of SeaTac assures that no person(s) shall be excluded from participation in, denied the benefits of, or subjected to discrimination under any of the City’s programs, policies, or activities, based on the person’s race, color, or national origin. The information gathered through this form improves how we serve the public and helps meet our data collection and public involvement obligations under Title VI.

For further information regarding this process, please contact bhumenay@seatacwa.gov or call 206-973-4811.

LOCATION INFORMATION

ZIP Code

RACE-Choose all that apply

RACE-Choose all that apply

White

Black/African American

Asian

American Indian/Alaskan Native

Native Hawaiian/Pacific Islander

Hispanic/Latino

Other (please specify) If other, type text here.

Prefer not to disclose

GENDER IDENTIFICATION

GENDER IDENTIFICATION

Male

Female

Other (please specify) If other, type text here.

Prefer not to disclose

AGE

AGE

Less than 18

18-29

30-44

45-64

65 and older

Prefer not to disclose

HAVE A DISABILITY

HAVE A DISABILITY

Yes

No

Prefer not to disclose

NATIONAL ORIGIN

NATIONAL ORIGIN

United States

African (please specify) If other, type text here.

European (please specify) If other, type text here.

Central American (please specify) If other, type text here.

South American (please specify) If other, type text here.

Mexican

Chinese

Vietnamese

Korean

Other (please specify) If other, type text here.

Prefer not to disclose

PRIMARY LANGUAGE SPOKEN AT HOME

PRIMARY LANGUAGE SPOKEN AT HOME

English only

Amharic

Chinese

Somali

Spanish

Tagalog

Vietnamese

Other (please specify) If other, type text here.

Prefer not to disclose

TOTAL HOUSEHOLD INCOME

TOTAL HOUSEHOLD INCOME

Less than $25,000

$25,000-$74,999

$75,000-$149,999

$150,000 or more

Prefer not to disclose

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