Invitation to Self-Identify Disability

The University of North Carolina at Pembroke is subject to certain nondiscrimination and affirmative action recordkeeping and reporting requirements in accordance with the Americans with Disabilities Act, and Sections 503 and 504 of the Rehabilitation Act of 1973 (as amended), for civil rights enforcement purposes.  As a result of new regulations, the University is required to survey our current employees.

It is the policy of the University not to discriminate against any employee or applicant for employment because he or she is a qualified individual with a disability. It is also the policy of the University to take affirmative action to employ all persons regardless of their status as qualified individuals with disabilities, and to base all employment decisions only on valid job requirements.

This policy applies to all employment actions, including but not limited to, recruitment, hiring, transfer, promotion, demotion, layoff, recall, termination, rates of pay or other forms of compensation, at all levels of employment.

The University of North Carolina at Pembroke invites applicants and employees to self-identify their status as an individual with a disability. The submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. Any information obtained will be kept confidential and may only be used in accordance with the provisions of applicable federal, state and local laws and regulations.

Applicants and employees may voluntarily self-identify their disability status at any time.  Applicants may provide this information through the University’s online application process.  Employees may voluntarily provide this information by filling out the form below.  Once you have filled out your form, you can bring it to Lumbee Hall, Room 347, or send it through campus mail to Dr. Nicolette Campus in the Human Resources Department.

We are required to periodically resurvey our employees every five years.

If you would like to request a reasonable accommodation, please contact Nicolette Campos at


Why am I being asked to fill out this form?

The University of North Carolina at Pembroke (UNCP) is considered a federal contractor and is required to maintain and analyze data on the race, ethnicity, veteran, and disability status of employees in compliance with the provision of Executive Order 11246 to the Office of Federal Contract Compliance Programs (OFCCP).

Federal contractors and subcontractors must use a form developed by OFCCP to survey for disability.  The agency mandates the use of this form to survey disability status at both pre and post-offer stages.  Please see below:

Voluntary Self-Identification of Disability

For more information go to

How will this information be stored?
Your “Voluntary Self-identification of Disability Form” will be stored separately from your personnel file in a locked file cabinet located in the office of the Director of Employee Relations and Workforce Development.

Who will have access to this information?
The Director of Employee Relations and Workforce Development will have access to the forms and will compile the information for reporting in the aggregate. 

Do I have to fill out this form?
No.  Because the University is considered to be a government contractor, we must document our efforts to hire and provide equal opportunity to qualified people with disabilities. To help us measure our efforts, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out.  Your individual information will be kept confidential.


What if I need to update my disability status?
Because a person may become disabled at any time, you may submit an updated form as needed.

Who can I contact for more information?
Dr. Nicolette Campos
Director of Employee Relations and Workforce Development
Lumbee Hall, Room 353
Phone:  (910) 775-4341

North Carolina Office of State Human Resources Reasonable Accommodation Policy