FORM APPROVED BY OMB
NO. 3046-0003 APPROVAL EXPIRES
12/31/2004
EQUAL EMPLOYMENT OPPORTUNITY COMMISSION
ELEMENTARY-SECONDARY STAFF INFORMATION (EEO-5)
Public school systems
This is a joint requirement of EEOC, and
the Office for Civil Rights and National
Center for Education Statistics of the
Department of Education.
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
STATE
ZIP
C. GENERAL STATISTICS
NUMBER OF SCHOOLS OPERATED
NUMBER OF ANNEXES OPERATED
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
EEOC-ORIGINAL
PAGE 1
April 96
PART II. STAFF STATISTICS AS OF (DATE)__________________
DO NOT INCLUDE ELECTED/APPOINTED OFFICIALS (SEE DEFINITION IN APPENDIX)
DISTRICT NAME: ______________________________
DISTRICT ID #:________________
STAFF TOTALS
MALE
FEMALE
ACTIVITY
ASSIGNMENT
CLASSIFICATION
OVERALL
TOTALS
(SUM OF
COL. B
THRU K)
A
WHITE
(NOT OF
HISPANIC
ORIGIN)
B
BLACK
(NOT OF
HISPANIC
ORIGIN)
C
HISPANIC
D
ASIAN
OR
PACIFIC
ISLANDER
E
AMERICAN
INDIAN
OR
ALASKAN
NATIVE
F
WHITE
(NOT
HISPANIC
ORIGIN)
G
BLACK