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201617 School Based Influenza Vaccine Consent Form BRANTLEY COUNTY HEALTH DEPARTMENT Section 1: Information About the Student Who Will Receive Influenza Vaccine (please print) MIDDLE INITIALSTUDENTS
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Start by locating the option or question that asks for your ethnicity.
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Circle or mark the option that accurately represents your ethnicity.
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If none of the provided options match your ethnicity, check for any additional instructions or a blank space where you can write in your specific ethnicity.
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Who needs ethnicity please circle?

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Ethnicity information may be required by various organizations, institutions, or surveys for statistical or research purposes.
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Government agencies and institutions often collect ethnicity data to ensure equal representation and access to resources.
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Research institutions may use ethnicity information to study social and health disparities.
04
Employers may collect ethnicity data to monitor diversity and inclusion efforts.
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Healthcare providers may request ethnicity information for medical research and to provide culturally appropriate care.
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Ethnicity refers to a person's identification with a particular group based on cultural, national, tribal, religious, or other affiliations.
All individuals may be required to disclose their ethnicity for various purposes such as government forms, surveys, and research studies.
To fill out ethnicity, simply circle or select the ethnicity category that best represents your background.
The purpose of collecting ethnicity data is to understand the diversity and demographics of a population for statistical analysis, representation, and equal opportunity purposes.
The information reported on ethnicity typically includes categories such as Hispanic or Latino, American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White.
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