Personal Information

Personal Information Form

All fields are required unless noted.

Name

Your legal name, as from a Government-issued ID

First Name (Value Required)

Middle Nameoptional

Last Name (Value Required)

Personal Data

Will you receive salary compensation from Stanford? (Value Required)

Social Security Number (SSN)

Birthdate (Value Required)

Expected format: MM/DD/YYYY

Place Of Birthoptional

Gender (Value Required)

Female

Male

Are you Hispanic or Latino of any race?optional

No

Yes

Race & Ethnicityoptional

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other pacific Islander

White

I decline to Identify

Contact Information

Country (Value Required)

Home address line 1 (Value Required)

Home address line 2optional

City / Town (Value Required)

State

State / Province / Region

ZIP/Postal Code (Value Required)

Mobile or daytime phone (Value Required)

Security

(Value Required)

Your IP address:

release 1.0 Set Screen Reader Mode On