Form 21 Attachment 7 Trainee Diversity Report

Program Director/Principal Investigator (Last, First, Middle):

Trainee Diversity Report
This report format should NOT be used for data collection from trainees.
Training Grant Title:

Total Number of Appointed:

Grant Number:

PART A. TOTAL TRAINEE APPOINTMENTS REPORT: Number of Trainees Appointed by Ethnicity and Race

Ethnic Category

Females

Males

Sex/Gender
Unknown or
Not Reported

Total

**

Hispanic or Latino
Not Hispanic or Latino
Unknown (individuals not reporting ethnicity)

*

Ethnic Category: Total of All Trainees*
Racial Categories
American Indian/Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Black or African American
White
More Than One Race
Unknown or Not Reported

*

Racial Categories: Total of All Trainees*
PART B. HISPANIC TRAINEE APPOINTMENTS REPORT: Number of Hispanics or Latinos Appointed
Racial Categories

Females

Males

Unknown or
Not Reported

Total

American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Black or African American
White
More Than One Race
Unknown or Not Reported

**

Racial Categories: Total of Hispanics or Latinos**
PART C. TRAINEES WITH DISABILITIES OR FROM DISADVANTAGED BACKGROUNDS
Number of Trainees with Disabilities:
Number of Trainees from Disadvantaged Backgrounds:
(*) (**) These totals must agree.

0925-0002 (Rev. 03/2020 Approved through 02/28/2023)

Page

Trainee Diversity Report Format Page