Attachment A
Submit only ONE copy of this form with your proposal. Attach it on top of the cover page of the copy of your proposal that bears the original signatures. Leave the back of the page blank. Do not include this form with any of the other copies of your proposal, as this may compromise the confidentiality of the information. Please check the appropriate answers to each question for all principal investigator(s)/project director(s) listed on the cover page, using the same order in which they were listed there:
Project Director 
1. Is this person
2. Is this person a
        U.S. Citizen             
        Permanent Resident             
        Other non-U.S. Citizen             
3. Which one of these categories best describes this person's ethnic/racial status? (If more than one category applies,
use the category that most closely reflects the person's recognition in the community.)
        American Indian or            
        Alaskan Native            
        Black, not of Hispanic Origin             
        Pacific Islander             
        White, not of Hispanic Origin            
4. Does this person have a disability* which limits a major life activity?
Check here if this person does not wish to provide some of all of the above information.
REQUIRED: Check here if this person is currently serving (or has previously served) as PI, Co-PI or PD on any Federally funded project.
AMERICAN INDIAN OR ALASKAN NATIVE: A person having origins in any of the original peoples of North American and who maintains cultural identification through tribal affiliation or community recognition.
ASIAN: A person having origins in any of the original peoples of East Asia, Southeast Asia or the Indian subcontinent. This area includes for example, China, India, Indonesia, Japan, Korea, and Vietnam.
BLACK, NOT HISPANIC ORIGIN: A person having origins in any of the black racial groups of Africa.
HISPANIC: A person of Mexican, Puerto Rico, Cuban, Central of South American or other Spanish culture or origin, regardless of race.
PACIFIC ISLANDER: A person having origins in any of the original peoples of Hawaii; the U.S. Pacific territories of Guam, American Samoa, and the Northern Marinas; The U.S. Trust Territory of Palau; the islands of Micronesia and Melanesia; or the Philippines.
WHITE, NOT OF HISPANIC ORIGIN: A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.

* Disabled: A person having a physical or mental impairment that substantially limits one or more major life activities; who has a record of such impairment; or who is regarded as having such impairment.

The Federal Government has a continuing commitment to monitor the operation of its review and award processes to identify and address any inequities based on gender, race, ethnicity, or disability of the proposed principal investigators/project directors and co-principal investigators. To gather the information needed for this important task, you should submit a single copy of this form with each proposal; however, submission of the requested information is not mandatory and is not a precondition of award. Any individual not wishing to submit the information should check the box provided for this purpose. (The exception is information about previous Federal support, the last question above.) Information from this from will be retained by Federal agencies as an integral part of their Privacy Act Systems of Records in accordance with the Privacy Act of 1974. These are confidential files accessible only to appropriate Federal agency personnel and will be treated as confidential to the extent permitted by law. Data submitted will be used in accordance with criteria established by the respective Federal agency for awarding grants for research and education, and in response to Public Law 99-383 and 42 USC 1885c.

NSF Form 1225 (SBIR 12/96)