Data Collection Form

As recipients of federal assistance, Southwest Texas Communications, is required to identify and document as accurately as possible the racial/ethnic data on the eligible population in our service area. Please check the appropriate group listed below.

Please note, your response is optional. The information you provide will be used only for Federal Government Reporting Purposes.

Should you have any questions, please contact our Commercial Manager at 830-683-2111.

Name

First Name

Last Name

Address

City

State/Province

Zip/Postal

Home Phone Number

Cell Phone Number

Checkboxes

White (not of Hispanic Origin)

Black (not of Hispanic Origin)

Hispanic

American Indian or Alaska Native

Asian or Pacific Islander