Cordova Telephone Cooperative
P.O. Box 459, Cordova Alaska 99574
(907) 424-2345  ·  Fax (907) 424-2344
 
DATA COLLECTION INFORMATION
 
NEW PATRONS

 As a participant in a Federal utilities financing program, Cordova Telephone Cooperative is required to identify and document as accurately as possible the racial/ethnic data on the eligible population in our service area.  We would appreciate you check the appropriate group listed below and returning this form to us within 2 weeks.

Please note your response is optional.  This information you provide will be used only for Federal Government reporting purposes.

Should you have any questions, you may contact Office Manager, Roger Casad at 424-2345.

Thank you for your cooperation in this matter.

 

NAME:                                                                          

 

ADDRESS:                                                                            

                                                                                        

                                                                                        

 
RACIAL / ETHNIC GROUP:

            A.   American Indian or Alaska Native                              

B.    Asian                                                                             

C.   Black or African American                                          

D.   Native Hawaiian or Other Pacific Islander                 

E.    White                                                                              

F.    Hispanic or Latino                                                         

G.   Not Hispanic or Latino