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RIGIN M 0 I-American Indian/Alaskan Native 0 8-Black. Non-Hispanic 0 H-Hispanic 0 A-Asian/Pacific Is
e date of entry Into an ESOL program? 0 032) silken LNES WITH (check one) Mother 0 Father 0 Both Parents 0 Other (33) DISCLOSURES FOR ENTRY INTO PBC SCHOOL DISTRICT YES NO 0 0 I. Has the student ever been e,pelled from school? 0 0 2. Has the student ever had an arrest resulting in a charge? 0 0 3. Has th
10) F 1 (11)RACFJETHMC ORIGIN y • Native 0 B-Black, Non-Hispanic 0 H-Hispanic 0 W-White, Non-Hispan
an ESOL program? (32) STTENT IJVES WITH: kited cone) V2 Mother O Father O Both Parents VOtper ‘ 214t sbPstiCEWKS (33) DISCLOSURES FOR ENTRY INTO PBC SCHOOL DISTRICT YES 14)," O 4 . _A. Has the student ever been expelled from school? O ril i 2. Has the student ever had an arrest resulting in a charge? O NY
X: RACIAL/ETHNIC GROUP: O White Not Hispanic 0 Black Not Hispanic 0 Hispanic 0 Arnettan I ncliaiThat
he date of entry Into an ESOL program? (32) STUDENT LIVES %1111. &Saone) O Mother O Father O Both Parents O Other (33) DISCLOSURES FOR ENTRY INTO PBC SCHOOL DISTRICT YES NO O • 1. Has the student ever been expelled from school? O O 2. Has the student ever had an arrest resulting in a charge? O O 3. Has the
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