O H-Hispanic O A-Asia Islander Non-Hispanic O M-Mularacial 0 0 DATE OF BIRTH (12) PLACE OF BIRTH (S)/sralotounliy) aSli . (13) RESIDENT STATUS O O. Foreign Exchange Student O 1. Out-of-county Resident O_ .., 2 Out-of-state Resident OJ 1. In-county Resident (14) USA ENTRY DATE (MMODAYTY) (15) FEDERAL IMPACT SURVEY

Hi panic O M-Multiracial (12) DATE OF BIRTH (I 3) PLACE OF BIRTH (city, stale. counIty) AIM Y • . Ph n Aw El. ppcie govoi 04) RESIDENT STATUS O O. Foreign Exchange Student ❑O 1. Out-of-county Resident. O 2. Out-of-state Resident CI 3. In-County Resident (1 3) USA ENTRY DATE (MMODYVYY) (la)FEDERAL IMPACT SURVEY YES