ellow/Report Card EFTA01710369 `STUDE • Legal • SEX IAL/ETHNIC GROUP 0 Hispanic RAC Le<thite, Not Hispanic 0 American Indian/Native Alaskan El Black, Not Hispanic 0 Asian/Pacific Islander STUDENT NUMBER , al.) BIRTHDATE: Verified by Birth Cenificate: i!E Yes If Not, Whet Type Verification?

ATE: - 5.5AL BIRTHDATE: I VerTied by Binh Certificate: G Yes G No If No. What Type Verification? SEX: M RACIAr DC GROUP: White Not Hispanic El Black Not bespeak El Hispanic G American IndiarYNallye AkIskan 13 Asian/Pacific Islander O Mufti RacIst STUDENT NUMBER: BIRTHPLACE: iez • CURRENT S

te. Promote IP/ Retain (R) Summer School (SS) PBSD0932 VN 01-9340 EFTA01710093 STUDENT NAME. SEX RACIAL/ETHNIC GROUP K White. Not Hispanic El Black, Not Hispan c K Hispanic K American Indian/Native Alaskan K Asian/Pacific Islander STUDENT NUMBER CURRENT SCHOOL (use pencil in this space, unti