ASICAACISLAADER H HISPANIC I I W NON-HISPANIC M MULTIRACIAL IS) DATE Of BIRTH maim riAY VIM 00/ PLACE OF BIRTH DADE COUNTY FL US OW sr/Ai FLORIDA ODUiRtY (I11 RESIDENT STATUS 3 . . ll D. FOREIGN EXCHANGE STUDENT El I. OUT-OF-COUNTY RESIDENT 2. OUT-Of-STATE RESIDENT I 3. IN-C