gal - _ SEX RACIAL/ETHNIC GROUP 0 Hispanic STUDENT NUMBER IX White, Not Hispanic 0 American Indian Native Alaskan F 0 Black, Nol Hispanic 0 Asran/Pac 'tic Islander MS BIRTHDATE: Verified by Birth Certificate 0 Yea If Not, What Type Verification? I, 3-44t3 L GUARDIAN OR OTHER RESPONSIBLE ADULT