Age: 10 Sex: F Date of Birth: 1/25/2000
Height: 4 Feet 4 Inches Weight: 58 Pounds Hair Color: Black Eye Color: Black
2. Attends School: Yes
3. Favorite School Subjects: Mathematics
Favorite Pastimes: Playing with dolls, Running
Chores at Home: Running errands, General housework
Talents or Hobbies: Drawing, Dancing, Singing
Languages Spoken: Spanish
INFORMATION ABOUT YOUR CHILD'S FAMILY:
4. Approximate monthly income for the family (in U.S. Dollars): $100.00
5. Name of Father: Victor Manuel Occupation:
(If not present, why?) Does not live at home at present
6. Name of Mother: Dulce Maria Occupation:
(If not present, why?) Deceased
7. Brothers and Sisters:
8. Child lives with: Relatives
INFORMATION ABOUT YOUR CHILD'S HOME:
9. Description of Home: Three Bedrooms, Dining Room, Kitchen
Construction: Walls: Concrete block Roof: Concrete Floor: Concrete
Cooking Facilities: Gas Stove
Sleeping Accommodations: Beds
10. Facilities and Services:
Water Source: Running water in home
Electricity: Available
Sanitary Facility: Toilet
Height: 4 Feet 4 Inches Weight: 58 Pounds Hair Color: Black Eye Color: Black
2. Attends School: Yes
3. Favorite School Subjects: Mathematics
Favorite Pastimes: Playing with dolls, Running
Chores at Home: Running errands, General housework
Talents or Hobbies: Drawing, Dancing, Singing
Languages Spoken: Spanish
INFORMATION ABOUT YOUR CHILD'S FAMILY:
4. Approximate monthly income for the family (in U.S. Dollars): $100.00
5. Name of Father: Victor Manuel Occupation:
(If not present, why?) Does not live at home at present
6. Name of Mother: Dulce Maria Occupation:
(If not present, why?) Deceased
7. Brothers and Sisters:
8. Child lives with: Relatives
INFORMATION ABOUT YOUR CHILD'S HOME:
9. Description of Home: Three Bedrooms, Dining Room, Kitchen
Construction: Walls: Concrete block Roof: Concrete Floor: Concrete
Cooking Facilities: Gas Stove
Sleeping Accommodations: Beds
10. Facilities and Services:
Water Source: Running water in home
Electricity: Available
Sanitary Facility: Toilet
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