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Get Printable Application (pdf*) - Great Basin College - Gbcnv

STUDENT NAME: STUDENT ID # MAILING ADDRESS: CITY, STATE, ZIP: HOME ADDRESS: APPLICATION DATE: EMAIL ADDRESS: LAST BACKGROUND CHECK AND/OR FINGERPRINTING DATE: CURRENT OVERALL GPA: LIST HUMAN SERVICE COURSES COMPLETED: *Attach a separate sheet describing reason(s) for fingerprinting and/or background reports. Prior arrests and/or convictions or health conditions may affect the ability to attend some practicum sites. Additional background, health, and drug scree.

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