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2. Please fill out this application completely. Your digital card will allow you to access our digital resources. No physical items or computer usage will be available on this card.
4. First Name*
5. Last Name*
6. Middle Initial*
8. Card Number (enter GCPLGPS12 plus 5 digit student ID)*
10. Date of Birth*
11. School*
12. PIN*
    enter the PIN: read
14. Email*
    In order to receive notification that your account has been activated enter email address above. Allow up to 3 business days to receive notification.
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16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit

* indicates a required field