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800 WEST 14TH ST CANUTE, KS 66720 620.431.2820 ext. 278 900 EAST LOGAN ST OTTAWA, KS 66067 785.242.2067 ext. 315 IN KANSAS 1800SAYNCCC www.neosho.eduSTUDENT DATA FORM 20122013Name: LastFirstM. I.SSN:
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