Youth and Young Adult Ministry - Diocese of Grand Island

1225 S. Poplar St, Suite 100
North Platte, NE 69103
Toll-Free: (800)252-9325
Phone: (308)532-2707
Fax: (308)532-3574

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Today's Date: TEC Date Preferred:

First Name: MI: Last Name:

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School presently attending: Grade

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School from which you graduated: Year

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Religious Background? Catholic Christian

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