This government document is issued by Lewis-Clark State College for use in Idaho
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https://www.google.com/url?client=internal-element-cse&cx=005940473117795338789:bg8klueq83a&q=https://www.lcsc.edu/media/5871/neurocognitive-verification-form-fillable.pdf&sa=U&ved=2ahUKEwiApqLB5fuGAxU6-QIHHcwgCuE4MhAWegQIAxAB&usg=AOvVaw3O-p6iXNx74esMmw4QbuwO&fexp=72519171,72519168