School Name

Program/Degree of Study

Please be Specific. If you have multiple Nursing programs, please list the actual degree of study. For example, Nursing - Graduate - MSN. Do not list only the general program name

Requested Distribution Date

(When GHRR should send links out) Please allow 1 business day for your request to process.

If possible, would you like your student links to be sent before the selected date?

Send Links ASAP

Send Links on Selected Date

Packages

select all that apply

Drug Screening

Background Screening

Deadline for students to create account and upload all documents

Deadline for completion of documents through ESS Quality Review/Student Deadline for all documents to be in compliance

Drug Testing Location

Lab Based

Onsite (minimum of 10 students testing required)

Onsite Scheduling

I need to schedule an onsite.

I have already scheduled an onsite.

Onsite Contact Phone

Onsite Contact Email

Onsite Location

Address | City | State | Zip

Will faculty/staff also be tested at this onsite?

Yes

How many staff/faculty members?

Desired Date

Selected date and time is not guaranteed.

Desired Time

Desired date and time is not guaranteed.

Payment Type

Student Pay

School Pay

Add On To Previous Group

Check this box if these will be added to a list you’ve already submitted. Please do not send duplicate names.

Upload the batch below using our standard template.

*Attach a single file. If multiple uploads are needed, please create a new submission.

Download the template by clicking here.

File

Upload the batch using the provided template ONLY. A link to download the file is located at the top of the page. Attach 1 Excel file. If multiple uploads are needed, please create a new submission.

California Restrictions on Personal Identifying Data

Student Order Batch Upload Request Form

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