ࡱ> -/,} 0 bjbjΨ .ʤfʤfhh*t>(ffffAAA@BBBBBB$5vfAAfff{ ff@@fN ,0a"aaA0q"AAAffAAAaAAAAAAAAAhX :  YESHIVA UNIVERSITY Office of Disability Services Beren Campus Wilf Campus Dr. Rochelle Kohn Ms. Abby Kelsen  HYPERLINK "mailto:Rkohn1@yu.edu" Rkohn1@yu.edu  HYPERLINK "mailto:akelsen@yu.edu" akelsen@yu.edu 646-592-4132 646-592-4280 Fax: 917-326-4811 REQUEST FOR MEAL PLAN MODIFICATION Name: ID: I am requesting exemption from the meal plan at 鶹ýӳ due to a medical condition. Nature of Condition: I understand that my request is not complete without a letter from my physician documenting my condition and supporting my request. I hereby grant permission to the designated physician affiliated with 鶹ýӳ and/or Yeshiva personnel to obtain and/or release information regarding my exemption request to and/or from the person and/or facility below: Physicians name: Phone: ______________________________ ___________________ Student Signature Date 12>CDOPwx       7 C D E F J K L N P Q S T U V 礚yuhq&hh1,C5>*\h}zhk1h-hh-5\hhq&5\hhq&5>*\hS5CJaJhcpI5CJaJhq&5CJaJhRuhq&5h; h1BhRu0JjhRuUhRu hBvhBv hRu5hBvhBv5,12Pw   D E F V W X W X @ gd/'gdq&gdcpI$a$gdq&gdRu$a$gdcpIV W X  V W X y  ! . > ? @ A B C K O R S T X ĽwmchhMv5\hh-5\hhq&5\hhq&5>*\hh/'5>*\hhcpI5>*\ h6hQEhq&h hQEh^sh-2 hBvh h6hq& h6hcpIh/'hhh; 5\hh; 5>*\ h>*h; hRuhcpI&@ A B a b c d e f g gd &d P gd$<&d P `gdBv &d P gd-2gd/'gdq& X ] _ ` a b c d e f g  ÿÿÿ÷hq&CJaJhy h6h6h hnTh-2hh+5\hhMv5\hh/'5\hh/'5>*\,1h/ =!"#$% x2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@66666_H mH nH sH tH @`@ q&NormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List 6U@6 Ru Hyperlink >*B*phPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vj\{cp/IDg6wZ0s=Dĵw %;r,qlEآyDQ"Q,=c8B,!gxMD&铁M./SAe^QשF½|SˌDإbj|E7C<bʼNpr8fnߧFrI.{1fVԅ$21(t}kJV1/ ÚQL×07#]fVIhcMZ6/Hߏ bW`Gv Ts'BCt!LQ#JxݴyJ] C:= ċ(tRQ;^e1/-/A_Y)^6(p[_&N}njzb\->;nVb*.7p]M|MMM# ud9c47=iV7̪~㦓ødfÕ 5j z'^9J{rJЃ3Ax| FU9…i3Q/B)LʾRPx)04N O'> agYeHj*kblC=hPW!alfpX OAXl:XVZbr Zy4Sw3?WӊhPxzSq]y V X  @  wXX8@0(  B S  ?=*urn:schemas-microsoft-com:office:smarttags PlaceName=*urn:schemas-microsoft-com:office:smarttags PlaceType9*urn:schemas-microsoft-com:office:smarttagsplace !Bg12CDOCEFPSUVy !.77BOT`aa! 8-/'-k1-2WG=1,CQEcpInT^sRu}z0|Sa6Zcq&C ; W$<W BvyMv-+@B___@UnknownG.[x Times New Roman5Symbol3. .[x ArialC.,.{$ Calibri Light7..{$ CalibriA$BCambria Math"hMg1#Hg ((!r4 3QHX ?q&2!xxH YESHIVA UNIVERSITYR. Kohn Rochelle Kohn Oh+'0 $ D P \ ht|YESHIVA UNIVERSITYR. KohnNormalRochelle Kohn14Microsoft Office Word@@J@6%e@N=( ՜.+,D՜.+,P  hp   鶹ýӳ YESHIVA UNIVERSITY Title  8@ _PID_HLINKSA xHmailto:akelsen@yu.eduK4mailto:Rkohn1@yu.edu  !"#%&'()*+.Root Entry FN01Table aWordDocument.SummaryInformation(DocumentSummaryInformation8$CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q