邢唷> -/,欹} 0 bjbjㄎㄎ .胜鋐胜鋐hh*t>(ffffAAA@BBBBBB$5vfAAfff{ ff@@fN ,0a"aaA0q"AAAffAAAaAAAAAAAAAhX :  YESHIVA UNIVERSITY Office of Disability ServicesBeren Campus Wilf Campus Dr. Rochelle Kohn Ms. Abby Kelsen  HYPERLINK "mailto:Rkohn1@yu.edu" Rkohn1@yu.edu  HYPERLINK "mailto:akelsen@yu.edu" akelsen@yu.edu 646-592-4132 646-592-4280 Fax: 917-326-4811 REQUEST FOR MEAL PLAN MODIFICATION Name: ID: I am requesting exemption from the meal plan at T156X Flagship Store - Buy with confidence Limb dampeners for crossbow noise reduction Best due to a medical condition. Nature of Condition: I understand that my request is not complete without a letter from my physician documenting my condition and supporting my request. I hereby grant permission to the designated physician affiliated with T156X Flagship Store - Buy with confidence Limb dampeners for crossbow noise reduction Best and/or Yeshiva personnel to obtain and/or release information regarding my exemption request to and/or from the person and/or facility below: Physician抯 name: Phone: ______________________________ ___________________ Student Signature Date12>CDOPwx       7 C D E F J K L N P Q S T U V 鼢蝼腌黩邕邕诌邕邕诌珑乙珑缡粮羚悓垊y殞uhq&hh1,C5>*\h騷zh1h-hh-5乗hhq&5乗hhq&5>*\h凷5丆JaJhcpI5丆JaJhq&5丆JaJh薘uhq&5h; h1Bh薘u0Jjh薘uUh薘u hBvhBv h薘u5hBvhBv5,12Pw   D E F V W X W X @ gd/'gdq&gdcpI$a$gdq&gd薘u$a$gdcpIV W X V W X y  ! . > ? @ A B C K O R S T X 镤邳种尹四近艚构秉杯僵寳亀mchhMv5乗hh-5乗hhq&5乗hhq&5>*\hh/'5>*\hhcpI5>*\ h6h燪Ehq&h h燪Eh歗sh-2 hBvh h6hq& h6hcpIh/'hhh; 5乗hh; 5>*\ h>*h; h薘uhcpI&@ A B a b c d e f g gd &d P gd$<勑&d P `勑gdBv &d P gd-2gd/'gdq& X ] _ ` a b c d e f g  絷嘀乙问妹每每每梅hq&CJaJh韞 h6h6h h鮪Th-2hh+5乗hhMv5乗hh/'5乗hh/'5>*\,1恏靶/ 班=!"#悹$悹%靶靶 愋x2 0@P`p€2( 0@P`p€ 0@P`p€ 0@P`p€ 0@P`p€ 0@P`p€ 0@P`p€8XV~€ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@66666_H mH nH sH tH @`@ q&NormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR Table Normal4 l4a (k (No List 6U@6 薘u Hyperlink >*B*phPK!檗[Content_Types].xml瑧薔0E鱄鼉-J湶@%閭菐洽|廊$韶钵UL襎B l,3鳛;鉹得槣B+$G]ミ7O侪V墎鎼j\纚揷媝/ID躦6wZ醽谒0s拕钔=D枘祑 %枟;r,q﹍E丌yDQ"Q,=c8B,活!g倣剎MD&閾M呅.壛/SA鸱e淉荿換砖埒腇陆仺億S藢餍D⒇ゲ廱j|扇E7錍<b始N€卲r8恌躰擐迂FrI.漿1賔鉜勨詤響$2睙1(驇榯流檥嚚kJV蝴1翓/ 脷攰Q縇该楓0斥7#刔ゝ嚽V娸崮虸h咑潰c镅M朲6/H邚 bW`軬v 钑Ts硿'鲌癇秶C秱晓t!馤Q#綣x荽yJ] €C:浝= 膵(t两R隥劕Ξ;^к蜻e1/-椄/A_Y)骬埕6(犓p避_埁猹&N箲}n€钊jzb抃->泓嚄廂嗝;n臯埠bС*欖.7玴媇M嬹€|麺MM# ud9c蒴47=匡iV菹7澨獈悝擇∶搁df脮由 5j鄳 z糌'^9J{rJ駷袃3A暅瀤鈢 楩餟9乩聟i3慟/B)L囀綬姍關x)04宜N O'> 瞐g宫沋eH毳j*櫋k鮞€棲譴C=hP瞁!alf撠p惃晳鬤屾 鯝Xl:X躒赙甖b詒忛 縕倅4鐏騍骊箇3?ぇW訆h扮PxzSq]y V X @ wX€X€8@€€€饞0(  養 S  ?⑧愑｀愑む愑=*€urn:schemas-microsoft-com:office:smarttags €PlaceName€=*€urn:schemas-microsoft-com:office:smarttags €PlaceType€9*€urn:schemas-microsoft-com:office:smarttags€place€ !Bg12CDOCEFPSUVy !.77BOT`aa! 8-/'-1-2WG=1,C燪EcpI鮪T歗s薘u騷z0|凷a6Zcq& ; W$<疻 Bv韞Mv-+@B___@UnknownG.郲x Times New Roman5€Symbol3. .郲x ArialC.,.鋥$ Calibri Light7..鋥$ CalibriA$BCambria Math"鹦hMg1#搰忷Hg ((!亖r4 3僎HX ?q&2!xxH瘴 YESHIVA UNIVERSITYR. Kohn Rochelle Kohn 鄥燆鵒h珣+'迟0 $ D P \ ht|YESHIVA UNIVERSITYR. KohnNormalRochelle Kohn14Microsoft Office Word@庩@J@6%e@N=( 胀諟.摋+,D胀諟.摋+,P  hp   T156X Flagship Store - Buy with confidence Limb dampeners for crossbow noise reduction Best YESHIVA UNIVERSITY Title  8@ _PID_HLINKSA xHmailto:akelsen@yu.eduK4mailto:Rkohn1@yu.edu  !"#%&'()*+.Root Entry F饜N0€1Table aWordDocument.SummaryInformation(DocumentSummaryInformation8$CompObjr F Microsoft Word 97-2003 Document MSWordDocWord.Document.89瞦