ÐÏࡱá>þÿ -/þÿÿÿ,ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿì¥Á} ð¿0µ bjbj¨Î¨Î .ʤäfʤäfµÿÿÿÿÿÿ·hhúúúúúÿÿÿÿ*Át>(ffffAAA@BBBBBB$5¶ëvfú�AA��fúúffÛ{���� úfúf@��@���fÿÿÿÿÀN¾×ÿÿÿÿš �,‘0Á�a¤"a�aú�œA0q"�“¯áAAAffÆÊAAAÁ����ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿaAAAAAAAAAhX À:  YESHIVA UNIVERSITY Office of Disability Services Beren Campus Wilf Campus Dr. Rochelle Kohn Ms. Abby Kelsen  HYPERLINK "mailto:Rkohn1@yu.edu" Rkohn1@yu.edu  HYPERLINK "mailto:akelsen@yu.edu" akelsen@yu.edu 646-592-4132 646-592-4280 Fax: 917-326-4811 REQUEST FOR MEAL PLAN MODIFICATION Name: ID: I am requesting exemption from the meal plan at 911±¬ÁÏÍø due to a medical condition. Nature of Condition: I understand that my request is not complete without a letter from my physician documenting my condition and supporting my request. I hereby grant permission to the designated physician affiliated with 911±¬ÁÏÍø and/or Yeshiva personnel to obtain and/or release information regarding my exemption request to and/or from the person and/or facility below: Physician’s name: Phone: ______________________________ ___________________ Student Signature Date 12>CDOPwx𛍩¯°ÓÔâãäû       7 C D E F J K L N P Q S T U V ÷÷ò÷ëç÷òçßçßÖßçßçßÖßççÒÒçççÊÁ¸¯ÁÁ礚�Œˆ„yšŒuhq&¢hý×h1,C5�>*\�hò}zh¦k1hÃ-hý×hÃ-5�\�hý×hq&¢5�\�hý×hq&¢5�>*\�h„S�5�CJaJhcpI5�CJaJhq&¢5�CJaJhËRuhq&¢5�h; ¯h1BhËRu0JjhËRuUhËRu hBvähBvä hËRu5�hBvähBvä5�,12Pwä   D E F V W X · ¸ ¹ Ï Ð Ñ Ò W X @ ÷÷÷òòòòòêåêàààààààààÛÛÛàågd�/'gdq&¢gdcpI$a$gdq&¢gdËRu$a$gdcpIV W X · ¸ ¹ Ì Ï Ð Ñ Ò Ô î  V W X y ± Ê Í î ü  ! . > ? @ A B C K O R S T X üøüôïäÚüÖÖüÒÒüËĽüô½¹¹üµ±ü±­½©¢—Œ—�wmchý×hMvó5�\�hý×h-þ5�\�hý×hq&¢5�\�hý×hq&¢5�>*\�hý×h�/'5�>*\�hý×hcpI5�>*\� hª6–h QEhq&¢hª Ûh QEhš^sh©-2 hBvähª Û hª6–hq&¢ hª6–hcpIh�/'hó²hý×h; ¯5�\�hý×h; ¯5�>*\� hó²>*h; ¯hËRuhcpI&@ A B a b c d e f g š ´ µ úúõè×ÊÅúúúúúgdª Û &d PÆÿ gd$<µ„Ð&d PÆÿ `„ÐgdBvä &d PÆÿ gd©-2gd�/'gdq&¢ X ] _ ` a b c d e f g  † • ™ š £ ´ µ ôêàÖÒÒÎÊÃÃÿÿÿ÷hq&¢CJaJhíyñ hª6–hª6–hª ÛhõnTh©-2hý×h+þ5�\�hý×hMvó5�\�hý×h�/'5�\�hý×h�/'5�>*\�,1�h°Ð/ °à=!°"°#� $� %°°Ð°Ð �Ðx2ÀÐàð 0@P`p€�ÀÐàð2(Øè 0@P`p€�ÀÐàð 0@P`p€�ÀÐàð 0@P`p€�ÀÐàð 0@P`p€�ÀÐàð 0@P`p€�ÀÐàð 0@P`p€�8XøV~� °ÀЀàð 0@àð 0@àð 0@àð 0@àð 0@àð 0@àð 0@àð 0@àð 0@àð 0@àð 0@àð 0@àð 0@àð 0@66666_H mH nH sH tH @`ñÿ@ q&¢NormalCJ_HaJmH sH tH DA òÿ¡D Default Paragraph FontRióÿ³R  Table Normalö4Ö l4Öaö (k ôÿÁ(No List 6U@òÿñ6 ËRu Hyperlink >*B*phÿPK!éÞ¿ÿ[Content_Types].xml¬‘ËNÃ0E÷Hüƒå-Jœ²@%é‚ÇŽÇ¢|ÀÈ™$ÉØ²§Uû÷LÒTB¨ l,Ù3÷ž;ãr½µÃ˜œ§J¯òB+$ëG]¥ß7OÙ­V‰�æ�j\À{“c‹p/âID±ÜgŒ6wZá�ÚË0s’„îÍùÄÄ=Dèĵw %–—;“r,q©lEØ¢yDQ"Qˆ,=õcì8ÝB,»î“!g‚�¤÷„xMDœ&é“�M…Ð.‰Á/SAð·e›ýÇ^“Q×©ÛøÄF½�¨ƒ|SËŒ÷ÐD¢Ø¥²�bj|ÉÈE²7åC×<bʼN€…pÉr8¯áô�fÜnß§ÓØFrIÆ.�{ˆ1ÙfãV„âÔ…í‘$2±Ÿ‹1„(òŽ˜tÁ÷™}‡¨kðJVºû1Á–»/Î� Ú”ŠQ¿L¸Ã—÷0³â·7¥#„]©f‡ÇVŠÝáÄÍIh…öÆ�¢cïÑçM–Z6/Hß� «ìbW`ÝGv¬ªë è•Ts³œ'÷ˆ°B¶‡C¶‚Ïþt!ñLQ#¾JóxÝ´yJ]ì €C:›À= Ä‹Ó(‡tÁ½RëQ„¬¦®…;^§Üòßeî1¸/�-—¸/A_Y»)ó^Ûôµ6(¦� Ëp¥[±Ü_ˆ¨âªÅ&N¹‘}Ón€îÈjzb’\Ø-ô>Õÿ®÷�ãü‡—ŽûàÃô;nÅV²ºb§³*™ì.ô7«p‹]M‹ñ€|üMMM’# ud9cÝô47=�ÿ¿ïiVÝÏ7�̪~㦓ñ¡Ã¸édfÕÓÉÍ ô5jà‘ zôØ'^9õJ{rJñžÐƒÏ3A•œžxâ| ˜FðU•9ØÀÂ…i�3ù‘Q/B)L‡Ê¾RŠ™êPx)04ÒËNÝ O'ñ> ²ag¹¬›YeHë¥j¾ƒ*™¡kõb€—«×lC=h�P²W!alf“Øp�¨Ï•‘ôXŒæ ¡OöAXl:XÜVêç®ZbÔr¯À·�é ¿Z‚y4ç�òSæê¹wµ3?¤§WÓŠh°çPxzSq]y µÿÿÿÿV X µ  @ µ  wš¨¯ÓâµXÿ€Xÿ€ð8ð@ñÿÿÿ€€€÷ð’ðð0ð( ð ððB ðS ð¿Ëÿ ?ðÿÿ¢à�Ó£à�Ó¤à�Ó··=*€urn:schemas-microsoft-com:office:smarttags €PlaceName€=*€urn:schemas-microsoft-com:office:smarttags €PlaceType€9*€urn:schemas-microsoft-com:office:smarttags€place€ ··ä!Bg·12CDOCEFPSUVyÊü !.77BOT`aa·!å 8-�/'Ã-¦k1©-2WG=1,C QEcpIõnTš^sËRuò}zö0|„S�aˆª6–Zcœq&¢£C¢– ­; ¯ó²Wµ$<µ¯WÉýת ÛBväíyñMvó-þ+þµ·ÿ@B___µ�@ÿÿUnknownÿÿÿÿÿÿÿÿÿÿÿÿG�ÿ.à[xÀ ÿTimes New Roman5�€Symbol3.� ÿ.à[xÀ ÿArialC.,ÿ.ä{$À ÿCalibri Light7.�ÿ.ä{$À ÿCalibriA�ÿàÿ$BŸCambria Math"ñˆðÐhM“g1#“‡�úHg �(�(!ð ´´��r4´´ 3ƒQðüýHX ðÿ?äÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿq&¢2!xx HÕÎ ÜÿÿYESHIVA UNIVERSITYR. 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