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Which might be beneficial to the student s physical or mental well-being. I. HEIGHT in. lbs. MEDICAL HISTORY ATTACH ADDITIONAL SHEETS AS NECESSARY Provide significant details of student s medical history including serious illness operations accidents allergies etc. Has the applicant ever been treated by a psychiatrist or psychologist documentation. YES NO. Attach additional sheets as necessary Date Signature of examining physician Name Please Print Phone Address City State Zip. PLEASE NOTE A...

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