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Tor: 5. Reason for Absence: 6. In case of absence due to illness, answer the following: Yes a. Did you visit OSU Student Health Services? b. Did you see another doctor? Yes No No Date Date Seen: Doctor's Name: c. If your answer to both (a) and (b) is "NO", can you give the name of someone who will vouch that you were ill? Yes No i. Name of person: ii. Address: iii. Phone Number: I certify that the above facts are true, to the best of my knowledge and belief, and I understand that I subje.

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