BPH Student Award Requests

BPH Student Award Requests

NOTE: ALL AWARD REQUESTS MUST BE APPROVED BY THE FUNDING MANGER BEFORE SUBMITTING THIS REQUEST.

Your Information

Your First & Last Name*

Your Berkeley.edu Email*

Student/Awardee Information

Student's Name*

Student's Email*

Student's SID # (if you don't know, put N/A)*

Program*

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Concentration*

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Requested Award

Award Period*

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Tuition and Fee Award Amount*

If this is an award for multiple terms, please include the TOTAL amount here. If the award request does not include a tuition fee payment, please enter $0.

Tuition & Fee Split Description

If you are splitting this award amount over multiple terms, please let us know how you would like the total amount to be awarded. For example, $5,000 Fall 2024 and $5,000 Spring 2024. If you are not awarding a tuition and fee award, you can skip this question.

Tuition & Fee Award Disbursement

For this question, please indicate what fees you would like this award to cover. If you are not awarding an award for tuition and fees, you can skip this question.

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Tuition & Fee Award - Refund Option

If you are awarding a tuition and fee award and this award exceeds the amount of the student's bill for that term, would you like the remainder of the award to be refunded to the student as a stipend. If you are not awarding an award for tuition and fees, you can skip this question.

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Stipend Award Amount*

Please enter TOTAL amount for this stipend award. If the award request does not include a stipend, please enter $0.

Stipend Award Disbursement Schedule

If you select the monthly disbursement option, please provide detail about those monthly payments below. If you are not awarding a stipend, you can skip this question.

Select

Stipend Award Disbursement Details

If you are awarding a stipend that will be disbursed over multiple months or terms, please provide the details below. For example, if you are awarding a $10,000 stipend that is split between two semesters, $5,000 Fall 2024 and $5,000 Spring 2025. If you are awarding a monthly stipend, an example is $2,500 monthly for August 2024 to May 2025.

Fund Information

Name of Funding Source *

For example, Block Grant, PDST, Epi Variable Budget, NIH F31 Fellowship, etc.

Award Chartstring*

[Fund Number] - [Dept. ID] - 78 - [Chartfield 1] - [Chartfield 2] Note: all award requests must be set to a 78 program code.

Is this a fund managed by Student Services?*

Was this fund listed in your fellowship allocation on your decision form? Is this fund tracked in the Master Funding Sheet? If yes to either of these questions, the answer to this is Yes.

Select or enter value

Fund Manager's First & Last Name*

This is the UC Berkeley staff who overlooks and verifies the availability of funds.

Fund Manager's Berkeley.edu Email Address*

Is donor reporting required for this award?*

Select

Comments/Clarifications*

Additional comments? Note: if this students has already received an award on this fund, please clarify the total amount you would like the student to receive.

Approval

All information provided in this request is accurate and BPH has the authorization to move forward with payment.

I agree with the statement above*

Send me a copy of my responses

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