Name(Required) First Last Berkeley Email(Required) Non-Berkeley Email(Required) Phone(Required)Mailing Address (where we can send a check)(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code HiddenWould you like to sign up to receive online payments?(Required) Yes No, I would like to receive a paper check Select Your Fellowship(Required)If you participated in more than one fellowship, please complete a form for each fellowship stipend. Crafting Consent Shorashim: Jewish Roots Fellowship Repair the World 23-24 Student Board Schultz Freshmen Fellowship Tell us in a few sentences what you enjoyed about your fellowship this semester.(Required)Blank W-9 Form HiddenW-9 upload: Required for stipends, payments over $600Max. file size: 100 MB. Δ
