Name *

First Name

Last Name

Phone *

For the United States, country code is 1

Country

(###)

###

####

Student's Name *

First Name

Last Name

Relationship to Student *

Model United Nations Club Advisor

Model United Nations Class Advisor

Teacher

Guidance Counselor

Other

How long have you known the student? *

Less than 1 year

1 year

2 years

3 years

4+ years

In the event that the student is awarded a scholarship but does not attend BMUN 72, they must contact treasurer@bmun.org to arrange a repayment of the said Alumni Scholarship funds back to the organization. I understand that failure to reach out by 3/10/2024 will result in all students from your school becoming ineligible for the scholarship for the next 3 years.

I agree

If the student is awarded a scholarship, the student must accept the aid in writing by the scholarship acceptance deadline of 1/31/2024. If the student does not accept the scholarship by this date, it will be forfeited and not disbursed. *

I agree

I hereby certify that the above information is accurate to the best of my knowledge. I understand that an incomplete or improperly completed form may prevent the student from receiving the scholarship. Furthermore, I acknowledge that unauthorized or fraudulent use of Berkeley Model United Nations funds is a severe offense which may result in disciplinary action including revocation of the scholarship and suspension from next year's BMUN conference. *

I agree