Application       
Clayton Bell Scholarship/Internship in Historic Preservation

Name: _________________________________ School:________________________________
Address:______________________________________________________________________                                      (Street, city, state, zip code)                                                                     
Phone numbers: __________________(Home)                   __________________________Cell)                                                                          
Email address:____________________________________________   Today’s Date: _______
Parents: ________________________________________    Phone:__________________ 
Formal academic classes and other experience (re enactments, travel, visits to historic sites, reading, etc.) in the field of history, historic preservation, and related areas:    (Continue on the back of the page as needed)
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
List several relevant career and academic goals: __________________________________________________________________________________________________________________________________________________________________________________________I affirm that the student will have adequate time to complete the internship hours. _______________________________________________(student)
Please attach a 300-word Essay on “Why Local Historic Preservation Matters”.
Make sure your name and the date is on the essay. Return application, essay and faculty nomination via e-mail or drop off at Marsh House in mailbox on porch by May 1, or by email to: . Or Mail to: PO Box 722, La Fayette, GA 30728.  								OVER---

Faculty member nominating the student
Name:________________________________________________________________________
Mailing Address:________________________________________________________________
Telephone numbers:_____________________________________________________________
E -mail_________________________________________________  
Agreement of faculty member at (school) ________________________________to support the student in developing and implementing a learning plan and in having a successful experience:
_____________________________________________________________________________                            (Signature) ( Date)
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(Do not write below this line-committee use only)
Committee evaluation of application

Areas of strength:

Other:

Decision:

Committee evaluation of essay: