Clark Scholarship
Application Form
(To be submitted to the Sr. Associate Dean, College of Liberal Arts)
Applicant's Name: _____________________________________
Please attach an official academic transcript, available from the Office of the Registrar, Eastman
1, telephone: 475-2821.
1. Describe below your proposed internship/co-op in seventy-five words or less.
2.Explain how your proposal is appropriate to your academic and/or professional plans.
3.Please describe how the receipt of a Clark Scholarship will allow you to pursue your proposed
internship /co-op which otherwise you would not be able to pursue.
4. Please indicate if you will receive any other payments for the proposed internship/co-op and
the amounts to be received.
5. Describe in what ways your proposed internship/co-op represents an original or creative
approach to professional or experiential learning.
Student Signature
Date
I have read this proposal from this student enrolled in my program and attest to the value of this
internship/co-op to the student’s professional preparation.
_________________________________________________
Chair of Degree Program