Geological Society of America, Archaeological Geology Division
Claude C. Albritton, Jr. Scholarship
Application Form
PART I: APPLICANT INFORMATION
Last name:
First name:
Middle initial(s):
Current address:
City:
Tel (including area code):
State/province:
Country:
Fax (including area code):
Zip/postal code:
E-mail:
Mailing address (if different from current address):
City:
Tel (including area code):
State/province:
Country:
Fax (including area code):
Institution:
Zip/postal code:
E-mail:
Department:
Academic supervisor:
Supervisor’s e-mail:
Supervisor’s telephone (including area code):
Supervisor’s fax (including area code):
Degree sought (e.g., M.A., M.Sc., Ph.D., etc.):
Area of specialization:
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PART II: BUDGET INFORMATION
A. Allowable expenses:
The award monies may only be used to directly support the student's thesis/dissertation
research. Allowable expenditures may include but are not limited to: travel, food, and lodging
during fieldwork activities, analytical services (e.g., dating, thin section preparation,
geochemical or isotopic analyses, etc.), and fully expendable supplies (chemicals and
reagents, photographic film processing, sample containers, etc).
The award monies may not be used for: tuition, salaries, consultants’ services, communication
costs, travel to conferences and meetings, word processing services, equipment or nonconsumable supplies, computer hardware or software, books, copying, printing or binding
services.
Travel
Amount ($):
Detail:
Food
Amount ($):
Detail:
Lodging
Amount ($):
Detail:
Analytical
services 1
Amount ($):
Detail:
Analytical
services 2
Amount ($):
Detail:
Expendable Amount ($):
supplies 1
Detail:
Expendable Amount ($):
supplies 2
Detail:
Other
Detail:
Amount ($):
Total amount requested ($):
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B. Other financial support:
Please outline other past, current or pending financial support for the costs of your
thesis/dissertation research.
Past or
current
GSA
support
Amount ($):
Pending
GSA
support
Amount ($):
Source:
Geological Society of America
Start date:
Source:
Geological Society of America
Projected start date:
Past or
current
support 1
Amount ($):
Amount ($):
Amount ($):
Amount ($):
End date:
Source:
Start date:
Pending
support 2
End date:
Source:
Start date:
Pending
support 1
End date:
Source:
Start date:
Past or
current
support 2
End date:
End date:
Source:
Start date:
End date:
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PART III: RESEARCH PROPOSAL
Title of thesis/dissertation:
Research start date:
Research end date:
Research abstract (250 words or less):
Research proposal:
Please attach a proposal outlining your research problem or question, its significance, a
brief review of previous research, and a clear description of methodology to be
employed, including the area and nature of any fieldwork that your research requires.
This proposal should be no longer than 2000 words, in a font size of no less than 12, and
in Word (.doc) or Rich Text (.rtf) format. Be sure to indicate your name, institution, and
the title of your thesis/dissertation on your proposal.
You may include one (1) figure in your proposal. Please embed it in your proposal or
send it as a separate attachment in JPEG (.jpg), GIF (.gif) or Adobe Reader (.pdf) format.
Please ensure that your figure is less than one (1) megabyte in size and includes your
name, institution, and the title of your thesis/dissertation.
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PART IV: RECOMMENDATION LETTER INFORMATION
Recommendation letter #1
Referee’s name:
Referee’s institution:
Referee’s department:
Referee’s telephone (including area code):
Referee’s fax (including area code):
Referee’s e-mail:
Recommendation letter #2
Referee’s name:
Referee’s institution:
Referee’s department:
Referee’s telephone (including area code):
Referee’s fax (including area code):
Referee’s e-mail:
By submitting this form to gsa.agd@gmail.com, the applicant agrees to abide by the Statement of
Responsibility pertaining to the GSA Archaeological Geology Division’s Claude C. Albritton, Jr.
Scholarship, as outlined below:
If selected for this award, I pledge to:
1. Submit a summary of research activity within six months of
completion of fieldwork/labwork;
2. Submit a summary of expenditures with the research summary;
3. Submit a final five-page report on the thesis/dissertation upon its
completion;
4. Provide a photograph if requested;
5. Acknowledge scholarship support wherever possible, particularly in
publications.
Date: ________________________________
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