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Hispanic College Liaison Program (HCLP) SCHOLARSHIP APPLICATION

Eligibility: This scholarship is offered to full time Hispanic students pursuing a bachelors or masters degree in the fields of science, technology, engineering, and math. This program does not apply to graduating students. Applicants must be U.S. Citizens or Visa-holding Permanent Residents. Applicant must have demonstrated leadership skills, resourcefulness, high personal standards and a personal commitment to helping the student organization, minority office and community achieve its goals on campus and off-campus. Please complete the following steps: 1. Complete the application 2. Submit an essay explaining why you are applying for the scholarship and why you would be the best applicant to receive a scholarship. Please include information about yourself such as academic background, extracurricular activities, career interests, financial need, involvement with the Society of Hispanic Professional Engineers (SHPE) and/or other minority organizations. 3. Include both current and previous semester GPA and cumulative GPA. Provide details about GPA standing. 4. Send all documents electronically to your local school contact or SHPE focal point.

Note: Xerox has the right to withdraw a scholarship if the student drops out of school after being awarded the scholarship.
Last Name, First Name, Middle Initial Student ID Number Date

School Street Address

City, State, Zip

School E-mail Address

School Phone (include area code)

Home Street Address

City, State, Zip

Personal E-mail Address

Personal Phone (include area code)

U.S. Citizen or Permanent Resident?

Black American/Alaskan Asian/Pacific Islander

Native American Hispanic Other

Male Female

Yes No Name of 4-year Institution Attending

Cumulative Scale Expected Degree Major Field of Study GPA (or (e.g. High 3.0 out BS MS School of 4.0) GPA, if Freshman) Are you currently (or were you ever) a HCLP Scholarship recipient? School Standing? Yes No Freshman Sophomore Junior Senior If yes, what year?

Expected Date of Graduation

Graduate

APPLICANTS SIGNATURE DATE My signature above indicates that I authorize school officials to release my information to Xerox for inclusion in my application for the Hispanic College Liaison Program (HCLP) Scholarship. Completed application should be submitted to your local school contact or SHPE focal point by March 15 of the current year. Scholarship recipients will be notified by email no later than April 15 of the current year.

Revised: 11/5/12