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Hispanic College Liaison Program (HCLP) SCHOLARSHIP APPLICATION

Eligibility: This scholarship is offered to full time Hispanic students pursuing a bachelor’s or master’s
Eligibility:
This scholarship is offered to full time Hispanic students pursuing a bachelor’s or master’s 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
Native American
Male
American/Alaskan
Hispanic
Female
Asian/Pacific Islander
Other
Yes
No
Name of 4-year
Institution Attending
Cumulative
Scale
Expected Degree
Major Field of Study
Expected Date
GPA (or
(e.g.
of Graduation
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
Graduate
If yes, what year?
APPLICANT’S 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