2020 Xerox Engineering Research Fellows Application

The David T. Kearns Center for Leadership and Diversity in Arts, Sciences, and Engineering

College Programs
Xerox Engineering Research Fellows Application
Application Deadline: February 15, 2020
Full Name *

First Name Last Name
Birth Date *

Month Day Year
Phone Number *

Area Code Phone Number
E-mail *
Student ID *

Permanent Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Gender *

Male Female
Do you identify as Hispanic? *

Yes No
Race - please check all that apply *

Native American/American Indian Asian/Pacific Islander African American/Black Caucasian/White
Citizenship *

U.S. Citizen Permanent Resident Other
GPA *
Major *
Minor
Expected Graduation Year *
Hajim Advisor *
Do you intend to pursue a doctoral degree? *

PhD MD MD/PhD PsyD JD PharmD Do not intend to pursue a doctoral degree
Do you intend to pursue a professional degree? *

MS MA MBA MPH Do not intend to pursue a professional degree
While in high school, did you live with a parent/guardian who had a four-year college degree? *

Yes No
Are you currently, or were you, a member of any of the following programs? Check all that apply *

ECO Talent Search Upward Bound Upward Bound Math/Science HEOP Gates Millennium GEAR UP Other Not Applicable
If "Other," please state the program's name

Supplemental Materials
Statement of Purpose: Please submit an essay in which you explain how participation in the HSEAS Xerox Engineering Research Fellows Program will fit into your long-range academic and professional goals. *
Resume/CV *
Attachments must be in pdf format only.
Unofficial Transcript *
Attachments must be in pdf format only.
Have you conducted research prior to this opportunity? *

Yes No
If you have conducted prior research, please provide a description of each experience on a separate document. Provide the name of your mentor, dates, and a brief synopsis of the project(s).
Research Experience
Please list at least three professors, in rank order, with whom you would be interested in conducting research. While three are required, it is preferable that you would list more than three. Visit our website to review faculty projects and descriptions: https://www.rochester.edu/college/kearnscenter/undergraduate/xerox-fellows/index.html
Name of Professor & Project Title *
Name of Professor & Project Title *
Name of Professor & Project Title *
Name of Professor & Project Title
Two letters of recommendation are required from professors who can speak to your abilities as a student and potential researcher. Please have your recommenders visit the following website in order to submit their letters: http://form.jotformpro.com/form/42885951813970
How did you hear about us? *
Terms of Agreement: By submitting your application and typing your name on the line below, you are indicating that all of the information contained within is complete and correct to the best of your knowledge. Additionally, you grant the Kearns Center permission to check all relevant academic and University records. *
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The David T. Kearns Center for Leadership and Diversity in Arts, Sciences, and Engineering

Xerox Engineering Research Fellows Application

Supplemental Materials