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 NameLast Name
Birth Date*

MonthDayYear
Phone Number*

Area CodePhone Number
E-mail*
Student ID*
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Gender*

MaleFemale
Do you identify as Hispanic?*

YesNo
Race - please check all that apply*

Native American/American IndianAsian/Pacific IslanderAfrican American/BlackCaucasian/White
Citizenship*

U.S. CitizenPermanent ResidentOther
GPA*
Major*
Minor
Expected Graduation Year*
Hajim Advisor*
Do you intend to pursue a doctoral degree? *

PhDMDMD/PhDPsyDJDPharmDDo not intend to pursue a doctoral degree
Do you intend to pursue a professional degree? *

MSMAMBAMPHDo 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?*

YesNo
Are you currently, or were you, a member of any of the following programs? Check all that apply*

ECOTalent SearchUpward BoundUpward Bound Math/ScienceHEOPGates MillenniumGEAR UPOtherNot 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.*

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Resume/CV*

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Unofficial Transcript*

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Have you conducted research prior to this opportunity?*

YesNo
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

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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