Greater Alabama Black Belt Region Louis Stokes Alliance for Minority Participation (GABBR LSAMP) 2021-22 Application Form
The GABBR Alliance provides scholarships and other academic benefits to promising underrepresented students majoring in Science, Technology, Engineering, or Mathematics (STEM) degree programs at the following institutions:

Auburn University
Auburn University Montgomery
Alabama State University
Enterprise State Community College
Southern Union State Community College
Troy University
Tuskegee University
University of West Alabama


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Part I - General Information
First Name *
Last Name *
Which GABBR LSAMP institution will you attend in Fall 2021? *
University ID Number: *
Address Line 1 *
Address Line 2
City *
County *
State *
Postal Code *
Email Address (official university email, if applicable) *
Alternate Email Address
Phone Number *
Sex (select one, optional)
Clear selection
Date of Birth (MM/DD/YYYY) *
Citizenship (choose one) *
What will your classification be during the Fall 2021 semester? *
Anticipated College Graduation Date (Month and Year)
Major *
Current cumulative GPA *
Are you a transfer student? *
If you will be transferring in Fall 2021, which institution did you previously attend?
Are you a veteran?
Clear selection
Ethnicity (select one) *
Race (select one or more) *
Required
Do you have a documented disability? (select one, optional)
Clear selection
Part II - Signature
I hereby acknowledge that all information submitted in this application is true and accurate. If selected as a recipient, I agree to participate in the GABBR LSAMP program activities and maintain a cumulative 3.00 grade point average.
Signature (type full name here): *
Date: *
Submit
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