GEAR UP Birmingham Intent Form

Welcome to the Alabama Community College GEAR UP Scholarship Follow-Up College Intent Form. When completing this form, we ask that you complete every section using your most recent information. Not completing or missing a requirement, could result in you losing eligibility for the scholarship.

If you have already submitted your intent form, you can click here to log in.

Student First Name *

Student Last Name *

Student Mailing Address *

City *

State / Province / Region *

Postal / Zip Code *

Country *

Personal Email *

Phone Number

Name of High School *

College of Interest *

Career/Area of Interest *

(i.e. transfer degree, Welding, Business, Industrial Manufacturing)

Please create a username and password before submitting this form. The user name and password you create will be the same username and password you will use to submit the Alabama Community College GEAR UP Scholarship Application in October 2019. PLEASE, WRITE DOWN YOUR USERNAME AND PASSWORD AND KEEP IT IN A SAFE PLACE!

Username *

Password *

Repeat Password *