Personal Information

Full Name:*

Date of Birth (MM/DD/YYYY)*

Gender:*

Male
Female

Are you a U.S. Citizen or legal resident living in Ohio?*

Yes
No

Primary Mailing Address:*

Street Address Address Line 2 City State ZIP Code

Primary Mailing Address:*

Home
School
Parent/Guardian's House

Secondary Mailing Address (if needed)

Street Address Address Line 2 City State ZIP Code

Secondary Mailing Address:

Home
School
Parent/Guardian's House

Phone:*

Email:*

Enter Email Confirm Email

Are you currently a student?*

Yes, full-time
Yes, part-time
No

Are you currently employed?*

Yes, full-time
Yes, part-time
No

Are you currently enrolled in the military or a veteran?*

Yes
No

Have you previously applied for an OGA Scholarship?*

Yes
No

If yes, what year(s)?

How are you funding your education?*

Personal Income
Scholarships
Financial Aid / Grants
Student Loans
Parent / Guardian Income
Other

Family Information

Mother's Employment/Occupation*

Father's Employment/Occupation*

Do you have any other siblings currently attending college?*

Yes
No

Do you, or a family member, currently work in the Ohio natural gas industry?

Yes
No

If yes, please list relationship(s), company names(s), and job title(s):

Educational Information for HIGH SCHOOL STUDENTS ONLY

Career Goal:

High School Name:

City, State:

GPA:

Anticipated Date of High School Graduation (MM/YY):

ACT Test Score (If applicable):

SAT Test Score (If applicable):

College, Technical, or Trade School you are planning to attend:

City and State:

Major/Field of Study:

Have you formally enrolled?

Yes
No

If not enrolled, please explain status of admission and reason:

Educational Information for CURRENT COLLEGE/ TECHNICAL STUDENTS ONLY

Career Goal:

College, Technical, or Trade School Attending:

City and State:

Major/Field of Study:

GPA:

Anticipated Graduation Date:

ACT Test Score (If applicable):

SAT Test Score (If applicable):

Signature and Required Attachments

Transcript, Essay & Letters of Recommendation Attached?*

Yes
No

Please make sure there are no social security numbers listed within your transcript. Two letters of recommendation from a teacher, employer or other mentor figure. Recommendations from family members are NOT acceptable.

File

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 1 MB, Max. files: 4.

Full Name of Applicant & Date:*

I certify that all information is true and accurate. I authorize independent verification. I understand that if I am awarded an OGA scholarship, information contained in this application may be released to the media.

Online Application

Personal Information

Family Information

Educational Information for HIGH SCHOOL STUDENTS ONLY

Educational Information for CURRENT COLLEGE/ TECHNICAL STUDENTS ONLY

Signature and Required Attachments

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