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

What year(s) did you receive an OGA Scholarship?*

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 CURRENT COLLEGE/ TECHNICAL STUDENTS

Career Goal:*

College, Technical, or Trade School Attending:*

City and State:*

Major/Field of Study:*

GPA:*

Anticipated Graduation Date:*

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

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.

Scholarship Renewal Application

Personal Information

Family Information

Educational Information for CURRENT COLLEGE/ TECHNICAL STUDENTS

Signature and Required Attachments

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