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 & Renewal Essay Attached?*

Yes
No

Please make sure there are no social security numbers listed within your transcript. Renewal Essay Prompt: 250 to 500 words reflecting on your academic journey over the past year. Focus on what you have accomplished or learned during this time, particularly in areas related to natural gas or energy education.

File

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 2 MB, Max. files: 6.

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.

OGA Scholarship Renewal Application