Appalachian Basin GPA Scholarship Application

Personal Information

First Name*

Middle Initial*

Last Name*

Phone Number*

Address (Street, City, State, ZIP)*

Email*

U.S. Citizen?*
YesNo

ABGPA Midstream Member?

Are you a current member of the ABGPA Midstream?*
YesNo

Education

Do you attend a school in PA, WV, OH, NY, or MD?*
YesNo

Name of School*

Address of School (Street, City, State, Zip Code)*:

Address of School Financial Aid Office (Street, City, State, Zip Code)*:

School Financial Aid Office Phone Number:

Expected Graduation Date (Month, Year)*:

Undergraduate Major*

Current GPA (indicate point scale)*

Major GPA (indicate point scale)*

Graduate Major (if applicable):

Trade/Technical School Program (if applicable):

Total Credits Completed at the end of Current Semester::

Number of Semesters Completed (including the current one):

Name of High School Attended:

High School Graduation Date (Month, Year):

Work Experience

Have you completed any internships or co-op programs for an oil and gas midstream company?*
YesNo

Employment History: Please provide employer name, location (City, State), start and end dates (Month, Year), number of hours worked per week, and type of work:*

Activities and Hobbies

Please describe your extra-curricular activities and hobbies outside of the classroom:*

Military Experience?

Did you service in the military?*
YesNo

Financial Need

Please breakdown your financial obligation into the following categories as a percentage. The total must be equal to 100% (e.g. 50% Loans Taken in Applicant Name, 50% Parents / Family Support)*
Earned Income %:

Scholarships / Grants %::

Loans Taken in Applicant's Name %::

Parents / Family Support %::

Other (provide detail) %:

Tell Us About Yourself

Please provide a letter of reference (200 words or less) from teachers or other adults (unrelated to you) who are familiar with your abilities and achievements. In lieu of attaching a letter here, you may have your reference email it to scholarship@abgpa.org as well:

Essay: Please describe why you are interested in entering the oil and gas midstream industry and how you plan to apply your degree towards this profession (1,000 words or less):*

I consent to allowing GPA Appalachian Basin to contact me and process my information.