University of Saint Joseph Sports Info Questionnaire

(Last/First/Middle)
(Month/Day/Year)
(City, State)
(Cellphone)
Bats/Throws (L/R/S)
Clarify if non-traditional situation; step-father, step-mother)
List below all high school athletics in which you participated (Sports & number of years).
List below championships won by you individually or by your teams. Include League, County, Region and State titles and years. Also, list below any athletic honors such as All-Conference, All-Area or All-State or team awards (team MVP, Coach?s award etc.) and years.
List below any memorable games/meets you had, or any records you hold.
List below those activities in which you have been involved or received recognition, be sure to include class offices held, scholastic honors/awards, societies, etc.
Briefly explain anything that might be good material for a feature story.
Name of daily or weekly papers in your area (with city, if not in title). List name of writer/editor if known. Example: Home Evening News/Plainfield, N.Y./Joe Smith-Sportswriter

READ BEFORE SUBMITTING--

Note: This form comes under the purview of the Family Educational Rights and Privacy Act of 1974.  Principle Specifications of Records: This consent statement authorizes administrative personnel of the Department of Intercollegiate Athletics to review and disseminate to third parties information in my personal “education records” including information contained on this form, photos and any other educational information collected and/or maintained by this institution, for public relations purposes.  Purposes of Disclosure: Information obtained from these records will assist in compilation of personal information for the use in official athletic department publications, for dissemination to the news media, for purposes of nominating me for honors programs and scholarships, and for general public relations purposes.  Party or Class of Parties to Whom Disclosure May Be Released: By signing this consent statement, I authorize administrative personnel of the Department of Intercollegiate Athletics to review and disseminate any information on this form and photos to third parties for general public relations purposes.

 

 
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