Current Student-Athlete Questionnaire for Sports Information Department

*

This form is a record kept on file by the Adrian College Sports Information Office to be used to compile information for programs, press guides and news stories. In order for us to create an accurate biography, please fill this out as completely as possible.

To help us create feature articles and notify the media of potentially interesting feature story ideas, please list any personal information that people might find interesting or may not know about you. For example, are you related to anyone famous? Did you have a career prior to coming to Adrian? Are you the first in your family to go to college?

*
Please include for example ACHA Hockey instead of just hockey, men's lacrosse instead of lacrosse, etc.
*
*
*
*
example Alamdari (All-um-dar-ee)
*
*
*
example 6-0, 5-10, etc.
*
*
*
*
*
*
*
*
*
*
*
To reach you strictly for story ideas and not made public.
So we can Tweet about your accomplishments!
*
*
*
*
*
example, Don and Shirley Smith or Don Smith and Shirley Jones, daughter of Shirley Jones, son of Don Smith
Please list name, relationship to you, sport, team and years played

HIGH SCHOOL INFORMATION

*
If more than one, please indicate years at each school
*
*
*
*
Please list all sports you lettered in and include year, sport, team record, head coach's name and any district, regional or state titles won
*
Please be specific. Example: 2012 First Team All-Conference and All-Region, 2010 Second Team All-State by Detroit News. Include any and all stats (example: career leader in school history for points)
*
Example: French Club, Choir, Band
*
Include hours spent doing the activity

JUNIOR/TRAVEL/CLUB TEAM INFORMATION

Please list all club/travel/junior sports you played and include year, sport, team record, head coach's name and any district, regional or state titles won
Please be specific and include all statistics, if known. Example: NAHL Showcase, team scoring leader, etc.

COLLEGE HISTORY (if a transfer from another school)

similar to high school and travel/club achievements sections above
similar to high school and travel/club achievements sections above

PERSONAL FUN INFORMATION (please, no more than 1 per question)

*
*
*
*
*
*
*

HOMETOWN MEDIA OUTLETS

*
*

Permission for the release of information

I, the undersigned, authorize Adrian College, to release my intercollegiate participatory sports records to the media requesting such information for publication or other use. I further authorize the institution to release such information which may include records earlier forwarded to this institution from high school and other colleges attended by me to the media by the AC sports information office.

The released information may include the following: actual game statistics, pertinent personal data such as height, weight, position, age, hometown, college class status and past schools attended, comments for use in feature articles and photographs, films, drawings or slides, pertinent medical information in consultation with the head athletic trainer, doctor or coach. Excluded from this information for release are any other academic records other than those of a positive nature such as for promotion with the mass media for conference or national athletic academic honors. Your grade point average may be used to highlight your achievement in print or online. I authorize Adrian College to use my image and/or likeness for promotional purposes with my consent.

I also acknowledge that I have read and understand Adrian College's social media policy and code of conduct.

*
Please print name and initials
*

This release is given at the request of the guidelines imposed by the Education Rights and Privacy Act of 1975.

 
* = required field