Current Student-Athlete Questionnaire for Sports Information Department

Email address *

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?

First Name *
Middle Name *
Last Name *
Pronunciation of your first and last name *
example Alamdari (All-um-dar-ee)
Nickname
How would you like your name to read in the media guide? *
Your sport(s) *
Please include for example ACHA Hockey instead of just hockey, men's lacrosse instead of lacrosse, etc.
Position or Event(s) *
Height (Feet-Inches) *
example 6-0, 5-10, etc.
Weight (males only) in pounds
Dominant hand/foot *
Lacrosse/Hockey (shoots)
Baseball/Softball only Bats
Baseball/Softball only Throws
City of Birth *
State of Birth *
Date of Birth (mm/dd/yyyy) *
Academic Major(s) *
Academic Minor(s) *
Academic Year in School *
Athletic Year in School *
Campus Address *
Campus Phone *
Cell Phone *
To reach you strictly for story ideas and not made public.
Permanent Home Address (address, city, state, zip) *
Parent's Phone Number
Father's Name and College (if applicable) *
Mother's Name and College (if applicable) *
Parents Marital Status *
In the media guide, how do you want your parents listed? *
example, Don and Shirley Smith or Don Smith and Shirley Jones, daughter of Shirley Jones, son of Don Smith
Do you have any relatives who are or have been involved in college or pro sports?
Please list name, relationship to you, sport, team and years played
Why did you choose Adrian College?
What are your athletic goals?
Who has been the biggest influence on you as an athlete and why?
What is your career goal?

High School Information

Name of High School(s) with nickname *
If more than one, please indicate years at each school
High School Graduation Year *
High School Location (City and State) *
Team Accomplishments *
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
Athletic Achievements and Honors *
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)
High School Academic Honors *
High School Activities besides Athletics *
Example: French Club, Choir, Band
Community Service or Volunteer Work *
Include hours spent doing the activiity

College History (if transfer from another school)

Prior College(s) Attended, location, years of attendance
Team Accomplishments
similar to high school achievements section above
Athletic Achievements and Honors

Personal Fun Information (please no more than 3 per question)

Favorite Sports Teams *
Favorite Athletes *
Favorite TV Shows *
Favorite Movies *
Favorite Writers/Authors *
Favorite Books *
Favorite Musicians/Groups *
Favorite Foods *
Hobbies *

Hometown Media Outlets

List the name of the local newspaper in or near your hometown and the name of the newspaper in the nearest big city *
Please provide a name at the local newspaper whom we can contact directly *
What is the best radio station for local sports in your hometown area?
What is the best television station for local sports in your hometown area?

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.

Your signature *
Please print name and initials
Today's Date (mm/dd/yyyy) *

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

 
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