CUW ATHLETIC COMMUNICATIONS STUDENT-ATHLETE PUBLICITY QUESTIONNAIRE

First Name *

Last Name: *

Name you want listed on website and roster: *

Height (ex. 5-11):

Weight (men's sports only, females type n/a):

Hometown (include city, state and zip code) *

Full name of high school: *

CUW academic major: *

Sport(s) participating in at CUW: *

Right/Left handed:

Right Left

Right/Left footed:

Right Left

Shoots (Hockey)

Right Left

Baseball/Softball Bats:

Right Left Switch

Baseball/Softball Throws:

Right Left

Golf only - Swings

Right Left

Twitter handle @:

Instagram handle:

Tik Tok handle:

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PERSONAL/CONTACT INFORMATION

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Email address *

Cell Phone Number: *

Father's Name:

Mother's Name:

Names and ages of brothers:

Names and ages of sisters:

Position of birth (ex. first born):

Marital status (spouse's name):

Name and age of children (if applicable):

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OTHER INFORMATION

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Relative(s) who play(ed) professionally and their relationship to you:

(Name, Relationship, Sport, College, Years Played)

Relative(s) who are famous or well-known and their relationship to you:

Any interesting stories of note about yourself:

Hometown Media Outlets

Newspaper(s), TV stations, Radio stations that your parents read regularly (include city and state)

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HIGH SCHOOL INFORMATION

Team Accomplishments means items such as record, conference/regional/sectional/state championships or appearances, rankings, etc.
Personal Accomplishments means items such as team awards, all-conference, all-area, all-state, captains, records broken, etc.
Personal Statistics/Personal Bests means numerical items such as per game averages, running times, best marks

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Year of graduation: *

High school nickname/mascot

Full name of high school: *

Conference high school is a member of (spell out -- i.e. Packerland Conference): *

Academic Accomplishments: *

(ex. Valedictorian, top-5 in class, Honor Roll, etc.)

Team Accomplishments (team, years and type): *

(ex. senior year basketball regional champions, sophomore year conference champions)

Personal Athletic Accomplishments (be specific with sport played and honors: *

(ex. set school record senior year, etc.)

Personal Statistics/Personal Best: *

Sport(s) participated in and year(s) lettered: *

(ex. basketball (4))

What is your biggest high school career highlight:

Esports: Gaming accomplishments

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JUNIOR TEAM, JUNIOR COLLEGE, TRANSFER OR PREVIOUS TEAM INFORMATION

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School/previous team nickname/mascot:

Previous school/team athletics and academic honors: (ex. first team all-conference, Honor Roll)

BE SPECIFIC WHEN LISTING SPORT AND ATHLETIC/ACADEMIC HONOR(S)

What is your biggest career highlight:

Previous school/team individual statistics:

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PERMISSION FOR RELEASE OF INFORMATION

By entering my name in the space below, I authorize permission to Concordia University Wisconsin's Athletic Communications Department to release my intercollegiate participatory sports records to the media requesting such information for publication or other use. I further authorize this institution to release such information which may include records earlier forwarded to this institution from high schools/colleges-universities/junior colleges attended by me, to the media by the Concordia University Wisconsin Athletic Communications Department. The released information may include any of the following: actual game participation statistics; pertinent personal data such as height, weight, position, age, hometown, college class status and past schools attended; athlete’s comments and image for use in personal feature articles and photographs, videos, drawings or slides. Excluded from the information for release are any academic records other than those of a positive nature such as for promotion with the mass media/coaches for conference and/or national athletic-academic honors or medical information protected by HIPAA.

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Electronic Signature (First & Last Name): *

Date: *

* required field