Hometown News Release Form

Your Name
Your E-mail
Your Phone Number
Home Town
Home State

Name of Student (if different)
Parents' Names (optional)

Graduation Year
Major
Department
School

Type of Release	Dean's List Other (specify below)
Other Awards or Activitites you want included in the release. Specify activities or sports here.
List the full name(s) of the newspaper(s) in which you want this release to appear. Please include the telephone, fax number, address, and/or email address of each paper.