New Student News Release Form

Please fill out this form completely. You may request that your information be sent to more than one newspaper.

Items marked with * are required fields.

* First/Given Name:

Middle Name:

* Last/Family Name:

Student Id (if known):

* Gender:

Male

Female

* E-mail address:

* Campus:

* Expected Embry-Riddle Enrollment Date:

Degree program:

High school attended:

High School graduation date (MM/DD/YY):

Home Town City:

Home Town State:

Country of Residence:

Would you like us to include scholarship information, if applicable?

Yes

(For newspapers in the United States, give as much information as possible. For newspapers outside the United States, a complete address must be provided.)

Name and address of hometown newspaper (one):

Name and address of hometown newspaper (two):

Name and address of hometown newspaper (three):

Father's full name, City and State of residence:

Mother's full name, City and State of residence:

Upload Photo (path - browse to select photo file):

Note: Photo must be of Passport Quality. MAXIMUM 10Mb