Current SHU Student-Athlete Questionnaire for Sports Information Department

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This form is a record kept on file by the Siena Heights University Sports Information Office to be used in the creation of game programs, media guides, athlete bios, and news stories. In an effort to help in the accuracy of the bios, please fill this form out as completely as possible.

You must complete ALL  required questions and answer the captcha at the bottom of the form in order for it to submit successfully. Once the form is completed correctly, you will be directed to a confirmation page. If the page reloads back to the form there will either be a notification that you missed one of the required questions or you did not successfully complete the captcha. Please make sure that you correct whichever issue before you click submit again. A confirmation email will be sent to the email address you provide on the form, provided that it was submitted correctly.

If you have any questions or are having difficulty completing this form, please contact SHU Sports Information Director, Corey Graham, at cgraham@sienaheights.edu 

Your Sport(s) *
Example: Corey Graham (Cor-ee Gram)
Example: Do you prefer Bobby instead of Robert, Cassie instead of Casandra, etc.
Example: John and Lisa Jones, John Jones and Lisa Smith, etc.
Please list name, relationship to you, sport, team, and years played (if known)

PERSONAL INFORMATION

Tagging Permission

HIGH SCHOOL INFORMATION

If more than one, please indicate years at each school.
Please list all sports you lettered in and include the years and any championships won (conference, district, regional, or state).
Please be specific. Example: 2016 First Team all-conference, 2015 Second Team all-state by Detroit News, etc.

JUNIOR/TRAVEL/CLUB TEAM INFORMATION

Please include the full team name and year(s) you participated.

COLLEGE HISTORY  (TRANSFERS ONLY)

Please include full name of institution, location (City,State), and Years enrolled.
Same as High School Section
Same as High School Section

PERMISSION FOR THE RELEASE OF INFORMATION

I, the undersigned, authorize Siena Heights University, 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 SHU 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 Siena Heights University to use my image and/or likeness for promotional purposes with my consent.

Full 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