Hometown News Release Questionnaire

Have you...

To receive publicity in your hometown for activities and accomplishments such as these, please complete this form.

Full Name:*

Please enter your full name.

Your Phone Number:*

Please enter the phone number where you can be reached at.

Your PLU E-mail Address:*

Please enter your PLU e-mail address.

Sex:

Please enter either male or female.

High School and Other Colleges/Universities:*

Name of school, year of graduation, city/state, degrees earned.

PLU Major and Minor and Expected Graduation Date:*

Please provide us with your PLU major, minor and graduation date.

Hometown:*

Please provide the city and state you consider to be your home.

Weekly Newspaper:

Please provide the name of your local weekly newspaper.

Daily Newspaper:

Please provide the name of your local daily newspaper.

Your news: Information you'd like published:

Be as specific as possible! (i.e. Graduation, Dean's List, travel, performance, offices held, clubs and organizations, etc.)

Parents/Guardians Full Names 1:

Please enter the full names of your parents/guardians.

Parents/Guardians City/State 1:

Please enter the city and state which your parents/guardians currently reside.

Parents/Guardians Full Names 2:

Please enter the full names of your parents/guardians.

Parents/Guardians City/State 2:

Please enter the city and state which your parents/guardians currently reside.

If you want a copy for your records, print this form before you submit it.:

Pacific Lutheran University