BRANDEIS SPORTS INFORMATION FORM

The information below is intended to aid the sports information office in promoting Brandeis Athletics to the best of its ability. It will be used to supply information to home-town newspapers in press releases; in pitching feature stories; in media guides; in nominating you for awards; and on the Brandeis web site. The more we know about you, the better we can promote the University and its student-athletes!

PERSONAL INFO

NAME IN FULL Name you go by
If your name is hard to say,
please spell it phonetically for our public address announcers

Sport(s) 

 


Email address  Cell Phone
Home address  CITY, STATE  ZIP
Date of Birth (MM/DD/YYYY)  Height Weight

 

 


Father’s name  Occupation  College/Year
Mother’s name  Occupation  College/Year

 

When available, Brandeis press releases include the names and hometowns of student-athletes' parents and copies will be mailed to parents. Please indicate non-custodial parents, step-parents and deceased parents. If you do not wish to have this information included, please indicate this.

Alternate Parent & Address:


HIGH SCHOOL INFO


High School  Year of graduation
Address
Prep/Additional Schooling Final year
Address

PARTICIPATION: List below all high school/prep school sports in which you have lettered and the position that you play, the event that you compete in or whatever
the equivalent might be for your sport.
Sport Position Letters Won Years starter Years captain Coach

HIGH SCHOOL MASCOT 

HIGH SCHOOL CONFERENCE (FULL NAME AND ABBREVIATION) 

CHAMPIONSHIPS, HONORS, MILESTONES: Please use the space below to indicate any honors that you have received or milestones that you achieved in high school or other amateur athletics. This might include championship teams that you were a part of or won by you individually. We are interested in league, city, county, state, regional or national titles; any All-Conference, District or State recognitions, first-team through honorable mention; school records that that you established, milestones reached or any career statistics you have available. Be sure to indicate which sport they apply.

NON-ATHLETIC EXTRA-CURRICULARS: List below any activities in which you have been involved and any other recognition you received recognition, i.e. class offices held, high honors earned, scholarships awarded.



OTHER INFORMATION: Please list any other activities you are involved in that you feel might make for a good feature. Include unusual hobbies and talents, summer jobs/internships, high school teammates that you may be playing against (or with) or relatives that may have attended Brandeis.


ABOUT BRANDEIS

Why did you choose Brandeis?


What is your planned major?
What non-athletic activities are you planning to participate? 

MEDIA CONTACTS

This is the most valuable way for us to accurately determine who should receive information on your exploits at Brandeis. Please list the principal hometown newspaper of your city and any other . For those from the Boston area, please indicate which GlobeWeekly (North, South, West) you receive. Please include any small daily or weekly newspapers that may give better emphasis to small college/prep sports. These papers have a higher chance of producing a larger benefit. Also, please include TV or radio stations that might also be interested.

Media Outlet Sports Contact Email address

NOTE: This form comes under the purview of the Family Education Rights and Privacy Act of 1974.

PRINCIPAL SPECIFICATION OF RECORDS: This consent statement authorizes administrative personnel of Brandeis University to review and disseminate to third parties information in my personal “education records”, including information on this form and any other education information collected and/or maintained by this institution for public relations purposes.

PURPOSE(S) OF DISCLOSURE: Information obtained from these records will assist in compilation of personal information for use in official athletics department publications for dissemination to the news media, for purposes of nominating me for honors programs and scholarships and for general public relations purposes.

PARTY OR CLASS OF PARTIES TO WHOM DISCLOSURE MAY BE RELEASED: By checking the following box, I authorize administrative personnel of Brandeis University to review and disseminate any information in my “education records” to third parties for general public relations purposes. 

DATE (MM/DD/YYYY)  

LAST FOUR DIGITS OF SAGE STUDENT ID #