Media Questionnaire | Official Site of the Cumberland University Athletics

Media Questionnaire

Information

Fill out in DETAIL

First Name

Middle Name

Last Name

Preferred Name

Date of Birth (mm-dd-yyyy)

Email Address

Hometown (City, State)

Country

Sport Playing at Cumberland

Height

Weight

Weight Class (Wrestling only)

What position do you play/event do you run?

Throw/Bat (Baseball and Softball only)

Academic Major

High School and/or Prep School Attended (School, City, ST, Year Graduated)

High School and/or Prep School Attended (School, City, ST, Year Graduated) (2)

High School/Prep Sports Played and Letters Earned in Each

High School/Prep Athletic Honors (All-State, All-Region, etc... List sports and years honored, answer in detail)

Outstanding High School/Prep Statistics

High School/Prep Community Non-Athletic Honors (Who's Who, Class Office, etc.)

Name of coach you had in High School for the sport you are participating in at Cumberland

If transfer, other College Attended (School, City, ST, Dates Attended)

If transfer, other College Attended (School, City, ST, Dates attended) (2)

Previous School Honors (List sports and years honored)

Plans After Graduation (Ambitions/Goals)

Favorite Hobbies

Married?

Yes No

Date Married

Spouse's Name

Children? (Give names, ages)

Father's Name

Father's Address, City, ST, Zip

Father's Occupation

Mother's Name

Mother's Address, City, ST, Zip

Mother's Occupation

Parents Separated/Divorced?

Yes No

Please note if either parent is deceased

Mother Deceased Father Deceased

Information on Relatives who were or are athletes (or other celebrities in family - relation to you, sport, etc., when, where, honors - answer in detail)

List Hometown Newspaper(s)

List Hometown TV Station(s) (supply call letters & Channel #)

List Hometown Radio Station(s) (supply call letters & channel #)

Release

Release: This consent statement authorizes administrative personnel of the Cumberland University Athletic Department to review and disseminate to third parties information from this form and my personal "education records" with such information to be used for compilation of official publications for use by the news media, for purposes of nominating me for honors or scholarships and/or general public relations purposes.

Type Name

Date

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