Submit Hometown Release

Hometown Release Form
Name (*)

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Email Address (*)

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Local Phone (*)

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Other Phone

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Major (*)

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Hometown (*)

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High School

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Graduation Year

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Names of Parents, Grandparents, or Guardians and the towns in which they live:* (Be specific as to how you wish to refer to your parents and include their first names. If you are married, please list your spouse's name) (*)

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Award, honor, scholarship, or recognition for which this release is to be written:* (include details describing why you won the honor or award) (*)

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Other Awards or Honors

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Extracurricular activities, clubs, memberships in campus or community organizations: (include offices held, if any)

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Plans following graduation

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Note: Any news releases are prepared for local media and/or newspapers in your home county. You may request releases be sent to a different county if, for example, your parents live in two different communities or your grandparents live elsewhere. Please note any additional requests here

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I authorize Tennessee Tech University's Office of Public Affairs to release this information to any media outlets.

As an electronic signature, please provide your initials here: (*)

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Date (*)

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Please Enter the Following Numbers
Please Enter the Following Numbers

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