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Student-Athlete Publicity Release Form

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This information is required from current Lawrence Tech University student athletes and will be used by the Sports Information Director for team rosters, press releases, media guides and various publicity functions of the university and the Department of Intercollegiate Athletics. We appreciate your help in filling out this form completely and in as much detail as possible.

PRINCIPLE SPECIFICATION OF RECORDS & PARTY OR CLASS OF PARTIES TO WHOM DISCLOSURE MAY BE RELEASED

This authorizes administrative personnel of the Lawrence Technological University Department of Intercollegiate Athletics and its Athletic Communications Office to review and disseminate to third parties, information in my personal education records, including information contained on this release form and any other education information, bodily injury/health data, or family tragedy facts collected and/or maintained by this institution for public relations purposes.

By signing this consent statement, I authorize administrative personnel of the Lawrence Tech University Department of Intercollegiate Athletics and its Athletic Communications Office to review and disseminate any information per Principal Specification of Records to third parties for general public relations.

PERSONAL CONTACT INFORMATION

HIGH SCHOOL INFORMATION

Please include year or class year of awards earned
Please include year the award was won

JUNIOR COLLEGE OR FOUR-YEAR COLLEGE INFORMATION

Please include year or class year of awards earned
Please include year the award was won
* required field