BAY PATH COLLEGE STUDENT NEWS RELEASE DATA 2010--2011
Name:________________________________________________________________________________
last name
first name (no nicknames)
middle name or initial
Home
Address:_____________________________________________________________________________
street & number
city, state, zip code
Home telephone#:____________________
On-Campus telephone#:___________________
Work Phone #:_________________________
Program of Study/Major:_____________________________________
Check all applicable:  Freshman  Sophomore
 Junior  Senior  Continuing Education Student
 Full Time  Part Time
 One-Day Student
 Graduate Student
OPTIONAL:
Student ID (SSN#) :___________________ Date of Birth:_______________
Photo/Video Release: I hereby grant permission to Bay Path College to use my photos and video images
taken by the institution or its agents for college publicity, advertising, promotional publications purposes and
on the Bay Path web site. Your
Signature:______________________________________ Date:________________________
The Department of Communications prepares news releases about your campus activities and academic
achievements for your hometown newspapers. This is an important way for us to share the good news of your
accomplishments with family and friends in your community, and it also brings the name of Bay Path College to others
in your area. If you are willing to have releases sent, please complete this card. If not, simply fill out the information
above the dotted line (for our records only) and check here ____NO RELEASES.
Name of Daily newspaper covering your hometown:__________________________________
Address of daily paper: _________________________________________________________
Daily Newspaper E-mail address:_________________________________________________
Name of Weekly paper:________________________________________________________
Address of weekly paper:_______________________________________________________
Weekly Newspaper E-mail address: ______________________________________________
What is the name of the
high school you attended:_________________________________________Year graduated:__________
high school name
city, state
If a transfer student, what college did you attend: ______________________________________________
college name
dates attended
degree/major
Please furnish the following information so that we may correctly identify you and your family in any news
release submitted to the newspapers you have listed.
Check (If Applicable): Father deceased 
Mother deceased 
Parents separated 
Parents divorced 

You live with: Both parents  Mother  Father  Other  Please give
relationship:___________________________________________
Give Full Name (no nicknames) of Parents, Parent, or Guardian with whom you live:
________________________________________________________________
Father/Guardian
Mother/Guardian
If your parents are separated, divorced, widowed, or remarried, please indicate how you would like to be
identified in a news release (please do not list parents at same address if divorced or separated - SEE
NOTE BELOW).
...daughter of _______________________________________________________
name(s)
name(s)
___________________________________________________________
address
address
ATTENTION CONTINUING EDUCATION & GRADUATE STUDENTS: If you wish to have your parent/s,
spouse or children mentioned in your news releases, please provide FULL NAMES and THEIR ADDRESS
IF DIFFERENT FROM YOURS:
_____________________________________________________________________________________
NOTE: You may list parents at two different addresses, such as: Jane Doe, daughter of Joan Doe of Middle Street, Middleville, and John Doe of Plain Street,
Plainville. Or, you may list a parent and step-parent as well as a biological parent, such as: Jane Doe, daughter of Joan and Joseph Jones (mother has
remarried) of Middle Street, Middleville, and John Doe of Plain Street, Plainville. If a parent is deceased, you may wish to be identified in this manner: Jane Doe,
daughter of John Doe of Plain Street, Plainville, and the late Joan Doe. If a widowed parent has remarried, you may wish to be identified: Jane Doe, daughter of
Joan Jones (orJoan and Joseph Jones) of Middle Street, Middleville, and the late John Doe. If you have any questions, please contact the Department of
Communications, Third Floor, Deepwood Hall.