HOMETOWN RELEASE FORM

Name Name First Last
Email Address
Local Phone Local Phone - ### - ### ####
Other Phone Other Phone - ### - ### ####
Major
Select Class...
Hometown and State
If your hometown is in Tennessee, select your county...
High school you graduated from
High school graduation year
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)
Award, honor, scholarship, or recognition for which this release is to be written:* (include details describing why you won the honor or award)
Other Awards or Honors
Extracurricular activities, clubs, memberships in campus or community organizations: (include offices held, if any)
Plans following graduation
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
I authorize Tennessee Tech University's Office of Communications & Marketing to release this information to any media outlets.
As an electronic signature, please provide your initials here:
Date Date / MM / DD YYYY
Type the letters you see in the image below.