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Media Release Information
First:
Middle:
Last:
Phone Number:
E-mail:
Hometown
City:  State: 
If you are from St. Louis/other large city, please indicate area/suburb so we can better target your news release.

Currrent Occupation: (if applicable)
Degree to be received:

Name of Newspaper:
Location of Newspaper
City:  State: 
If newspaper listed is not within a 30-mile radius of your permanent residence, please list a reason for requested release to that paper:
If you have indicated RELATIVE IN AREA or OTHER please fill in the corresponding box below.
Relative's Name:
Relationship:
If Other please specify:

Name of Second Newspaper:
Location of Second Newspaper:
City:   State:
 
Name of Third Newspaper:
Location of Third Newspaper:
City:   State:

Do you want your parent's names to be included in the news release?
Parents are: 
Father's Name:
Father's City:
Mother's Name:
Mother's City
Any additional information you would like to include: