Student Hometown Press Release Form

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Student Hometown Press Release Form

* = required field

About You

I would like to promote *

Dean's List

Graduation

Name *

First

Last

Preferred Pronouns

Custom Pronoun

Phone Number *

###

####

Email Address *

Your Website

Parent Name *

First

Last

Parent Name (additional)

First

Last

Address *

Street Address

Street Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

High School Graduation Year *

High School Name *

High School City *

High School State *

Other College(s) Attended

Major or Graduate Program at MICA *

Minor(s) at MICA

Current Semester Classification

Optional: upload digital images(300 dpi, 5x7 inches)

Image(s)

Spam Prevention *

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